Background: Unmanaged stress is a major contributing factor to the development of disease in both men and women. Middle-aged adults (40-64) have some of the highest stress of all age groups and the use of meditation may provide relief for conditions such as stress. A smartphone application (app) may help limit the magnitude of the perceived challenges of meditation. The purpose of this study is to determine the feasibility of a consumer-based meditation app (i.e., Calm) to reduce stress in middle-aged adults who self-report elevated stress. The preliminary effects of Calm on stress and health outcomes related to stress were explored as well as the preliminary effects of Calm on mindfulness and coping behaviors for stress were explored.

Methods: Adults were recruited to a 4-week app-based health and well-being study. Participants were randomized into either a mindfulness meditation (i.e. Calm) group or a health education (POD) control group. Participants were asked to participate at least 10 minutes per day. Assessments were conducted for stress, anxiety, depression, mindfulness, physical activity, eating habits, and coping behaviors at pre- and post-intervention and voluntary phone interviews were held post-intervention. App usage data were collected subjectively through weekly participation logs and through objective app usage data provided by Calm.

Results: Eighty-three participants were enrolled into the study and 60 completed the intervention and were analyzed. Feasibility and demand benchmarks were met with 96% of participants satisfied with the intervention and 93% found it enjoyable, appropriate, and useful. There was a 70% adherence (minutes/week) to the meditation intervention. Recruitment of men into the intervention group was 38.1% and retention of men was 81.3%. Significant changes were not observed in stress, anxiety, depression, or mindfulness, physical activity, eating habits, and coping behaviors.

Conclusion: The findings of this study support the feasibility of a 4-week, mobile app-based mindfulness meditation intervention (i.e. Calm) in middle-aged adults. These finding do not demonstrate preliminary efficacy of Calm to reduce stress, anxiety, and depression or improvement of mindfulness, physical activity, eating habits, or coping behaviors among middle-aged adults who report elevated stress. These results can be applied for improved design of future studies.