Objectives: The objectives of this study were to determine the effects of the novel Buddhism-based walking meditation (BWM) and the traditional walking exercise (TWE) on depression, functional fitness, and vascular reactivity.

Design: This was a randomized exercise intervention study.

Settings/location: The study was conducted in a university hospital setting.

Subjects: Forty-five elderly participants aged 60–90 years with mild-to-moderate depressive symptoms were randomly allocated to the sedentary control, TWE, and BWM groups.

Interventions: The BWM program was based on aerobic walking exercise incorporating the Buddhist meditations performed 3 times/week for 12 weeks.

Outcome measures: Depression score, functional fitness, and endothelium-dependent vasodilation as measured by the flow-mediated dilation (FMD) were the outcome measures used.

Results: Muscle strength, flexibility, agility, dynamic balance, and cardiorespiratory endurance increased in both exercise groups ( p < 0.05). Depression score decreased ( p < 0.05) only in the BWM group. FMD improved ( p < 0.05) in both exercise groups. Significant reduction in plasma cholesterol, triglyceride, high-density lipoprotein cholesterol, and C-reactive protein were found in both exercise groups, whereas low-density lipoprotein cholesterol, cortisol, and interleukin-6 concentrations decreased only in the BWM group.

Conclusions: Buddhist walking meditation was effective in reducing depression, improving functional fitness and vascular reactivity, and appears to confer greater overall improvements than the traditional walking program.