It's okay to not be okay.

Elevated blood pressure (BP) is defined as an office-measured systolic BP (SPB) between 120–139 mmHg and/or a diastolic BP (DBP) between 70–89 mmHg. These values exceed the optimal BP range yet remain below the threshold for a clinical diagnosis of hypertension (HTN), representing a pre-hypertensive state associated with an increased risk of progression to overt HTN and cardiovascular morbidity. Worldwide, the prevalence of elevated BP is increasing at an alarming rate, representing a significant public health concern and affecting 25% to 50% of the global population. Malaysia mirrors these trends, with 41–46% of its population being affected, particularly young male adults. Elevated BP induces significant abnormalities in the cardiovascular system, and its relationship with cardiovascular diseases (CVDs) is well documented in literature. The risk of CVDs rise exponentially with an increase in SBP of 20 mmHg or DBP of 10 mmHg. Consequently, individuals with elevated BP exhibit a twofold greater likelihood of developing CVDs compared to those with normal BP. Among the various contributors to the rise of elevated BP, physical inactivity emerged as a dominant and modifiable risk factor. It is a widespread phenomenon, impacting 27.5–31.3% of the adults globally. Physical inactivity is a key contributor to HTN, CVD, stroke, and other non-communicable diseases (NCDs), responsible for over 5 million deaths annually. In Malaysia, more than 37% of the adults are classified as physically inactive. Alarmingly, the prevalence of physical inactivity is even higher among young adults, ranging between 41.4 and 66.4%. In addition to physical inactivity, autonomic imbalance particularly in the form of elevated resting heart rate (RHR) has been identified as a significant contributor to increased BP and the development of cardiovascular dysfunction. Research demonstrates a positive correlation between elevated RHR and increased sympathetic nervous system activity, coupled with reduced parasympathetic tone, resulting in high vascular resistance and cardiac workload, factors that accelerate the progression from elevated BP to established HTN. It has been further reported that individuals with a higher RHR (≥ 90 beats/minute) demonstrate an increased risk of all-cause mortality. Elevated BP is a precursor of HTN and warrants significant lifestyle modifications and non-pharmacological management to prevent its progression to HTN. Lifestyle changes, especially regular physical training (PT), has proven to reduce SBP/DBP and RHR through improved endothelial function, autonomic regulation, and cardiac efficiency. Moderate to vigorous PT can lower SBP by 7.5 mmHg and DBP by 4.4 mmHg, significantly decreasing CVD risk and mortality. Mental training (MT), encompassing interventions like mindfulness-based stress reduction (MBSR) presents a low-cost, accessible approach that has shown beneficial effects on autonomic regulation. MBSR is a “non-judgmental, present-moment awareness of physical sensations, emotions and thoughts,” and involves objectively observing sensory input and mental phenomena, then responding skilfully to these stimuli. A growing body of evidence strongly supports the positive impact of MT, confirming MT’s efficacy in lowering BP across populations with elevated BP and HTN. Globally, elevated BP and physical inactivity poses significant public health challenges and demands urgent attention. Although the individual benefits of PT and MT in managing BP have been previously studied, there remains a notable paucity of research exploring the synergistic or cumulative effects of mental and physical training (MAPT) interventions when applied in combination, particularly among physically inactive young adults with elevated BP. No study to date has systematically investigated the combined impact of PT and MT on BP and RHR, representing a critical knowledge gap. Given the distinct but potentially convergent pathways through which PT and MT exert their effects, their integration may offer enhanced benefits. Addressing this gap could facilitate the development of holistic, non-pharmacological strategies to mitigate the early progression of HTN. We hypothesized that the MAPT intervention would produce greater reductions in BP and RHR compared to MT alone, PT alone, and the DASH diet among physically inactive young adults with elevated BP.