Mindfulness-Based and Forest Bathing Interventions for Older Women With Treated Arterial Hypertension

This pilot study, conducted by the Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, and funded by the University of Rijeka (project no. uniri-iskusni-biomed-23-181), evaluated two adjunctive non-pharmacological interventions - an eight-week Mindfulness-Based Living Course (MBLC) and a guided forest bathing (Shinrin-yoku) program - relative to a non-randomized comparison group, in older women with treated arterial hypertension. The study used a non-equivalent, pre-test/post-test quasi-experimental design; allocation was non-randomized, based on geographic catchment area and registration with community patronage nurses, with first-come, first-served enrollment until recruitment targets were met. A total of 60 women over 60 years of age were planned for enrollment: 20 in the MBLC group, 20 in the forest bathing group, and 20 in a comparison group receiving usual care. The MBLC group attended eight weekly two-hour workshops based on the Mindfulness Association (UK) curriculum, led by certified facilitators in Rijeka. The forest bathing group attended three weekly guided sessions of approximately 120-150 minutes each at a forest site near Delnice, Gorski Kotar, led by an FTHub-certified guide following the Forest Therapy Hub (FTHub) Walk Activities Sequence. The comparison group received no structured intervention. Outcomes were assessed at baseline and immediately after each group's intervention period (approximately 8 weeks for MBLC; approximately 3 weeks for forest bathing; a matched interval for the comparison group). The primary outcome was perceived stress (10-item Perceived Stress Scale). Secondary outcomes included chronic-disease self-efficacy, health-related quality of life, systolic and diastolic blood pressure, heart rate, and serum cortisol. Eligible participants were women over 60 with documented, treated arterial hypertension who gave written informed consent; exclusions included age under 60, inability to participate for the study duration, homelessness, a diagnosed psychiatric condition, cognitive impairment, and alcohol or substance dependence. The study was approved by the Ethics Committee of the University of Rijeka, Faculty of Medicine (Class: 007-08/24-01/70; 22 October 2024) and was conducted January-May 2025 in Rijeka and the Gorski Kotar region, Croatia. The study is being registered retrospectively, after data collection was complete.

Inclusion Criteria: * Woman older than 60 years * Diagnosed arterial hypertension (pharmacologically treated) * Signed informed consent form for participation Exclusion Criteria: * Age under 60 years * Inability to participate in the study over a six-month period (e.g., persons planning extended travel or terminally ill patients) * Without stable housing (homeless individuals) * Diagnosed psychiatric disorder(s) * Cognitive impairment * Alcohol or other substance dependence * Unsigned consent form for participation