Effects of Breath Awareness Mindfulness Meditation on Heart Rate and Blood Pressure in Cancer Patients: A Preliminary Study

Development and administration of the intervention

The Breath Awareness Intervention was developed based on a thorough review of current literature regarding breath-centric methodologies and their effects on psychological health. This intervention aims to integrate evidence-based practices derived from studies on mindfulness and relaxation. The development process involved a comprehensive literature review, examining existing research and theoretical models related to breath awareness and its impact on mental health. Consultations with specialists in mindfulness and clinical psychology were conducted to ensure the intervention’s relevance and effectiveness. To evaluate the internal consistency of the components of the tool, we used Cronbach’s alpha, which yielded a value of 0.85, indicating high reliability. The content validity of both the instrument and the intervention was established through assessments by nine experts in medical-surgical nursing, psychiatric nursing, clinical psychology, counselling, and psychiatry. The content validity agreement percentage for demographic performance was 0.96, with only minor modifications recommended, which were subsequently implemented. The proposed changes to the intervention script were integrated, resulting in an agreement rate of 0.94.

Ongoing feedback was collected from participants and facilitators, leading to iterative modifications and enhancements designed to improve the intervention’s effectiveness and user experience. Mindfulness meditation is a practice that involves focusing intentionally on the present moment without judgment or attachment. This study included breath awareness and mindful meditation techniques that promote conscious breathing. Participants practised inhaling and exhaling slowly and deeply, either by counting their breaths or concentrating on them. The participants engaged in mindfulness meditation sessions three times a week, each lasting 10 minutes, in the morning, between 6:00 and 6:30 am. They were organised into small groups of three to four members in separate rooms and provided with headsets to listen to guided meditation instructions. These instructions were given in the local language to ensure clarity and understanding. Post-tests were administered on days 7, 15, and 30. The researcher personally conducted the intervention, ensuring that participants listened attentively and engaged in the meditation process. The researcher underwent three weeks of mindfulness meditation training in Chennai and completed several online courses. This study includes Stage II and III cancer patients receiving chemotherapy or radiation therapy, while excluding those with severe physical or mental conditions or those already using relaxation techniques for pain management. Data analysis was performed using SPSS version 16.0 for descriptive statistics of the baseline data and inferential methods, such as repeated measures ANOVA and paired t-tests, for comparisons at various time points. A significance level of p < 0.05 will be applied to determine statistical significance.

Description of the participants based on demographic characteristics

In the control group, the majority of participants, four individuals (40%), were aged 56 years or older. More than half of the participants, specifically 60%, were female, and a significant majority, 70%, were married. Sixty percent of the participants lived in rural areas. Four individuals (40%) identified as Christians, while six participants (60%) were engaged in various occupations. Notably, 70% fell within the monthly income bracket of less than Rs 10,000. Additionally, half of the participants (50%) were diagnosed within a year, and half of those diagnosed (50%) had a family history of cancer. All ten participants (100%) in the intervention group were aged 56 years or older. Over 80% of these participants were female, and all (100%) were married, 90% lived in rural areas, and the majority—eight individuals (80%)—identified as Hindus. Most participants, nine out of ten, were unemployed. A significant 90% were within the monthly income category of less than 10,000. Moreover, six individuals (60%) received their diagnosis within a span of 1 to 5 years, while over half (90%) reported no family history of cancer.

The intervention group demonstrated a consistent reduction in heart rate, decreasing from an average of 78.30 ± 5.95 beats per minute (bpm) before the test to 72.60 ± 4.01 bpm by post-test 3, resulting in a total decrease of 5.7 bpm. Similarly, systolic blood pressure decreased from 120.0 ± 11.54 mmHg to 109.0 ± 9.94 mmHg, while diastolic blood pressure dropped from 70.90 ± 6.08 mmHg to 65.50 ± 4.97 mmHg, indicating a significant improvement in cardiovascular health.

In contrast, the control group had a lower heart rate at the beginning, starting at 69.10 ± 2.76 bpm, but this increased to 71.00 ± 3.27 bpm by post-test 3. Systolic blood pressure in this group rose slightly from 105.0 ± 5.27 mmHg to 110.0 ± 7.97 mmHg, and diastolic blood pressure also increased from 61.70 ± 4.08 mmHg to 65.30 ± 6.88 mmHg. These statistical findings indicate a clinically meaningful improvement in cardiovascular markers for the intervention group, while the control group exhibited no such benefits and, in some cases, a slight deterioration. This suggests that the intervention had a positive effect on cardiovascular health [Table 1].

The table compares mean scores from pre- and post-tests for the intervention and control groups. In the intervention group, scores were statistically significantly improved from the pre-test (78.30 ± 5.94) to post-test 3 (72.60 ± 4.01), with a t-value of 5.15 and a p-value of less than 0.001. This indicates a positive impact of the intervention over time. Additionally, progressive improvements were noted between successive post-tests: from post-test 1 to post-test 2 (t = 4.10, p = 0.003), from post-test 1 to post-test 3 (t = 6.01, p < 0.001), and from post-test 2 to post-test 3 (t = 3.74, p = 0.005). In contrast, the control group did not change significantly from pre-test to post-test 2 (t = 0.00, p = 1.00). However, a slight yet statistically significant increase was observed between post-test 1 and 3 (t = -3.54, p = 0.006) and from post-test 2 to post-test 3 (t = -2.89, p = 0.018). Overall, the results indicate that the intervention group showed a more consistent and significant improvement across the post-tests, suggesting the intervention was effective [Table 2].

The results demonstrate a significant reduction in both systolic and diastolic blood pressure in the intervention group over time. Systolic pressure significantly decreased from the pre-test to post-test 2 (t = 6.00, p < 0.001) and from pre-test to post-test 3 (t = 11.00, p < 0.001). Diastolic pressure also exhibited significant reductions, with changes noted from pre-test to post-test 2 (t = 3.92, p = 0.003) and from pre-test to post-test 3 (t = 5.93, p < 0.001). Notably, there was a significant difference in both systolic (t = 9.00, p < 0.001) and diastolic (t = 5.39, p < 0.001) pressures when comparing post-tests 1 and 3. In contrast, the control group displayed only minor changes, with some significance noted between pre-test and post-tests (e.g., systolic t = -2.58, p = 0.029). However, no significant differences were found between post-tests 2 and 3, indicating that the intervention had a stronger and more consistent impact on blood pressure reduction [Table 3].

Effectiveness of BAMM on heart rate

The intervention group showed a consistent and statistically significant reduction in heart rate across all three post-test measurements (p < 0.001). The average heart rate decreased from 78.30 beats per minute (bpm) before the test to 72.60 bpm after the third post-test. The results suggest that the effect of BAMM on heart rate was progressive, with further practice leading to even more significant reductions.

In contrast, the control group exhibited only slight variations in heart rate, with no clear trend toward improvement; their heart rate actually increased by the third post-test. This initial drop, followed by an increase, may be attributed to normal fluctuations in heart rate experienced in stressful situations, such as cancer treatment, particularly in the absence of a calming intervention like mindfulness meditation.^[6]

Mindfulness practices, especially breath-focused meditation, have been shown to lower heart rate through relaxation and stress reduction,^[5] which aligns with the current findings. It is well-established that anxiety and stress associated with cancer treatments can elevate heart rates and, over time, increase the risk of cardiovascular events.^[6] Consistent with earlier studies demonstrating the cardiovascular benefits of mindfulness, this study found a decrease in heart rate linked to such practices.

Effectiveness of BAMM on systolic and diastolic blood pressure

The intervention group demonstrated significant improvements in heart rate and systolic and diastolic blood pressure. There was an 11 mmHg reduction in mean systolic blood pressure, from 120.0 mmHg before testing to 109.0 mmHg after the third post-test. The mean diastolic blood pressure decreased from 70.90 mmHg to 65.50 mmHg between the pre-test and post-test. The statistically significant decreases in both systolic and diastolic blood pressure (p < 0.001) highlight the effectiveness of BAMM in enhancing these vital cardiovascular parameters.

In contrast, the control group showed increased systolic blood pressure, rising from 105 mmHg before the test to 110.50 mmHg after the third post-test. While this increase was statistically significant, it suggests that cancer treatment can exacerbate hypertension if no intervention is implemented. Furthermore, the diastolic blood pressure in the control group also rose over time, although this increase was not statistically significant (p = 0.07). This evidence supports the need for effective interventions to help cancer patients manage their cardiovascular health.

Consistent with prior research highlighting mindfulness’s positive effects on blood pressure regulation, the intervention group experienced substantial improvements in their blood pressure readings. The sympathetic nervous system, which is known to constrict blood vessels and elevate blood pressure under stress, may have been moderated by mindfulness meditation. This practice can reduce sympathetic activation, as evidenced by BAMM’s relaxation techniques and focus on breathing awareness, which promotes a parasympathetic response that contributes to lower blood pressure.

These research findings align with previous studies examining the impact of mindfulness meditation on cardiovascular outcomes in cancer patients.^[7] There is comparatively limited research focused specifically on cancer patients, particularly in contrast to studies involving the general population or individuals dealing with chronic stress.^[8] This highlights that mindfulness interventions could significantly lower healthy adults’ heart rate and blood pressure.^[9] The emphasis here is on cancer patients undergoing treatment, a particularly vulnerable demographic. Some studies have shown that cancer patients often experience elevated stress levels, which can worsen hypertension, tachycardia, and other cardiovascular issues.^[10] The current research findings suggest that BAMM might help alleviate these side effects, thereby enhancing the quality of life for cancer patients.

BAMM appears to lower both blood pressure and heart rate, which could mitigate long-term cardiovascular risks associated with cancer treatments. The mechanisms underlying mindfulness meditation help explain these heart rate and blood pressure improvements.^[11] BAMM incorporates controlled deep breathing that activates the parasympathetic nervous system. This activation promotes relaxation, subsequently lowering heart rate and blood pressure. Additionally, mindfulness meditation has been shown to reduce stress hormones like cortisol, which are often elevated in cancer patients and contribute to cardiovascular dysfunction.^[12] Mindfulness meditation may also alleviate psychological stress. Elevated levels of anxiety, depression, and emotional distress in cancer patients can negatively impact cardiovascular function.^[13] Therefore, BAMM may help reduce these psychological burdens, improving heart rate and blood pressure.

Implications for clinical practice

The results of this study have significant implications for managing the cardiovascular health of cancer patients. Those undergoing cancer treatment can benefit from BAMM’s non-pharmacological approach to improving heart rate and blood pressure, as it is a low-cost and low-risk method.^[14] This intervention is easy to implement in routine care and requires minimal resources.

Healthcare providers should seriously consider incorporating mindfulness-based interventions, such as BAMM, into the treatment plans for cancer patients, particularly those receiving radiation or chemotherapy. The stress and toxicity associated with these treatments place patients at a higher risk for cardiovascular complications.^[15] When used alongside other medical therapies, BAMM can empower patients to take control of their health and alleviate some of the symptoms they experience.

Limitations

While the study offers valuable insights, several significant limitations must be considered. First, the findings cannot be generalised to a larger population due to the small sample size. Although the results are statistically significant, it is essential to validate these effects in a larger cohort of cancer patients through more extensive studies. Future research should aim to replicate this study with a larger and more diverse sample, including cancer patients at various stages of the disease and those receiving several types of treatments.

Secondly, the post-test measurements were conducted over just 30 days, making the study short. Longitudinal studies are needed to assess the long-term effects of BAMM on cardiovascular health. Additionally, future research could compare the impact of different mindfulness approaches on cardiovascular outcomes to determine which practices are most effective for cancer patients. Finally, future studies should include additional cardiovascular markers, such as heart rate variability and inflammatory markers, to gain a comprehensive understanding of BAMM’s effects on cardiovascular health, as this study only focused on blood pressure and heart rate.