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

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.