Pulmonary hypertension is a progressive lung disease characterized by shortness of breath. Patients often have limitations on their daily activities and social roles. Treatment primarily involves pulmonary vasodilative medications, which can cause headaches, nausea, diarrhea, and other side effects. Severe cases carry an elevated risk for heart failure and sudden death. 

Many patients experience depressive and anxiety symptoms as well as elevated perceived stress. While mindfulness-based interventions (MBIs) may lower psychological distress, there have been no MBIs specifically designed for pulmonary hypertension patients. Takita et al. [Journal of Medical Internet Research] conducted a pilot single-arm, pre-post study to describe the acceptability, feasibility, and adherence of an online MBI self-management program for patients with pulmonary hypertension.

The researchers recruited 12 Japanese pulmonary hypertension patients (average age = 42 years; 75% female) to participate in a novel MBI based on Mindfulness-Based Cognitive Therapy. The program also included elements of psychoeducation and self-management skill building. To accommodate patient limitations due to their disease status, session lengths were shortened to one hour, and the yoga component typically included in the original program was eliminated.

The program was delivered in eight weekly synchronous online sessions. Each session included 10-30 minutes of meditation practice, group discussion, and was led by a trained facilitator. Homework included daily meditation practice and reflection journaling. Each participant also used a smartwatch-linked self-management app integrated into the intervention to record daily physical condition and activity. 

Feasibility was assessed using participation and completion rates, and acceptability was evaluated through post-intervention interviews. Participants completed self-report questionnaires at baseline, 4 weeks, and 8 weeks (program completion), with an additional 12-week follow-up assessment. These questionnaires served as secondary outcome measures of quality of life, resilience, and psychological symptoms.

Results showed that 75% of the patients completed the intervention. Those who dropped out did so for medical reasons, including hospitalization and catheter infection. Most participants rated the overall program length, session duration, and session intervals as generally acceptable. Questionnaires were pencil-and-paper-based and returned by mail. Response rates were good at baseline and week 4 (75%), but declined at week 8 (67%) and week 12 (56%). Some participants expressed a preference for fewer sessions or for incorporating on-demand sessions rather than requiring attendance at fixed times. 

Patient-rated pulmonary hypertension health and resilience scores significantly improved at 4 and 8 weeks compared to baseline, but these improvements were not maintained at the 12-week follow-up, likely in part due to reduced response rates. 

This pilot study suggests that a synchronous online MBI self-management research protocol is feasible and acceptable for many pulmonary hypertension patients who are willing to participate in research. Reducing the number of synchronous sessions and replacing some with on-demand sessions may further improve acceptability. There is evidence of temporary subjective health benefits based on self-report. The study is limited by its lack of a control group, its small sample size, and declining response rates at post-intervention and follow-up assessments. 

Reference:

Takita, Y., Morishita, J., Park, S., Goda, A., Inami, T., Kikuchi, H., Kohno, T., Kataoka, M., & Fujisawa, D. (2025). Mindfulness-Based Self-Management Program Using a Mobile Application for Patients with Pulmonary Hypertension: A Single-Arm Feasibility Study. JMIR Cardio.

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