This study employed a quasi-experimental design with four parallel groups and a pretest–posttest approach (Handley et al., 2018; Sommana et al., 2025). Following eligibility screening and the provision of written informed consent, eligible participants were allocated to one of four study groups using a computer-generated randomization sequence developed with Research Randomizer (Randomizer.org). The four groups comprised progressive muscle relaxation (PMR), autogenic training (AT), combined PMR + AT, and a control group receiving standard care. Outcome assessments were conducted at baseline and after the intervention period using standardized procedures across all study sites. This design enabled the comparison of intervention effects while maintaining consistency in participant allocation and outcome measurement.

The study was carried out at four branches of Panti Sosial Harapan Kita located in Palembang, Indralaya, Musi Rawas, and Lubuk Linggau, South Sumatra Province, Indonesia. These facilities served as the recruitment sites and venues for intervention delivery and outcome assessments. A standardized study protocol was implemented across all sites, and trained healthcare personnel at each facility assisted with participant screening, recruitment, intervention delivery, and data collection to ensure procedural consistency (Khairani et al., 2024; Mohsen & Hassan, 2024).

The study was conducted between September 2025 and February 2026. During the preparatory phase, ethical approval was obtained, the study protocol was finalized, research staff received standardized training, and all study procedures and materials were prepared. Participant recruitment commenced in November 2025 following ethical approval. After eligibility screening and written informed consent, eligible participants were enrolled and allocated to the study groups according to a computer-generated randomization sequence. The intervention was subsequently implemented, followed by post-intervention outcome assessments, data management, and statistical analyses. All study procedures were completed by February 2026.

The study population comprised all older adults with hypertension living in social welfare facilities in South Sumatra, Indonesia. Participants were enrolled using a systematic screening procedure in conjunction with the healthcare personnel at the social welfare facilities. Information regarding residents diagnosed with hypertension was acquired from the institutions’ health records, followed by an eligibility assessment based on blood pressure readings and cognitive conditions (Agarwal, 2021; Rahayu et al., 2024).

The required sample size was estimated using G*Power version 3.1 (Faul et al., 2009) based on one-way ANOVA assumptions, with a significance level of 5%, statistical power of 80%, and an anticipated moderate effect size (Cohen et al., 2017). To compensate for potential attrition of approximately 10%, the target sample size was increased to 200 participants, with 50 participants allocated to each of the four study groups. A total of 200 eligible participants were enrolled and randomized. During the four-week intervention period, six participants were lost to follow-up or withdrew from the study. Consequently, 194 participants completed the study and were included in the final analysis.

Information on antihypertensive medication use was obtained from institutional medical records and verified through participant interviews at baseline. Participants were instructed to continue their prescribed antihypertensive medication regimen throughout the study period, and the research team did not modify any medication during the intervention. Medication use was monitored throughout the study, and no changes in antihypertensive therapy were reported during follow-up.

The intervention was delivered over four consecutive weeks, comprising three sessions per week for a total of 12 sessions. Each session lasted approximately 30–45 minutes. Participants allocated to the progressive muscle relaxation (PMR) group received PMR based on Jacobson’s technique, which involves the systematic contraction and relaxation of major muscle groups (Astuti et al., 2019; Toussaint et al., 2021). Participants in the autogenic training (AT) group received relaxation training using the Schultz and Luthe approach, emphasizing self-suggestion through sensations of heaviness, warmth, calmness, and controlled breathing (Naibaho & Arianti, 2025). Participants in the combined PMR + AT group received PMR followed immediately by AT within the same session to maximize physiological and psychological relaxation responses. Participants in the control group continued to receive routine care provided by the social welfare facility without additional relaxation therapy.

All intervention sessions were delivered by trained nursing personnel who had completed standardized intervention training before study implementation. Intervention fidelity was monitored throughout the study using a structured fidelity checklist completed by trained supervisors to ensure consistent delivery of the intervention across all study sites (Pathan et al., 2023).

The primary outcome of this study was systolic and diastolic blood pressure. Secondary outcomes, including perceived stress, anxiety, and quality of life, were collected as part of the study protocol but are beyond the scope of the present report and will be presented separately. The questionnaire can be accessed at https://doi.org/10.5281/zenodo.19395989 (Setya Rini, 2026b).

Outcome assessments were performed at two time points: baseline (before the intervention) and immediately after completion of the four-week intervention. Blood pressure was measured using a validated and calibrated automated digital sphygmomanometer (Omron HEM-8712) following internationally accepted measurement guidelines (Mukkamala et al., 2025; Muntner et al., 2019). Participants were instructed to rest quietly for at least 5 minutes before measurement while seated with their back supported, feet flat on the floor, and the measured arm supported at heart level. Two consecutive measurements were obtained at 1–2-minute intervals, and the average value was used for statistical analysis. To minimize diurnal variation, blood pressure measurements were performed at approximately the same time of day for each participant (Nongkynrih et al., 2024).

All outcome assessments were conducted by trained healthcare personnel who were blinded to participants’ group allocation to minimize measurement bias (Hrobjartsson et al., 2012).

The study was approved by the Research Ethics Committee of Universitas Muhammadiyah Ahmad Dahlan Palembang, Indonesia, on 22 September 2025 (Approval No. 004869/KEP/2025). The study was subsequently registered with the Thai Clinical Trials Registry (TCTR20251117013, 01 November 2025, https://www.thaiclinicaltrials.org/show/TCTR20251117013). Because registration was completed after enrollment of the first participant, the trial was retrospectively registered.

Written informed consent was obtained from all participants before enrollment. Participants were informed of the study objectives, procedures, potential benefits, and their right to decline participation or withdraw from the study at any time without affecting the care or services they received.

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki, the 2016 CIOMS International Ethical Guidelines for Health-related Research Involving Humans (CIOMS, 2016) and the WHO Standards and Operational Guidance for Ethics Review of Health-Related Research with Human Participants (Part III; WHO, 2011).

Participant confidentiality and privacy were protected by assigning unique identification codes and removing all personally identifiable information from the study dataset. Access to research data was restricted to the research team.

Progressive muscle relaxation and autogenic training were delivered as non-invasive behavioral interventions by trained nursing personnel following standardized intervention protocols. Participants continued their usual antihypertensive treatment throughout the study. Adverse events were monitored during the intervention period, and no intervention-related adverse events were observed.

Descriptive statistics were used to summarize participants’ demographic characteristics and blood pressure measurements. Continuous variables were presented as means and standard deviations (SD), whereas categorical variables were summarized as frequencies and percentages (Mishra et al., 2019). Data normality was assessed using the Shapiro–Wilk test, and homogeneity of variances was evaluated using Levene’s test.

Within-group changes in systolic and diastolic blood pressure from baseline to post-intervention were analyzed using paired-samples t-tests (Cohen et al., 2017; Lakens, 2013). Between-group differences in blood pressure were examined using one-way analysis of variance (ANOVA), followed by Bonferroni post hoc tests for pairwise comparisons when significant differences were identified. Multivariate analysis of variance (MANOVA) was performed to evaluate the overall effects of the interventions on systolic and diastolic blood pressure simultaneously. Statistical significance was set at p < 0.05. All statistical analyses were performed using IBM SPSS Statistics version 26 (Chen et al., 2025).

Nineteen-four geriatric individuals with hypertension were included in this study and allocated into four groups: progressive muscle relaxation (PMR) (n = 49), autogenic training (AT) (n = 49), PMR + AT combination (n = 48), and control (n = 48). Figure 1. CONSORT flow diagram of participant recruitment, allocation, follow-up, and analysis. The CONSORT checklist is available at https://doi.org/10.5281/zenodo.21488681 (Setya Rini, 2026).

Table 1 shows the participants’ demographic data. Establishment equivalence among the four groups was evaluated using ANOVA for age and analysis for categorical variables using chi-square. No significant differences were identified across groups in terms of age, sex, or educational attainment, confirming comparable baseline conditions before intervention delivery. The participants were aged approximately 70–74 years, with a mean age of 72.34 ± 7.67 years. Women comprised slightly more than half of the study population, and junior high school was the most frequently reported level of education among the participants.

Table 2 presents the findings of the examination of the alterations in SBP and DBP before and after the intervention in each group. The data demonstrated that all relaxation therapies significantly lowered blood pressure, with the combination of PMR and AT yielding the best results.

In the PMR group, the average SBP decreased from 158.10 ± 10.88 mmHg to 155.18 ± 11.04 mmHg, indicating a mean reduction of 2.92 mmHg (t = 6.828). DBP exhibited a notable reduction from 88.29 ± 5.90 mmHg to 85.92 ± 5.69 mmHg, reflecting an average decrease of 2.37 mmHg (t = 8.214). Effect size analysis demonstrated substantial intervention effects on both systolic (d = 0.975) and diastolic (d = 1.173) blood pressure outcomes, as reflected by large Cohen’s d values.

In the AT group, SBP decreased from 159.39 ± 11.98 mmHg to 156.71 ± 11.70 mmHg, resulting in an average drop of 2.67 mmHg (t = 7.003). DBP exhibited a notable reduction from 88.92 ± 6.83 mmHg to 85.63 ± 6.88 mmHg, resulting in an average decrease of 3.29 mmHg (t = 7.967). Cohen’s d values demonstrated a substantial effect size for SBP (d = 1.000) and DBP (d = 1.138).

Among all intervention groups, the combined PMR and AT program produced the greatest improvement in blood pressure outcomes. Systolic blood pressure decreased from 160.33 ± 12.19 mmHg to 154.46 ± 11.71 mmHg, reflecting an average reduction of 5.88 mmHg (t = 13.661), whereas diastolic blood pressure declined from 89.67 ± 5.81 mmHg to 84.19 ± 6.22 mmHg, indicating an average decrease of 5.48 mmHg (t = 14.594). Cohen’s d indicates that the intervention had a large effect size on systolic blood pressure (d = 1.972) and diastolic blood pressure (d = 2.107).

In contrast, the control group exhibited elevated blood pressures throughout the study period. Systolic blood pressure increased from 161.40 ± 11.12 mmHg to 162.67 ± 10.90 mmHg (t = −3.367), whereas diastolic blood pressure increased from 88.85 ± 5.93 mmHg to 89.71 ± 6.38 mmHg (t = −3.168). Cohen’s d values demonstrated a small-to-moderate effect size for both variables.

Table 3 presents the findings of the one-way ANOVA regarding the mean changes in blood pressure among the groups. The partial eta-squared value indicated that the intervention significantly influenced blood pressure changes.

The analysis revealed a substantial disparity in systolic blood pressure variations between the research groups (F = 51.918; partial eta squared =0.450). The PMR + AT combination group exhibited the most significant mean reduction in systolic blood pressure (−5.87 ± 2.98 mmHg), followed by the PMR (−2.92 ± 2.99 mmHg) and AT (−2.67 ± 2.67 mmHg) groups, whereas the control group showed an increase in systolic blood pressure (1.27 ± 2.62 mmHg).

Marked differences were observed in the alterations in diastolic blood pressure among the groups (F = 58.560; partial eta squared =0.480). The PMR + AT combination group exhibited the most significant average reduction in diastolic blood pressure (−5.48 ± 2.60 mmHg), followed by the AT (−3.29 ± 2.89 mmHg) and PMR groups (−2.37 ± 2.02 mmHg), whereas the control group showed an increase in diastolic blood pressure (0.85 ± 1.87 mmHg).

Table 4 presents the results of the Bonferroni post-hoc analysis. No notable difference in systolic blood pressure was observed between the PMR and AT groups (p = 1.000). The PMR + AT combination group had a significantly lower systolic blood pressure than the PMR (p < 0.001), AT (p < 0.001), and control (p < 0.001) groups. Similar outcomes were observed for the diastolic blood pressure. The PMR + AT combination group exhibited a markedly greater decrease in diastolic blood pressure than the PMR (p < 0.001), AT (p < 0.001), and control (p < 0.001) groups. These findings suggest that combining PMR and AT may provide greater benefits for blood pressure management than either intervention delivered separately.

The MANOVA results are presented in Table 5. Multivariate analysis revealed a significant multivariate impact of the intervention on both systolic and diastolic blood pressure. Pillai’s Trace indicated a substantial result (V = 0.602, F = 27.293, partial eta squared =0.301), as did Wilks’ Lambda (V = 0.408, F = 35.615, partial eta squared = 0.361), Hotelling’s Trace (V = 1.425, F = 44.638, partial eta squared = 0.416), and Roy’s Largest Root (V = 1.406, F = 89.073, partial eta squared =0.584).

The partial eta-squared values indicated that the interventions significantly influenced simultaneous changes in systolic and diastolic BP. The combined intervention consistently produced the largest reductions in both systolic and diastolic blood pressures compared with the other study groups. The findings of this investigation suggest that mind–body relaxation techniques may serve as a useful complementary non-pharmacological approach for blood pressure management in older adults with hypertension (Toussaint et al., 2021).

The authors gratefully acknowledge the support provided by Universitas Muhammadiyah Ahmad Dahlan Palembang and Lincoln University College, Malaysia, Faculty of Nursing, particularly for the scholarly support and provision of facilities for this study. We also appreciate the administrators and staff of social welfare institutions for older adults in South Sumatra for their valuable assistance during the implementation of the study and the data collection processes. The authors thank all the participants for their involvement, which was essential for completing this study.

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