In this survey study among 300 outpatient breast cancer patients 17.7 % have used yoga after cancer diagnosis. Greater yoga use was observed among white patients as compared to non-whites. Race was not found to be significant in the multivariate analysis; however, this may be due to the fact that only two non-white women practiced yoga since cancer diagnosis. Additionally we found education level and Body Mass Index (BMI) as independent predictors of yoga use, with yoga users more likely to be well educated and with lower BMI levels. These findings provide an understanding of existing pattern of yoga use among breast cancer patients and also highlight the challenge ahead to make yoga a therapy available to individuals of greater diversity.
The prevalence of yoga use among breast cancer patients in our study (17.7%) is higher than that reported in the national studies conducted among general US population but is comparable to the prevalence of yoga use among breast cancer patients using localized samples. The National Health Interview Survey suggests that 6% of civilian non-institutionalized US adults used yoga in 2007 4
. Another study has reported that yoga was found to be one of the most commonly used mind-body techniques with a prevalence rate of 3.7 % 30
. On the other hand, prevalence of yoga use among breast cancer patients has been reported from 11.5% to 22.2% in localized samples, and the prevalence we found falls right within these numbers 20–23
Few studies have looked at the factors associated with yoga use among the general population, however even less is known in this area among breast cancer patients. Studies conducted among the general US population found that yoga users were more likely to be white, female, young, college educated, and urban dwellers 31, 32
. A study conducted to understand the use of mind body therapies among breast cancer patients found the use of yoga and other components of yoga like meditation and deep breathing to be more common among non-Hispanic whites than any other ethnic or racial groups 22
Our results are consistent with most of the published yoga research findings that suggest higher education level is associated with yoga use. Unfortunately, relatively little information is available regarding the reasons for these notable differences. Some of the potential explanations could be: Patients with low education level may have limited ability to access or desire to seek health information such as practicing yoga. Lack of knowledge or familiarity about yoga, lack of access to yoga classes, or cost might be important barriers towards the use of yoga in this population. In order to target yoga to this socially vulnerable group, more research is needed to understand the specific barriers so interventions can be developed to overcome these challenges.
Our study revealed that breast cancer patients with normal weight (BMI < 30) are more likely to use yoga than obese patients (BMI >30). Similar results were found in a study evaluating the use of CAM by obese adults with yoga use less prevalent among obese individuals as compared to normal-weight individuals 33
. Limited research suggests that yoga may be a useful intervention for weight management 34, 35
, however; little is known about obese patients’ barriers towards use of yoga. Some potential explanations are that obese women might have negative preconceptions about yoga being extremely challenging for obese and non-flexible individuals, the perception being partly contributed by the projected image of yoga by the mass media as being practiced by thin and very flexible individuals. More research is needed to identify specific barriers to yoga use among this population in order to design yoga programs that are aligned with the needs of obese patients.
As with prior research, we found use of yoga to be higher among whites than other ethnic and racial groups. The effect of race became non-significant in our multivariate analysis and may be due to the fact that only two out of 47 non-white (mostly black) patients used yoga since cancer diagnosis. Lower education level and higher BMI might explain some differences in the use of yoga across races however there can be other barriers towards the use of yoga among non-white patients. Additionally, yoga is often portrayed by the mass media as being a religious practice or being practiced by whites, which might lead to further racial barriers. It is possible that deeply spiritual/religious non-white participants may consider yoga to interfere with their religious paradigm. A study conducted to evaluate the barriers to yoga practice among the general population found time constraints, yoga not being aerobically challenging, challenging for people who are not flexible, and yoga being some type of religious practice as some of the important barriers to yoga use 36
. Similar studies among non-white breast cancer patients would yield a better understanding of the low uptake of yoga among this population for cancer-symptom management.
It is important to acknowledge several limitations of this study. The study relied on self-reports and is not a direct measure of the actual yoga use among breast cancer patients. Study participants are limited to breast cancer patients receiving aromatase inhibitors and completion of cancer treatments at least 1 month before enrollment as the participants of this study were part of a study on symptoms associated with aromatase inhibitors. Hence the study results might not be generalizable to those newly diagnosed with breast cancer or those undergoing active treatment. Additionally, our sample was predominantly white and seen in an academic cancer center; thus, studies of more racially diverse populations of breast cancer patients are needed. The study did not provide information regarding patients’ attitudes towards yoga use, frequency of yoga use or use of yoga before cancer diagnosis. Future studies should focus on these important constructs in order to gain better understanding of yoga use among breast cancer patients. Also, the academic cancer center where the patients were being treated did not offer yoga to cancer patients which might impact the generalizability of the findings to other settings.
Despite the limitations, the study provides useful information about the characteristics of yoga users among breast cancer patients. In order for yoga to be an effective public health practice, it is critical to understand why differences based on race, education and BMI level exists in the use of yoga. Further research is needed to understand the specific attitudes and barriers of populations of non-white race, low education and obese individuals towards the use of yoga. Such investigation will help design yoga programs that are aligned to the needs of these populations for reducing symptom distress, promoting health and wellness, improving quality of life and ultimately reducing health disparities in cancer symptom management. Furthermore, in order for yoga to appeal to more diverse populations, the image of yoga may need to be tailored to appeal to obese individuals and individuals of diverse racial and ethnic background. As the efficacy of yoga is being investigated for different health conditions, identifying and developing strategies to deliver yoga to diverse populations at risk for health disparities is an important public health effort.