What is the clinical evidence from this study?

Study design: Other. Population: Elderly patients with cardiovascular diseases in China. Intervention: Mindfulness. Primary outcome: Intrinsic capacity measured by neuropsychological testing.

What question did this study set out to answer?

The aim is to investigate how mindfulness therapy enhances intrinsic capacity in elderly patients with cardiovascular diseases through emotion regulation.

February 28, 2026Open Access

Mechanism of the effectiveness of mindfulness on intrinsic capacity in elderly patients with cardiovascular diseases: a dual-pathway emotion regulation framework

Key Result

Mindfulness improves intrinsic capacity in elderly patients with cardiovascular diseases through mechanisms related to emotion regulation.

Key Points

The aim is to investigate how mindfulness therapy enhances intrinsic capacity in elderly patients with cardiovascular diseases through emotion regulation.
Cross-sectional design with convenience sampling of 573 elderly CVD patients from two provinces in China.
Measurements included WHO's IC assessment tool, Ch-CAMS–R, CD-RISC-10, ERQ, and Personal Mastery Scale.
Serial multiple mediation analysis conducted using SPSS macro PROCESS.
Mindfulness positively affects intrinsic capacity directly and indirectly through mediating pathways.
Psychological resilience significantly mediates the relationship, while personal mastery does not.
Cognitive reappraisal positively mediates the effect, while expressive suppression has a suppressive effect on the relationship.

Structured PICO

Is mindfulness associated with higher intrinsic capacity in elderly patients with cardiovascular diseases?

Population

573 elderly patients (aged ≥60 years) clinically diagnosed with cardiovascular diseases (including hypertension, coronary heart disease, arrhythmia, heart failure, valvular heart disease, pericardial disease, endocarditis, congenital heart disease) from seven hospitals in China.

Intervention

Mindfulness (assessed observationally via the Chinese Version of the Cognitive and Affective Mindfulness Scale-Revised [Ch-CAMS-R])

Outcome

Intrinsic capacity (IC) assessed via the WHO detailed assessment tool (composite score 0-10 based on locomotion, cognition, psychology, vitality, and sensory capacity)composite

Mindfulness is positively associated with intrinsic capacity in older cardiovascular patients, with psychological resilience and cognitive reappraisal acting as key mediators.

Limitations

Neuropsychological tests were not adjusted for illiteracy, sensory impairment, or language barriers, which may affect test performance.
Use of local dialects and untrained translators during testing may have introduced bias.
Differences in the CHARLS-HCAP testing methodology compared to prior waves complicate longitudinal cognitive assessments.
Missing data and non-numeric responses due to inability to answer or sensory issues could bias results.

Abstract

Elderly patients with cardiovascular diseases (CVD) face long-term disease survivorship accompanied by widespread multidimensional functional impairments in intrinsic capacity (IC). Mindfulness interventions are recognized as effective adjunctive therapies that complement pharmacological treatments and the multifaceted therapeutic needs of patients. To explore the mechanisms underlying the health benefits of mindfulness in this population, this study investigates the dual-pathway mechanism through which mindfulness enhances IC in elderly CVD patients, involving positive psychological resources (personal mastery, psychological resilience) and emotion regulation strategies (cognitive reappraisal, expressive suppression). This study used a cross-sectional design and convenience sampling to recruit 573 older adult patients with cardiovascular diseases from two provinces in China. Measurements were conducted using the WHO detailed assessment tool for IC, the Chinese Version of the Cognitive and Affective Mindfulness Scale–Revised (Ch-CAMS–R), the 10-Item Connor-Davidson Resilience Scale (CD-RISC-10), the Emotion Regulation Questionnaire (ERQ), and the Personal Mastery Scale (PMS). A serial multiple mediation analysis was performed using the SPSS macro PROCESS and tested. Mindfulness was not only directly associated with IC but also showed indirect associations through multiple mediating pathways. These included: (1) Psychological resilience demonstrated a significant independent positive mediating effect, whereas the independent mediating effect of personal mastery was not significant; (2) Among emotion regulation strategies, cognitive reappraisal showed a significant independent positive mediating effect; the use of expressive suppression exhibited a statistically significant suppression effect in the model; (3) Psychological resilience was linked to increased use of expressive suppression, which subsequently partially offset the positive association between mindfulness and IC; The serial mediation path of “personal mastery → cognitive reappraisal” was not significant. Mindfulness is associated with IC in older cardiovascular patients through a complex pattern involving increases in psychological resilience and cognitive reappraisal, while concurrently counteracting the negative role of expressive suppression. Future mindfulness interventions for this population require cultural tailoring and precise optimization: the core components should focus on fostering psychological resilience, strengthening cognitive reappraisal, and guiding patients to reduce reliance on expressive suppression strategies.

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