Impact of mindfulness training on depression and walking ability in patients with lower extremity arteriosclerosis obliterans and depression

Abstract

BACKGROUND

Lower extremity arteriosclerotic occlusive disease (LEAOD) is a prevalent chronic vascular condition that significantly increases the risk of lower limb dysfunction and depressive symptoms. Mindfulness-based interventions have demonstrated efficacy in improving mood and coping ability in patients with various chronic illnesses; however, their specific impact on the dual burden of depression and walking ability in patients with LEAOD remains unclear.

AIM

To explore mindfulness training impact on depression scores and walking ability in patients with LEAOD complicated with depression.

METHODS

From September 2023 to October 2025, 176 patients with LEAOD and depression were enrolled and divided into the control (routine treatment/nursing, n = 93) and study (mindfulness training plus routine treatment/nursing, n = 83) groups. Baseline confounding factors were balanced between the groups using 1:1 propensity score matching, with 62 cases in each group. Depression scores, walking ability, self-efficacy, quality-of-life, and complications were compared between the two groups before the intervention, 8 weeks after the intervention, and at 1 month follow-up.

RESULTS

After 8 weeks of intervention and at 1 month follow-up, the Self-Rating Depression Scale score of the intervention group were 37.21 ± 5.32 and 30.76 ± 4.94 points, respectively, which were significantly lower than those of the control group (44.68 ± 5.77 and 38.94 ± 5.13 points) (P < 0.05). The pain-free walking distance in the intervention group were 243.06 ± 13.44 m and 263.35 ± 11.52 m, respectively, and the six-minute walk distances were 387.24 ± 15.22 m and 426.55 ± 13.02 m, respectively, both of which were higher than those of the control group (pain-free walking distance: 224.55 ± 11.87 m and 244.56 ± 10.43 m; six-minute walk distances: 364.45 ± 13.34 m and 307.06 ± 10.73 m) (P < 0.05). The Chinese Self-Efficacy Exercise Scale and MOS36-item short form health survey scores of the two groups were significantly higher than those before the intervention (P < 0.05). The total complication rate in the intervention group was 3.23% lower than that in the control group (14.52%) (P < 0.05).

CONCLUSION

Mindfulness training effectively alleviated depression and enhanced walking ability, self-efficacy, and quality-of-life in patients with LEAOD concomitant with depression, suggesting a valuable supplementary rehabilitation intervention.

Key Words: Lower extremity arteriosclerotic occlusive disease; Depressive state; Mindfulness training; Depression score; Walking ability

Core Tip: This retrospective cohort study is the first to apply mindfulness training in patients with lower extremity arteriosclerotic occlusive disease and depression. Using propensity score matching to balance confounders, we found that mindfulness training significantly reduced depression scores (Self-Rating Depression Scale), improved walking ability (pain-free walking distance, six-minute walk distances), enhanced self-efficacy, and increased quality of life (MOS36-item short form health survey), while also lowering complication rates. These findings provide a novel psychotherapeutic approach and evidence-based support for incorporating mindfulness training into the rehabilitation of lower extremity arteriosclerotic occlusive disease patients with depression.

INTRODUCTION

Lower extremity arteriosclerotic occlusive disease (LEAOD) is a chronic ischemic vascular disease with a high incidence in middle-aged and older individuals. According to a survey, more than 200 million patients have LEAOD worldwide, and approximately 8.5 million people in the United States are affected. Among them, 5%-10% of Americans aged 40 years and above have arteriosclerotic occlusive disease[1-3]. The disease mainly manifests as limb pain, intermittent claudication, and lower-extremity motor and sensory dysfunction caused by lower-extremity arterial stenosis or occlusion. Motor dysfunction is characterized by limb weakness, decreased muscle strength, and difficulty in walking, while sensory dysfunction presents as numbness, tingling, and hypoesthesia of the lower extremities. In severe cases, it can progress to limb ulcers, gangrene, and even amputation, imposing heavy physiological and psychological burdens on patients[4,5]. Depression is a common psychological complication in patients with LEAOD, with an incidence of approximately 40.9%-58.3%, which is significantly higher than that in the general population[6,7]. Depression aggravates vascular endothelial injury through neuroendocrine mechanisms, forming a psychological-vascular, vicious cycle. Moreover, it reduces the patient’s walking ability and quality-of-life by reducing treatment and rehabilitation compliance[8].

Currently, the clinical treatment for LEAOD is primarily based on vascular recanalization surgery and drug treatment. Rehabilitation interventions focus on limb function training, while targeted interventions for patients’ psychological state are insufficient. Routine nursing care cannot effectively improve depression among patients[9,10]. Current management strategies aim to improve limb blood perfusion through revascularization (e.g., endovascular therapy, bypass surgery) and pharmacological interventions (e.g., antiplatelet agents, vasodilators), while rehabilitation mainly emphasizes supervised exercise training for functional recovery. However, these approaches largely overlook the psychological comorbidities that affect a substantial proportion of LEAOD patients. Although antidepressant medications are effective for depression, their use in LEAOD patients may be limited by potential drug-drug interactions (e.g., with antiplatelets or anticoagulants) and side effects, such as orthostatic hypotension[11,12], which could increase fall risk in this already vulnerable population. Psychological interventions, such as cognitive behavioral therapy, are underutilized in clinical practice due to limited accessibility and lack of integration into routine vascular care[13]. Therefore, there is an urgent need for a feasible, safe, and effective psychological intervention that can be seamlessly integrated into existing rehabilitation protocols for LEAOD patients with depression.

Mindfulness training, a psychological intervention method based on mindfulness-based stress reduction therapy, has been proven to have a significant effect on the emotional regulation of people with chronic pain, depression, and other diseases by guiding them to focus on the present, accept their own emotions and physical feelings, and avoid critical reactions[14,15]. In recent years, the application of mindfulness training in patients with chronic diseases, such as cardiovascular disease and diabetes, has gradually increased[16,17]. However, its application in patients with LEAOD concomitant with depression has not been fully verified. Currently, there are few studies on the application of mindfulness training in patients with LEAOD complicated by depression, and even fewer have simultaneously focused on its comprehensive effects on both psychological status and walking ability. Due to the difficulty of sample recruitment and a long follow-up period in prospective randomized controlled trials, this study used a retrospective cohort design to explore the effect of mindfulness training on the depression score and walking ability of patients with LEAOD with depression by analyzing real-world clinical data to provide a scientific basis for the clinical formulation of comprehensive rehabilitation intervention strategies.

MATERIALS AND METHODS

Study design and participants

This retrospective study included clinical data from 176 patients diagnosed with LEAOD with depression who visited Henan Provincial People’s Hospital from September 2023 to October 2025. The inclusion criteria were as follows: (1) LEAOD diagnosis according to established criteria[18], confirmed by lower extremity arterial color Doppler ultrasound or computed tomography angiography showing arterial stenosis ≥ 50%; (2) Age between 45 and 80 years; (3) Meeting the diagnostic criteria for depressive states, with a Self-Rating Depression Scale (SDS) score ≥ 53[19]; (4) Clear consciousness, ability to communicate normally, and basic understanding and execution capabilities; and (5) Complete clinical data including baseline information, intervention measures, and follow-up data. The exclusion criteria included: (1) Severe limb ischemia (Rutherford classification ≥ 5) and presence of gangrene or ulcers that are not healing; (2) Coexisting severe cardiovascular diseases, hepatic or renal insufficiency, malignant tumors, or other serious organic diseases; (3) History of psychiatric disorders or cognitive impairment (Mini-Mental State Examination < 24); (4) Incomplete intervention over an eight-week period or missing follow-up data; and (5) Pregnant or breastfeeding women. This study was approved by the Ethics Committee of Henan Provincial People’s Hospital.

Based on differences in the intervention methods received by the patients, they were divided into an intervention group (n = 83) and a control group (n = 93). To minimize the impact of baseline confounding factors on the outcomes, propensity score matching (PSM) was employed using sex, age, disease duration, Fontaine stage, and comorbidities (hypertension, diabetes mellitus, and coronary heart disease) as covariates. A matching ratio of 1:1 was applied, resulting in each group containing 62 patients. A patient screening flowchart is presented in Figure 1.

Figure 1 Flowchart of patient screening. LEAOD: Lower extremity arteriosclerotic occlusive disease; SDS: Self-Rating Depression Scale; PSM: Propensity score matching.

Methods

Control group: Routine treatment and rehabilitation care for LEAOD. The specifics were as follows: (1) Routine treatment: This included antiplatelet aggregation (enteric-coated aspirin 100 mg/day), lipid regulation (atorvastatin calcium tablets 20 mg/day), and medication to improve circulation, along with vascular intervention or surgical treatment when necessary; (2) Rehabilitation care: This encompassed disease education, dietary guidance (low-fat, low-sugar, and high-fiber diet), smoking cessation and alcohol limitation advice, limb care (keeping warm and avoiding injuries), and regular limb function training (such as ankle pump exercises and slow walking on flat ground for 30 minutes per session, five times a week); and (3) Psychological support: General comfort and encouragement were provided to patients while addressing their questions without targeted psychological interventions.

Study group: In addition to the control group’s regimen, an eight-week mindfulness training intervention was implemented by professionally-trained rehabilitation therapists. The specific plan was outlined as follows: (1) Pre-training phase (week 1): A one-time offline mindfulness training lecture (60 minutes) introducing the principles, methods, and precautions of mindfulness training was organized alongside the distribution of a mindfulness training manual and audio materials recorded by professionals; (2) Formal training phase (weeks 2-8): Online and offline approaches were combined with weekly offline group sessions lasting for one hour each. During other times at home, the participants practiced the approaches daily for 20 minutes per session. Training content included mindful breathing, body scanning, mindful walking, and mindful meditation; and (3) Consolidation phase (post-intervention after eight weeks): Patients were encouraged to continue practicing mindfulness during follow-up visits at least three times per week for 20 minutes on each visit. Both groups underwent continuous intervention for eight weeks.

Observation indicators and data collection

Baseline data: Patient demographics, such as sex, age, duration of illness, Rutherford classification levels, and comorbidities (hypertension and coronary heart disease) were collected from the hospital's electronic medical record system.

Depression scores: Depression scores were obtained before the intervention at baseline assessment, at eight weeks post-intervention follow-up, and one month later using the SDS. The scale consists of 20 items rated on four levels; total scores below 53 indicate normality, scores between 53 and 62 denote mild depression; 63 to 72 indicates moderate depression; and scores above 72 indicate severe depression[19].

Walking ability assessment: Walking ability was evaluated before the intervention, eight weeks post-intervention, and at one month follow-up using the six-minute walk distance (6MWD) and pain-free walking distance (PFWD). A quiet and straight indoor corridor measuring 30 m was selected, with markers placed every 3 m on the floor (a red tape was used to mark the starting point, and orange cones denoted turnaround points). The patients walked back-and-forth along this corridor at their maximum speed for 6 minutes, taking breaks if they experienced breathlessness or fatigue, but the timing continued throughout rest periods. A vascular surgery nurse or intern accompanied the patients, closely monitoring patient status, recording distances walked until claudication occurred, and defining that segment’s distance as PFWD. Total distance covered within 6 minutes was recorded. Larger values in both measures indicate lesser impairment in patients’ ambulation.

Self-efficacy evaluation: Self-efficacy was assessed pre-intervention, at eight weeks post-intervention, and at 1-month follow-up using the Chinese Self-Efficacy Exercise Scale (SEE-C)[20]. The SEE-C comprises nine items assessing patients’ confidence regarding physical activity under various conditions. Scores range from zero (no confidence) to ten (the highest level of assurance), with 90 being the maximum score. Higher SEE-C values reflect stronger self-efficacy concerning exercise.

Lifestyle quality measurement: The MOS36-item short form health survey (SF-36)[21] was administered prior to and eight weeks after intervention and at 1-month follow-up to evaluate quality-of-life across dimensions including functional capacity, physiological functioning, bodily pain, general health vitality, social functioning, emotional role, and mental health. The scale has a total score of hundred, correlating positively with overall life satisfaction.

Adverse events monitoring: Complications that arose during interventions alongside subsequent occurrences, including re-stenosis, skin infections, delayed wound healing, pressure ulcers, etc.

Quality control

Two researchers independently extracted data from electronic medical records. Prior to data extraction, both researchers received standardized training, which included a detailed explanation of the study protocol, uniform definitions of all variables (e.g., demographic characteristics, SDS scores, PFWD, 6MWD), and hands-on practice using a standardized data collection form. The training lasted for two days and was followed by a pilot test on 20 randomly selected records to ensure inter-rater reliability (kappa > 0.85). Logical checks were performed on scoring data, eliminating anomalies, and PSM was applied to balance baseline confounding factors and enhance comparability between the groups.

Statistical analysis

Statistical analysis were conducted via SPSS software, version 27 (IBM Corp., Armonk, NY, United States). Patient demographic information was matched using PSM in a 1:1 ratio established below 0.2. Normal distribution metrics are expressed as mean ± SD, and independent sample t-tests were used to compare the groups. Count data were expressed as n (%), and the χ² test was used for comparison between the groups. A significance threshold was established at P < 0.05, indicating statistically meaningful differences between groups.

RESULTS

Comparison of baseline data before and after matching between the two groups

Before matching, no significant differences existed between the two groups in sex, age, hypertension, diabetes, or coronary heart disease (P > 0.05), while significant differences were observed in disease course and Fontaine stage (P < 0.05). After PSM, 62 pairs were successfully matched, and no statistically significant differences were found between the two groups in any baseline characteristics, including sex, age, disease course, Fontaine stage, hypertension, diabetes, and coronary heart disease (all P > 0.05; Table 1).

Table 1 Comparison of baseline data before and after propensity score matching between the two groups, n (%)/mean ± SD.

Items	Before matching		χ2/t	Pvalue	After matching		χ2/t	Pvalue
	Intervention group (n = 83)	Control group (n = 93)			Intervention group (n = 62)	Control group (n = 62)
Sex			0.028	0.867			0.035	0.852
Male	51 (61.45)	56 (60.22)			39 (62.90)	40 (64.52)
Female	32 (38.55)	37 (39.78)			23 (37.10)	22 (35.48)
Age (years)	61.04 ± 7.31	60.99 ± 7.47	0.042	0.967	61.15 ± 7.37	62.11 ± 7.13	0.743	0.459
Course of disease (years)	2.65 ± 0.66	2.28 ± 0.68	0.604	< 0.001	2.49 ± 0.60	2.46 ± 0.64	0.231	0.817
Rutherford grade			7.996	0.018			0.254	0.881
I-II	42 (50.60)	65 (69.89)			38 (61.29)	36 (38.71)
III	30 (48.39)	17 (18.28)			15 (18.07)	15 (16.13)
IV	11 (13.25)	11 (11.83)			9 (10.84)	11 (11.83)
Hypertension			0.189	0.664			0.576	0.448
Yes	26 (31.33)	32 (34.41)			23 (27.71)	19 (30.65)
No	57 (91.94)	61 (65.59)			39 (46.99)	43 (69.35)
Diabetes			0.330	0.565			0.827	0.363
Yes	29 (34.94)	18 (19.35)			14 (22.58)	10 (16.13)
No	64 (77.11)	75 (80.65)			48 (77.42)	52 (83.87)
Coronary heart disease			0.090	0.764			0.000	1.000
Yes	12 (14.46)	12 (12.90)			8 (12.90)	8 (12.90)
No	71 (85.54)	81 (87.10)			54 (87.10)	54 (87.10)

Comparison of SDS scores between the two groups before and after the intervention

Before the intervention, the SDS score of the intervention and control groups was 60.64 ± 5.42 and 60.03 ± 5.39 points, respectively. There was no significant difference between the two groups (P > 0.05). After 8 weeks of the intervention and at 1-month follow-up, the SDS scores of the intervention group were 37.21 ± 5.35 and 30.76 ± 4.94 points, respectively, and those of the control group were 44.68 ± 5.77 and 38.94 ± 5.13 points, respectively. The scores for the intervention group were lower than those for the control group (P < 0.05, Figure 2).

Figure 2 Comparison of depression scores between the two groups before and after the intervention. SDS: Self-Rating Depression Scale. ^nsP > 0.05; ^cP < 0.001; ^dP < 0.0001.

Comparison of walking ability between the two groups before and after the intervention

Before the intervention, the PFWDs and 6MWDs of the intervention group were 152.16 ± 14.41 points and 303.97 ± 2.87 m, respectively while those of the control group were 151.85 ± 15.65 points and 304.58 ± 2.75 m, respectively. After 8 weeks of intervention and at the 1-month follow-up, the PFWD of the study group was 243.06 ± 13.44 and 263.35 ± 11.52 points, respectively and those for the 6MWD were 387.24 ± 15.22 m and 426.55 ± 13.02 m, respectively. The PFWDs for the control group were 224.55 ± 11.87 and 244.56 ± 10.43 points, respectively, and the 6MWDs were 364.45 ± 13.34 m and 307.06 ± 10.73 m, respectively. There was no significant difference between the two groups before the intervention (P > 0.05). After 8 weeks of the intervention and at the 1-month follow-up, the PFWDs and 6MWDs for the intervention group were significantly higher than those for the control group (P < 0.05, Figure 3).

Figure 3 Comparison of walking ability between the two groups before and after the intervention. A: Pain-free walking distance; B: 6-minute walk distance. PFWD: Pain-free walking distance; 6MWD: 6-minute walk distance. ^nsP > 0.05; ^cP < 0.001; ^dP < 0.0001; ^eP < 0.00001.

Comparison of SEE-C scores between the two groups before and after the intervention

Before the intervention, there was no significant difference in the SEE-C scores between the two groups (intervention group: 51.55 ± 2.03 points vs control group: 51.76 ± 1.96 points, P > 0.05). After 8 weeks of intervention, the SEE-C scores in both groups increased compared with baseline, with the study group scoring 74.45 ± 7.54 points and the control group scoring 67.55 ± 8.20 points, showing a significantly higher score in the study group (P < 0.001). At 1-month follow-up, the SEE-C score in the study group further increased to 79.82 ± 4.51 points, while the control group scored 71.95 ± 5.20 points, and the difference remained statistically significant (P < 0.001). These results are presented in Table 2.

Table 2 Comparison of Chinese Self-Efficacy for Exercise Scale scores between the two groups before and after intervention, mean ± SD.

Group	Before intervention	After 8 weeks of intervention	At 1 month follow-up
Intervention group (n = 62)	51.55 ± 2.03	74.45 ± 7.54	79.82 ± 4.51
Control group (n = 62)	51.76 ± 1.96	67.55 ± 8.20	71.95 ± 5.20
t	0.584	4.877	8.998
P value	0.560	< 0.001	< 0.001

SEE-C: Chinese Self-Efficacy for Exercise Scale.

Comparison of quality of life between the two groups before and after the intervention

Before the intervention, there was no significant difference in the SF-36 scores between the two groups (P > 0.05). After 8 weeks of the intervention and at the 1-month follow-up, the scores for each dimension of the SF-36 in both groups were higher than those before the intervention, and the scores for the intervention group were significantly higher than those for the control group (P < 0.05, Table 3).

Table 3 Comparison of quality-of-life scores between the two groups before and after the intervention, mean ± SD.

Dimensions		Intervention group (n = 62)	Control group (n = 62)	t	P value
Life function	Before intervention	56.15 ± 5.33	55.45 ± 5.61	0.705	0.482
	After 8 weeks of intervention	70.65 ± 6.35	66.71 ± 6.14	3.508	< 0.001
	At 1 month follow-up	80.11 ± 6.53	74.15 ± 6.87	4.957	< 0.001
Physiological functions	Before intervention	56.24 ± 5.24	56.44 ± 5.12	0.208	0.835
	After 8 weeks of intervention	69.85 ± 5.74	63.88 ± 4.95	6.214	< 0.001
	At 1 month follow-up	81.21 ± 5.63	74.85 ± 5.94	6.109	< 0.001
Body pain	Before intervention	47.53 ± 5.66	48.32 ± 5.15	0.813	0.418
	After 8 weeks of intervention	65.19 ± 5.43	59.03 ± 5.27	6.409	< 0.001
	At 1 month follow-up	75.16 ± 6.11	67.34 ± 5.65	7.402	< 0.001
Overall health	Before intervention	51.84 ± 5.56	52.06 ± 5.33	0.231	0.818
	After 8 weeks of intervention	68.85 ± 5.52	62.93 ± 6.11	5.657	< 0.001
	At 1 month follow-up	82.32 ± 6.13	74.82 ± 6.32	6.703	< 0.001
Vitality	Before intervention	52.79 ± 5.60	53.71 ± 5.18	0.949	0.345
	After 8 weeks of intervention	67.74 ± 4.72	62.77 ± 4.89	5.758	< 0.001
	At 1 month follow-up	76.85 ± 5.01	70.11 ± 4.95	7.540	< 0.001
Social functions	Before intervention	55.11 ± 5.27	54.21 ± 5.17	0.963	0.337
	After 8 weeks of intervention	68.44 ± 4.85	62.02 ± 5.76	4.618	< 0.001
	At 1 month follow-up	79.68 ± 6.26	72.32 ± 6.09	6.634	< 0.001
Emotional function	Before intervention	51.10 ± 4.82	51.71 ± 4.46	0.736	0.463
	After 8 weeks of intervention	67.37 ± 5.61	61.37 ± 6.65	5.432	< 0.001
	At 1 month follow-up	78.65 ± 6.13	71.87 ± 6.51	5.964	< 0.001
Mental health	Before intervention	56.37 ± 4.65	56.82 ± 4.79	0.533	0.595
	After 8 weeks of intervention	69.11 ± 6.33	62.54 ± 5.71	6.066	< 0.001
	At 1 month follow-up	78.53 ± 6.81	70.63 ± 6.13	6.791	< 0.001

Comparison of complications between the two groups

The total complication rate in the intervention group (3.23%) was lower than that in the control group (14.52%) (P < 0.05, Table 4).

Table 4 Comparison of complications between the two groups, n (%).

Group	Vascular restenosis	Skin infection	Delayed healing of incision	Skin ulcer	Total complications (%)
Intervention group (n = 62)	1 (1.61)	0 (0.00)	1 (1.61)	0 (0.00)	2 (3.23)
Control group (n = 62)	3 (4.84)	2 (3.23)	3 (4.84)	1 (1.61)	9 (14.52)
χ2					4.888
P value					0.027

DISCUSSION

This study focused on the intervention value of mindfulness training in patients with LEAOD complicated with depression. Its core purpose was to clarify its practical efficacy in improving depressive mood and enhancing walking function, to provide evidence for clinical application. Clinically, the limb ischemic symptoms and depressive state of LEAOD patients often overlap. Conventional rehabilitation nursing mainly focuses on relieving physical symptoms, lacking targeted intervention for depressive mood, and this deficiency has become a key factor restricting the recovery of patients’ walking function. Existing studies have confirmed that mindfulness training has a significant emotional regulation effect on patient groups with psychological distress, such as chronic pain and cardiovascular diseases[22,23], which provides important theoretical support for its application in these patients to facilitate depression improvement and walking ability recovery.

The study results indicated that after an 8-week intervention and a 1-month follow-up, the SDS scores of patients in the intervention group were significantly lower than those of patients in the control group. Additionally, the PFWDs and 6MWDs of the intervention group were notably superior to those of the control group (P < 0.05). This suggests that mindfulness training can effectively improve depressive symptoms and enhance walking ability in patients with LEAOD combined with depression, which is consistent with the findings from multiple studies conducted on patients with chronic diseases[24,25]. Mindfulness training may alleviate depression through various mechanisms. In a randomized controlled trial on anxiety disorders, Hoge et al[26] found that mindfulness practice was associated with enhanced regulatory function of the prefrontal cortex over the amygdala, potentially serving as a key neural mechanism for alleviating negative emotions. From the perspective of neuroplasticity, mindfulness training enhances emotional memory encoding by improving hippocampal volume and functional connectivity while increasing cognitive reappraisal capacity regarding pain signals via the anterior cingulate cortex[27]. For patients with LEAOD, pain induced by walking often triggers catastrophic thinking; however, mindfulness training helps these patients dissociate from such negative thoughts by fostering a non-judgmental awareness of their present experiences, thereby alleviating emotional distress. Regarding the improvements in walking ability, the mechanisms may be more behavioral and psychological. Depression is frequently accompanied by a lack of motivation for physical activity and avoidance behaviors; thus, mindfulness training may effectively disrupt the “pain avoidance-functional decline” vicious cycle by enhancing patients’ tolerance to discomfort and management skills while boosting their self-efficacy related to exercise[28,29]. In a systematic review, McDermott and Polonsky[30] emphasized that addressing psychological disorders is crucial for improving physical activity levels in patients with peripheral artery disease. This aligns with our findings, indicating that mindfulness training may be effective for addressing such psychological issues.

Furthermore, our study revealed that after an 8-week intervention followed by a one-month follow-up period, SEE-C and SF-36 dimension scores were higher in the intervention group than in the control group (P < 0.05). The overall complication rate in the intervention group was recorded at 3.23%, significantly lower than that observed within the control group (14.52%; P < 0.05). These results suggest that mindfulness training can effectively enhance self-efficacy and quality-of-life among patients with LEAOD experiencing depressive states while demonstrating good safety profiles. Self-efficacy is a critical predictor of health behavioral changes among patients with chronic disease[31]. As participants experience increased control over negative thoughts and discomfort through mindful practice, their confidence in exercise adherence, which constitutes the core motivation necessary for sustaining long-term rehabilitation efforts, also increases. Quality-of-life enhancement attributed to mindfulness training likely operates by reducing psychological distress while bolstering coping abilities against disease challenges. These mechanisms comprehensively elevate subjective experiences across physiological and emotional functioning domains, including the social domain[32]. Jalali et al[33] studied quality-of-life improvements among Iranian participants undergoing mindfulness-based stress reduction therapy for the first time and reported improvements across various dimensions, including mental health status and social engagement levels.

Despite the above valuable findings, this study has certain limitations. It is a single-center retrospective investigation necessitating multi-center validation for broader applicability; objective indicators, such as serum inflammatory factors or neurotransmitters remain unmeasured, warranting further exploration into the underlying mechanisms. In addition, the follow-up duration spanned only 3 months, requiring extended tracking to determine the long-term effects. Future prospective randomized controlled trials incorporating biomarker assessments (e.g., serum cortisol or serotonin levels) are recommended to clarify the sustained efficacy of mindfulness therapy along core target pathways, enabling personalized interventions tailored specifically toward individuals suffering from LEAOD concomitant with depressive conditions.

CONCLUSION

In summary, mindfulness training is effective for ameliorating depressive symptoms while enhancing walking capabilities, self-efficacy, and overall quality-of-life metrics among individuals diagnosed with LEAOD concomitant with depression, all of which exhibit commendable safety standards. This study enriches the clinical intervention program of LEAOD combined with depression, which is of great significance to improve the overall rehabilitation effect and long-term prognosis of the patient group.