Who practices yoga? A systematic review of demographic,
health-related, and psychosocial factors associated with yoga
Crystal L. Park •Tosca Braun •Tamar Siegel
Received: December 13, 2013 / Accepted: January 11, 2015 / Published online: January 29, 2015
ÓSpringer Science+Business Media New York 2015
Abstract Yoga has become increasingly popular in the
US and around the world, yet because most yoga research
is conducted as clinical trials or experiments, little is
known about the characteristics and correlates of people
who independently choose to practice yoga. We conducted
a systematic review of this issue, identifying 55 studies and
categorizing correlates of yoga practice into sociodemo-
graphics, psychosocial characteristics, and mental and
physical well-being. Yoga use is greatest among women
and those with higher socioeconomic status and appears
favorably related to psychosocial factors such as coping
and mindfulness. Yoga practice often relates to better
subjective health and health behaviors but also with more
distress and physical impairment. However, evidence is
sparse and methodological limitations preclude drawing
causal inferences. Nationally representative studies have
minimally assessed yoga while studies with strong
assessment of yoga practice (e.g., type, dose) are generally
conducted with convenience samples. Almost all studies
reviewed are cross-sectional and few control for potential
confounding variables. We provide recommendations for
future research to better understand the correlates of yoga
Keywords Yoga Mental well-being Physical
well-being Psychosocial correlates
Yoga’s increased visibility in media, advertising and com-
mercial enterprises is paralleled by increased practice as evi-
denced in national surveys (Barnes et al., 2008). Research is
also proliferating on the practice of yoga for myriad health
conditions, ranging from postmenopausal symptoms and low
back pain to cancer and heart disease (Field, 2011). Most
research on yoga has focused on determining its effects, often
relying on experimental designs or clinical trials. Other studies
have relied on case reports or surveys of convenience samples
some outcome measure. While important for understanding the
effects of yoga on health and well-being, these studies do not
provide information on a more general question: who does
yoga? That is, what do we know about the characteristics of
individuals who elect to practice yoga when they have not been
assigned to do it as part of a trial or experiment?
Yoga is complex, comprising many different elements,
including physical poses, breathwork, concentration, and
meditation, ethical tenets, spirituality, inward attention, and
self-knowledge. When considering results across studies, it
is important to note that the yoga studied may vary greatly
in terms of speciﬁc tradition and style, location, class level,
teacher characteristics, and relative vigor and intensity of
aerobic and musculoskeletal exercise. Little research has
systematically examined different types of yoga and, in
fact, most provide little information on the speciﬁc types of
yoga practiced by participants.
Characterizing yoga practitioners in terms of demograph-
ics, psychosocial factors and physical and emotional well-
being is important, because understanding who practices yoga
may be useful in developing yoga interventions tailored to
appeal to different groups, and suggest future research
directions regarding the effects of yoga on various aspects of
Electronic supplementary material The online version of this
article (doi:10.1007/s10865-015-9618-5) contains supplementary
material, which is available to authorized users.
C. L. Park (&)T. Braun T. Siegel
University of Connecticut, Box 1020, Storrs, CT 06269, USA
J Behav Med (2015) 38:460–471
well-being as well as potential mechanisms through which
such effects are achieved. Further, given that yoga is
increasingly demonstrating efﬁcacy for various health con-
ditions, knowing more about who is not practicing yoga may
inﬂuence efforts for promotion and outreach as well as for
improving maintenance of yoga practice over time.
Finally, the complex interplay between selection and
causal effects with regard to yoga practice is a little-dis-
cussed but important consideration. For instance, those
self-selecting to yoga may evidence more health concerns
prior to initiating practice, while yoga could also facilitate
improvements relative to personal baseline. Reporting on
convenience samples in addition to clinical, large, and
nationally representative samples affords better character-
ization of selection effects (i.e., individual characteristics
that facilitate self-selection to yoga practice) versus causal
effects. Most data reported here are cross-sectional, ren-
dering causality impossible to infer. However, where
available, we report on demographics data, data comparing
yoga novices to advanced practitioners, and studies
exploring dose-related effects to facilitate consideration of
selection versus causal effects. We aimed to aggregate the
published evidence regarding the correlates of unsolicited
yoga practice in the general population as well as in con-
venience and clinical samples. Speciﬁcally, we address the
question: Which demographic characteristics, psychosocial
variables, and health-related characteristics are related to
the practice of yoga and to the amount of yoga practiced?
This systematic review is based on a literature search
conducted using four scholarly databases (MedLine, Psy-
cInfo, CINAHL, Google Scholar). We attempted to iden-
tify all studies that documented statistical associations
between the practice of yoga and demographic, psycho-
social, or well-being variables in non-intervention trials
published in English in peer-reviewed journals through
October, 2014. The keyword searched was ‘‘yoga’’, pro-
ducing large numbers of abstracts. For example, the Pub-
Med search yielded 2,637 potential sources and the
PsychInfo search yielded 1,678, many of which were
overlapping. All abstracts were read for potential inclusion;
for those that potentially met criteria, full articles were read
for relevance to the research questions listed above.
Articles were included if they met the following criteria:
(1) was an original empirical study (i.e., not an editorial or
other commentary), (2) examined people who elected to do
yoga on their own rather than describing people recruited
into a clinical trial or experiment, (3) examined yoga
explicitly and singularly (rather than aggregated with other
CAM modalities), (4) assessed demographic, psychosocial,
or well-being variables, and (5) presented inferential sta-
tistics (i.e., not just percentages or frequencies of yoga
practice by demographic or health-related factors).
In total, 55 published articles were located that met all
inclusion criteria, despite the broad deﬁnitions of demo-
graphic, psychosocial factors, and health behaviors applied.
Many articles were excluded because even though they
assessed yoga separately, they reported only on general
CAM use (e.g., Van Tilburg et al., 2008) or CAM use by
categories, combining yoga with other mind–body modal-
ities such as meditation (e.g., Penman et al., 2012) or other
types of exercise, such as Pilates (e.g., Neumark-Sztainer
et al., 2011). For detailed information on included articles,
see Appendix Table 1 (online).
Description of included articles
Sixteen (29.1 %) articles comprised analyses of six nation-
ally representative datasets: the 2002 and 2007 NHIS, a
1997/1998 telephone survey on CAM use, the Nurse’s
Health Study (Buettner et al., 2006), American Cancer
Society’s cancer survivor studies (Stein et al., 2009), the
Study of Women’s Health Across the Nation (Gold et al.,
2007), and the Health Survey for England (HSE; Ding &
Stamatakis, 2014). Recently, the NHIS included a CAM
component; 10 (18.2 %) articles were sub-analyses of spe-
ciﬁc populations drawn from the NHIS, nine from the 2002
report (Bertisch et al., 2008,2009;Birdeeetal.,2008;
Fouladbakhsh & Stommel, 2010;Garrow&Egede,2006;
Graham et al., 2005; Mao et al., 2010; Mehta et al., 2007;
Shah et al., 2008) and one from the 2007 report (Wells et al.,
2011). Two (3.6 %) analyses of a 1997/1998 telephone
survey on CAM use were published (Conboy et al., 2005;
Saper et al., 2004). Three (5.5 %) articles were subanalyses
from other national samples: cancer survivors from the
Nurse’s Health Study (Buettner et al., 2006), disease-free
colorectal cancer survivors in the US by the American
Cancer Society (Stein et al., 2009), and women from the
Study of Women’s Health Across the Nation (SWAN Study;
Gold et al., 2007). The Health Survey for England (HSE)
refers to a series of independent cohort studies implemented
between 1997 and 2008 (Ding & Stamatakis, 2014). Prev-
alence rates from the NHIS are non-comparable to the HSE
due to differences in deﬁnition of current yoga practice
(within past year or past 4 weeks, respectively).
The next most representative articles report on data from
a national survey of Iyengar practitioners, resulting in two
publications (3.6 %), with demographic norms that closely
J Behav Med (2015) 38:460–471 461
approximate yoga practitioner norms observed in nationally
representative studies (Ross et al., 2012,2013). Next are
three moderately-sized international and regional US sam-
ples that represented a low proportion of yoga- relative to
non-practitioners, resulting in four publications (7.3 %).
These include a comparison of yoga practitioners and non-
practitioners in a large Northwestern US cohort (Kristal
et al., 2005) and an investigation of sexual orientation and
CAM use in Pittsburgh, PA (Smith et al., 2010). Finally, a
study from Germany employing a large convenience sample
of internal and integrative medicine patients resulted in two
published comparisons (Cramer et al., 2013a,b).
The majority of articles (63.6 %) comprised US and
international convenience samples. Nineteen (34.5 %)
compared yoga practitioners to non-practitioners (e.g.,
Monk-Turner & Turner, 2010; Prichard & Tiggemann,
2008; Yoshihara et al., 2011); six (10.9 %) compared
practitioners and non-practitioners within a group with
speciﬁc health concerns (e.g., Desai et al., 2010; Park et al.,
2013; Wells et al., 2011); ﬁve (9.1 %) assessed within-group
characteristics of yoga practitioners (e.g., Dale et al., 2011;
Delaney & Anthis, 2010); three (5.5 %) compared those
with less experience to those with more (Brisbon & Lowery,
2011; Kiecolt-Glaser et al., 2010,2012; ); one (1.8 %)
dichotomized the sample into those who practiced for psy-
chospiritual versus physical reasons (Dittmann & Freedman,
2009); and one (1.8 %) compared yoga practitioner norms to
UK population norms (Hasselle-Newcombe, 2005).
Sixteen articles (29.1 %) explored dose (i.e., frequency or
duration of yoga practice), including one large national
sample of practitioners of a particular style of yoga (Iyengar;
Ross et al., 2012), one regional sample (Kristal et al., 2005),
and eleven convenience samples (e.g., Dale et al., 2011;
Kiecolt-Glaser, et al., 2012; Moliver et al., 2011,2013).
Seventeen articles (30.9 %) were conducted with samples
outside of the US (e.g., Zajac & Schier, 2011; Vera et al.,
2009), fourteen (25.5 %) were conducted with ill or survivor
populations (e.g., Fouladbakhsh & Stommel, 2010;Garrow&
Egede, 2006), and three (5.5 %) examined samples of Iyengar
practitioners (Ross et al., 2012,2013; Hasselle-Newcombe,
2005). We divided the studies’ heterogeneous array of cor-
relates into three categories: Yoga and sociodemographics,
psychosocial characteristics, and mental/physical well-being.
Many studies contributed ﬁndings in all three areas.
Relationships between yoga practice and
In virtually all of the research conducted in the US, women
practice yoga more than do men (Ross et al., 2013). In the
2002 NHIS, 76 % of yoga practitioners were women
(Birdee et al., 2008). Similar ratios are reported for cancer
survivors (Fouladbakhsh & Stommel, 2010), colorectal
cancer survivors (Stein et al., 2009), and those with med-
ical conditions (Bertisch et al., 2009). Other data from
nationally (Conboy et al., 2005; Saper et al., 2004; Stein
et al., 2009) and internationally representative studies
(Ding & Stamatakis, 2014) and national surveys (Ross
et al., 2012,2013) have observed a similar pattern.
Convenience samples also generally reﬂect this pattern
(e.g., Carbonneau et al., 2010), as well as the general
tendency to conduct studies of female yoga practitioners
only (e.g., Kiecolt-Glaser et al., 2012), unless they are
speciﬁcally gender-balanced (e.g., Venkatesh et al., 1994).
A greater proportion of females has also been observed in
international convenience samples (Cramer et al., 2013a;
Lafaille, 1997; Vera et al., 2009; Carbonneau et al., 2010),
excepting two samples in India skewed towards males
(Balakrishanan et al., 2007; Bankar et al., 2013).
Yoga practice in the US has been consistently linked with
being White and, to a lesser extent, Asian.The most thorough
examination of race/ethnicity and yoga use (yes/no) to date in
the US is the 2002 NHIS, which indicates that yoga use is
positively related to being White and negatively related to
being Black (Birdee et al., 2008; Bertisch et al., 2009 Graham
et al., 2005;Upchurchetal.,2010). A smaller nationally
representative sample found yoga practice was positively
associated with Japanese, Chinese, and White race/ethnicity
(Gold et al., 2007).These ﬁndings are consistentwith those of
convenience samples linking yoga practice to White race
(Desai et al., 2010; Kraemer & Marquez, 2009; Moliver et al.,
2011,2013; Satin et al., 2014). No differences in race or
ethnicity were shown in a smaller nationally representative
sample of CAM practitioners in 1997–1998 (Saper et al.,
2004) or in cancer survivors drawn from theNational Nurses’
Health Survey (Buettner et al., 2006) nor in the nationally
representative sample of English yoga practitioners (Ding &
Some studies suggest a fairly equitable distribution of yoga
practitioners across the lifespan, while others indicate a
greater proportion of the middle-aged. In the 2002 NHIS,
the most representative survey of age among US yoga
practitioners to date, 26 % of yoga practitioners were under
age 30; 27 % aged 30–39; 23 % aged 40–49; 20 %, aged
50–64; and 4 %, aged 65 or greater (Birdee et al., 2008).
This pattern was also present in the 2002 NHIS subsample
of people with medical conditions (Bertisch et al., 2008), in
462 J Behav Med (2015) 38:460–471
a smaller nationally representative sample (Conboy et al.,
2005) and in a convenience sample of breast cancer sur-
vivors (Park et al., 2013. However, nationally representa-
tive samples have indicated higher rates of middle-aged
yoga practitioners (Saper et al., 2004), including among
breast cancer survivors in the US (Fouladbakhsh &
Stommel, 2010) and English yoga practitioners in the HSE
(Ding & Stamatakis, 2014). Similar ﬁndings were observed
in medical patients in Germany (Cramer et al., 2013a). The
greater prevalence of the middle-aged among yoga prac-
titioners in patient populations may be, in part, attributable
to older age of onset for health-related concerns.
Existing evidence suggests no substantive relationship
between yoga practice and income. However, the most recent
NHIS (2002) indicates that 48 % of yoga practitioners (Birdee
et al., 2008) earned a household income of at least $65,000 per
year, but did not test for statistical signiﬁcance. The median
income appeared substantially higher among yoga practitio-
ners, given that the median U.S. household income in 2002
was $42,409 (DeNavas-Walt et al., 2003), however no rela-
tionship between income and yoga practice was found inother
studies reviewed here (e.g., Conboy et al., 2005; Saper et al.,
2004). While studies testing for signiﬁcance did not ﬁnd an
association, and studies analyzing the 2002 NHIS lack sig-
niﬁcance testing (Birdee et al., 2008; Bertisch et al., 2009),
there may be an association, given the apparently much higher
income of yoga practitioners in the 2002 NHIS.
Yoga practice is strongly and consistently linked with edu-
cation. According to the 2002 NHIS, 50 % of yoga practi-
tioners (Birdee et al., 2008) and yoga practitioners with
medical conditions (Bertisch et al., 2009) have a college
degree relative to 23 % of all non-practitioners (Birdee et al.,
2008). This pattern been replicated in other representative
(Saper et al., 2004) and internationally representative studies
(Ding & Stamatakis, 2014), national (Ross et al., 2012,2013),
regional (Kristal et al., 2005) and convenience samples (e.g.,
Cramer et al., 2013a; Desai et al., 2010;Fouladbakhsh&
Stommel, 2010; Kiecolt-Glaser et al. 2012).
Most studies reporting on marital status found no association
with yoga practice (e.g., Buettner et al., 2006;Conboyetal.,
2005; Park et al., 2013). However, one study found yoga
was more likely to be practiced among men who had never
married or who were unmarried but living with a partner
(Kristal et al., 2005). Male yoga practitioners have also been
shown to be about 60 % less likely than females to be
married or living with a partner (Ross et al., 2013).
Only one study has explored the relationship between sexual
orientation and yoga use. In a large Northeastern study that
explored CAM use in heterosexual- and lesbian women,
heterosexual women participated in yoga at higher rates than
did lesbian-identiﬁed women (Smith et al., 2010).
Summary of demographics and yoga practice
In aggregate, these studies present a picture of the typical yoga
practitioner as female, upper socioeconomic status, educated,
middle-aged and White. The predominance of this proﬁle
among yoga practitioners selecting to practice is likely due to a
combination of opportunity and culture. However, it is impor-
tant to note that only 6.1 % of people in the US reported any use
of yoga for health in the past year in the 2007 NHIS (Barnes
et al., 2008) and on the HSE, only .46 % of people in the UK
reported any use of yoga in the prior 4 weeks (Ding & Sta-
matakis, 2014), indicating that even among predominant
groups, yoga practice has substantial room to grow. Demo-
graphic characteristics may be considered selection effects of
yoga, given that they are unlikely to change due to yoga practice.
Given the increasing evidence of yoga’s potential to
promote health and alleviate suffering associated with
many physical and mental conditions (e.g., Field, 2011),
attention to these demographic factors may elucidate bar-
riers to participation. Investigation of factors both practical
(e.g., ﬁnancial concerns) and sociocultural (e.g., lack of
role models) associated with low rates of yoga participation
(e.g., among men, some racial minorities, lower income)
may suggest strategies to make yoga more accessible and
appealing to broader swaths of the population. Future
investigation is needed to better understand and capitalize
on the facets that promote yoga in the demographic groups
documented here that most commonly practice yoga. Such
knowledge can inform efforts to encourage greater practice
among diverse groups and those of lower socioeconomic
backgrounds and to develop culturally-appropriate modes
of delivery for yoga practice and interventions.
Relations between psychosocial characteristics and
Interpersonal relationships and social support
Little research has explored links between yoga and social/
relational outcomes. In one convenience sample, Indian
J Behav Med (2015) 38:460–471 463
college students, relative to yoga practitioners, reported
having more satisfying interpersonal relationships and
greater tolerance of others (Monk-Turner & Turner, 2010).
And in a convenience sample yoga practitioners did not
differ signiﬁcantly in levels of social support from runners
or sedentary controls (Satin et al., 2014).
Three convenience samples have explored relations
between personality and yoga practice, one ﬁnding that
Indian yoga practitioners demonstrated lower scores on
neuroticism relative to non-practitioners (Venkatesh et al.,
1994). The second, of German medical patients, found that
high internal health locus of control was positively and
external-fatalistic health locus of control was negatively
associated with yoga practice (Cramer et al., 2013a).
Finally, higher internal locus of control was reported
among college students in India who practiced yoga (Gill
& Kumar, 2014).
In the national survey of Iyengar yoga practitioners, yoga
practice frequency and years of practice independently
predicted mindfulness in multivariate analyses (Ross et al.,
2012). These ﬁndings are consistent with ﬁndings from one
convenience sample in the Northeastern US in which
beginning yoga practitioners evidenced lower mindfulness
scores than advanced practitioners (Brisbon & Lowery,
2011). A comparison of yoga practitioners to runners and
sedentary individuals found no differences in trait mind-
fulness (Satin et al., 2014).
Life stressors and coping
The few studies that examined stress, coping and yoga
found that yoga may be related to less stress and less
maladaptive coping. In India, yoga practitioners reported
experiencing fewer stressful life events during the past year
than non-practitioners (Venkatesh et al., 1994). However,
among college students, yoga practice was unrelated to a
history of one speciﬁc major life stressor, abuse (Dale
et al., 2011). Only one small convenience sample examined
coping styles, reporting that higher dose of yoga practice
was negatively related to dysfunctional coping, but unre-
lated to adaptive coping (Dale et al., 2011).
Several studies report higher levels of spirituality among
yoga practitioners compared to general population norms.
In a UK study of Iyengar practitioners, 83 % described
themselves as having a spiritual life compared to 45 % of
the overall population (Hasselle-Newcombe, 2005). In a
study comparing yoga practitioners to college students, a
higher percentage of yoga practitioners reported expressing
their spirituality appropriately and in a healthy way. No
differences were observed on measures of experiencing
harmony within, being in touch with the soul within,
experiencing self-satisfaction or being content with them-
selves (Monk-Turner & Turner, 2010). Another study of a
convenience sample of yoga practitioners found increasing
length of time practicing was positively correlated with
meaning in life and with gratitude (Ivtzan & Papantoniou,
While UK Iyengar practitioners were more likely to
report being spiritual, they were less likely to report being
‘‘religious’’ compared to national norms (1 vs. 11 %;
Hasselle-Newcombe, 2005). Among breast cancer survi-
vors, those who practiced yoga were less likely to have a
religious afﬁliation than were non-practitioners (Buettner
et al., 2006). While all rates of Christian denominations
were lower among yoga practitioners in the UK Iyengar
practitioner study compared to UK national norms, 13 % of
practitioners were Buddhist, as compared to only 1 % of
the UK population (Hasselle-Newcombe, 2005). In a
nationally representative US survey, ‘‘Christian’’ afﬁliation
was inversely related to yoga practice (Saper et al., 2004).
In contrast, a study in Holland reported that new yoga
practitioners did not differ from the general population in
terms of religious afﬁliation (Lafaille, 1997).
The relatively high level of spirituality reported among
yoga practitioners is not surprising given yoga’s historical
development within Eastern spiritual traditions. It does,
however, raise the question of whether yoga attracts the
spiritually inclined or whether yoga enhances spirituality.
The literature on spirituality as a motivation for yoga is
limited, although one study reported that 67 % of their
West Coast sample practiced yoga for ‘‘psychospiritual’’
reasons (Dittmann & Freedman, 2009), and a convenience
sample of yoga practitioners found that with continued
practice, primary motives for practicing yoga shifted
towards the spiritual (Park et al. in press). Future research
should explore this notion further, perhaps by examining
novice yoga practitioners’ spirituality levels pre and post-
initiation to a yoga practice.
Summary of psychosocial characteristics and yoga practice
Studies reviewed here are generally consistent with the
notion that yoga relates favorably to many psychosocial
factors such as social support, coping, and mindfulness,
but the evidence is based on a handful of results from
464 J Behav Med (2015) 38:460–471
convenience samples. Further, given the current body of
literature, it not possible to determine whether these per-
sonal characteristics are causally related to yoga practice or
whether the relationships are spurious and due to some
underlying third variable.
More research is needed to determine the psychosocial
characteristics of those who choose to practice and how
these characteristics may change with continued practice.
For example, yoga is related to spirituality and religious-
ness, but the nature of these relationships has been seldom
studied empirically. Yoga as it is presently practiced may
not appeal to people of some religious backgrounds, or
might even be perceived as counter to their religion
(Nicholson, 2013). Others who start practicing yoga may
ﬁnd its spiritual aspects increasingly appealing as they gain
yoga experience (Hasselle-Newcombe, 2005). Under-
standing the role of psychosocial factors is especially
important for developing yoga interventions and creating
outreach programs that appeal to and are effective for
Relations between physical and mental health and yoga
Health conditions The relationship between yoga and
health conditions is complex, with yoga practice frequently
associated with higher levels of health conditions that it
may also beneﬁt. In a large regional survey (Kristal et al.,
2005) and in the HSE (Ding & Stamatakis, 2014), yoga
practitioners reported being in better overall health than
Nationally representative studies have linked yoga
practice to higher levels of food or odor allergy and hyper-
tension (Bertisch et al., 2008), rheumatoid arthritis (Buettner
et al., 2006), and asthma (Birdee et al., 2008). However, in
the 2002 NHIS, hypertension was inversely related to yoga
practice in multivariate analyses, with no relation observed
between yoga use and neurologic or cardiovascular condi-
tions (Birdee et al., 2008). Among yoga practitioners with
medical conditions in the 2002 NHIS, yoga use was not
associated with history of bowel disease, irregular heartbeat,
or thyroid conditions (Bertisch et al., 2009). In the HSE,
fewer yoga participants than non-yoga participants reported
having physician diagnosed hypertension, diabetes, and
cardiovascular disease (Ding & Stamatakis, 2014).
Several nationally representative studies suggest yoga is
not related to pulmonary conditions (Bertisch et al., 2009;
Birdee et al., 2008; Buettner et al., 2006), but one (Saper
et al., 2004) found yoga practice positively related to lung
problems. In the 2002 NHIS, yoga practice was unrelated
to recency of diagnosis or pain among cancer survivors;
breast cancer survivors were less likely to practice yoga
than were other cancer survivors (Fouladbakhsh & Stom-
mel, 2010) and diabetes patients were less likely to practice
yoga than were those without diabetes (Garrow & Egede,
2006). Several studies have found breast cancer or treat-
ment variables unrelated to yoga practice (Buettner et al.,
2006; Mao et al., 2010).
Yoga may provide relief from some physical symptoms
(e.g., hypertension, asthma), which may partially explicate
both the positive relationship between yoga use and self-
rated health status as well as the number of health condi-
tions with which yoga practice is positively associated. In
attempting to interpret these contrary ﬁndings, it should be
noted both that many people turn to yoga for relief of
health problems (Birdee et al., 2008), and that intervention
research generally suggests yoga may be beneﬁcial for a
range of health concerns (Field, 2011).
Musculoskeletal conditions The relationship between
yoga and musculoskeletal conditions is complex. While
some studies indicating generally higher rates of muscu-
loskeletal complaints among yoga practitioners, interven-
tion studies suggest yoga can alleviate such conditions. The
2002 NHIS linked yoga use to higher levels of sprains and
musculoskeletal conditions, even after controlling for a
number of sociodemographic variables (Birdee et al.,
2008). In the subsample of the 2002 NHIS of adults with
medical conditions, yoga practice was associated with
higher levels of neck pain but not joint or back pain
(Bertisch et al., 2009). Compared to non-practitioners, one
study found that yoga practitioners reported more neck and
back pain (Saper et al., 2004). These primarily positive
associations between musculoskeletal conditions may be
because people with these conditions self-select to the
practice as a means of relief or because increased rates of
these health issues result from practice.
Pain unrelated to a speciﬁc condition Few studies have
explored non-speciﬁc pain in the context of yoga. In the
subsample of 2002 NHIS of adults with medical condi-
tions, yoga use was associated with face pain but not dental
pain or headache (Bertisch et al., 2009). In a recent fMRI
study, North American yoga practitioners tolerated pain
over twice as long as well-matched controls, evidencing
more grey matter in multiple brain regions and increased
left intrainsular white matter integrity (involved in pain
processing). Insula size in yoga practitioners correlated
positively with yoga experience, suggesting a causal rela-
tionship. Relative to controls, yoga practitioners employed
cognitive strategies to tolerate pain, which may have
facilitated the observed increase in insular volume
J Behav Med (2015) 38:460–471 465
(Villemure et al., 2014). Finally, ﬁbromyalgia patients
reported greater pain catastrophizing and pain ratings than
did yoga practitioners and controls. The yoga group did not
differ from healthy volunteers in pain ratings but were
lower in pain reactivity (Bradshaw et al., 2012).
Sleep Research generally suggests that yoga practice is
related to improved sleep. The national survey of Iyengar
yoga practitioners found favorable levels of sleep distur-
bance when compared to the general population and more
frequent yoga practice was positively associated with better
sleep quality, especially when practice was vigorous (Ross
et al., 2013). Convenience samples in India (Bankar et al.,
2013) and Spain (Vera et al., 2009) had better sleep quality
and less sleep disturbance than did controls. However, US
studies found no differences in sleep quality (Kiecolt-
Glaser et al., 2012; Satin et al., 2014).
One analysis of 2002 NHIS data in yoga practitioners
with medical conditions found no association with insomnia
(Bertisch et al., 2009), but analysis of the cancer survivor
subset of these data found that female cancer survivors with
insomnia were less likely to do yoga than those without,
while male cancer survivors with insomnia were more likely
to do yoga than were those without (Fouladbakhsh &
Stommel, 2010). This gender discrepancy may be partially
explicated by the moderating role of depression; for men
with cancer, depression was related positively to yoga
practice, while the opposite was the case for women.
Medication use In several convenience samples, yoga
practitioners reported taking fewer prescribed medications
than did the non-yoga group (Bankar et al., 2013; Moliver
et al., 2011), although one study found no differences
(Kiecolt-Glaser et al., 2012). Adjusting for covariates,
medication use was unrelated to calendar years of yoga
practice, but was inversely related to lifetime hours of
practice (Moliver et al., 2011).
Smoking status Yoga practice has been linked to lower
rates of smoking. One nationally representative study found
17 % of yoga practitioners were current smokers relative to
21 % of smokers in the US population (Bertisch et al., 2009),
while another showed yoga practitioners were less likely
than non-practitioners to use tobacco (Birdee et al., 2008).
This has also been demonstrated in national (Birdee et al.,
2008; Gold et al., 2007; Kristal et al., 2005; Ross et al., 2013)
and convenience (e.g., Cramer et al., 2013a) samples.
Lower rates of smoking among yoga practitioners are
consistent with smoking reductions observed in yoga pro-
gram participants relative to controls following yoga
training (Bock et al., 2010). Yoga may prompt reductions
in smoking through a number of pathways. For example,
breathwork (pranayama) may render practitioners more
mindful of limited lung capacity and engender an increased
desire to quit. Alternately, selection effects may play a role,
with those drawn to yoga practice being more oriented to
healthy lifestyles and less likely to use tobacco.
Alcohol consumption The relationship between alcohol
consumption and yoga practice is unclear. In the 2002
NHIS, yoga practitioners reported higher alcohol con-
sumption than non-practitioners, particularly moderate and
heavy use (Birdee et al., 2008). However, in the national
survey of Iyengar practitioners, higher frequency of prac-
ticing gentle poses—but not other aspects of yoga prac-
tice—was associated with less alcohol consumption (Ross
et al., 2012). In a convenience sample (Kiecolt-Glaser
et al., 2012), investigators found no differences in alcohol
intake between experienced and novice yoga practitioners.
Additionally, the 2002 NHIS ﬁndings indicate a strong
positive link between yoga practice and alcohol con-
sumption. It is unclear whether there is a causal linkage and
if so, in which direction it runs.
Diet Multiple national and regional surveys (Gold et al.,
2007; Kristal et al., 2005; Palasuwan et al., 2011; Ross
et al., 2012) have linked yoga participation to healthy
dietary habits. However, this association was not observed
in a convenience sample comparing yoga novices to
experts (Kiecolt-Glaser et al., 2012), suggesting selection
rather than causal effects.
In a large sample of middle-aged adults, yoga practi-
tioners consumed greater energy (Kristal et al., 2005). In
the national survey of Iyengar yoga practitioners, nearly
10 % followed a vegetarian diet (no meat, ﬁsh, or poultry),
nearly four times the general US population (Ross et al.,
2013). A third nationally representative study found higher
rates of the beneﬁcial soy phytoestrogen genistein among
yoga practitioners relative to non-practitioners (Gold et al.,
2007). Data from a convenience sample of mind–body
practicing females in Thailand indicated that yoga practi-
tioners also consumed less fat than did those who were
sedentary or who practiced Tai Chi (Palasuwan et al.,
2011). Yoga practitioners reported consuming a signiﬁ-
cantly higher proportion of recommended servings from
each food group than did a comparison group of college
students (Monk-Turner & Turner, 2010). Compared to
runners and sedentary individuals, yoga practitioners were
signiﬁcantly less likely to eat meat (Satin et al., 2014).
Healthy dietary behaviors have been related to
frequency of yoga practice (Kristal et al., 2005;
466 J Behav Med (2015) 38:460–471
Ross et al., 2012) and longer practice duration (Kristal et al.,
2005). In the national survey of Iyengar practitioners, daily
fruit and vegetable servings were positively associated with
frequency of home practice and gentle and standing yoga
postures. More frequent practice of gentle postures, home
practice, and study of yoga philosophy were positively
linked to vegetarian status (Ross et al., 2012).
Exercise The HSE observed a lower likelihood of occu-
pational physical activity but higher non-occupational
moderate to vigorous physical activity among English yoga
practitioners when compared to non-practitioners in a
multivariable model (Ding & Stamatakis, 2014). Other
studies generally report positive associations between yoga
practice and non-yoga exercise. In a nationally represen-
tative study of US adults with medical conditions, 65 % of
yoga practitioners engaged in vigorous and 25 % in mod-
erate exercise, while 10 % were sedentary (Bertisch et al.,
2008). Studies of large regional and smaller convenience
samples suggest that yoga practitioners report higher rates
of exercise than do non-practitioners. In a large sample of
adults from the Northwestern US, yoga practitioners
engaged in substantially more non-yoga physical activity
than did non-practitioners (Kristal et al., 2005). A higher
percentage of yoga practitioners than college students
reported maintaining ﬁtness through exercise and weight
control and doing exercises to maintain range of motion
(Monk-Turner & Turner, 2010). Yoga practitioners have
also been found to exercise more than healthy controls or
ﬁbromyalgia patients (Bradshaw et al., 2012).
In a comparison of female aerobics and yoga class
participants from Poland and Canada, Polish yoga students
reported less exercise motivation in terms of weight man-
agement relative to all other groups, and yoga students of
both nationalities reported more exercise motivation for
stress management and positive health relative to both
aerobics groups (Zajac & Schier, 2011). In an Australian
sample of exercisers, yoga practice was inversely related to
exercise motives related to appearance, positively to
health/ﬁtness motives, and unrelated to mood/enjoyment
motives (Prichard & Tiggemann, 2008). Finally, yoga
practice was unrelated to physical activity rates or exercise
self-efﬁcacy in a convenience sample of older adults
(Kraemer & Marquez, 2009), but yoga practice frequency
related positively to levels of non-yoga physical activity in
a large sample of adults from the Northwestern US (Kristal
et al., 2005).
BMI and body weight In analyses of the 2002 NHIS
(Birdee et al., 2008; Bertisch et al., 2008) and HSE (Ding
& Stamatakis, 2014), national/regional surveys (Ross et al.,
2012,2013; Kristal et al., 2005), and convenience samples
(Desai et al., 2010; Palasuwan et al., 2011; Moliver et al.,
2011), yoga practitioners reported lower BMI relative to
non- practitioners. These ﬁndings have generally replicated
in the US convenience samples (Daubenmier, 2005; Desai
et al., 2010; Framson et al., 2009; Moliver et al., 2011) and
Thailand (Palasuwan et al., 2011). Among breast cancer
survivors, yoga use predicted lower BMI in multivariate
regression analysis (Desai et al., 2010). Three notable
exceptions failed to observe differences in weight or BMI:
yoga experts versus novices (Kiecolt-Glaser et al., 2012),
those practicing yoga for physical versus psychospiritual
reasons (Dittmann & Freedman, 2009), and walkers versus
yoga practitioners (Kraemer & Marquez, 2009).
Most studies indicate that yoga practice was linked to
lower BMIs and attenuated weight gain over time, but data
are unclear on selection versus causal effects. That is, yoga
may facilitate weight loss among the overweight, or people
of lower BMI may be more attracted to yoga practice.
Suggestively, in the national survey of Iyengar yoga
practitioners, frequency of yoga practice, yoga philosophy
study, home practice, and engagement in vigorous postures
each independently predicted BMI (Ross et al., 2012).
Mental health status
Disordered eating, body image, and related outcomes In
convenience samples, yoga practice is consistently linked
with body satisfaction. Compared to aerobic exercisers and
controls, yoga practitioners demonstrated greater body
awareness, responsiveness, and satisfaction and less self-
objectiﬁcation. Practitioners also had lower disordered
eating attitudes than did the aerobics group (Daubenmier,
2005). Higher body satisfaction was also observed among
women practicing yoga for psychospiritual relative to
physical reasons in a sample of yoga practitioners from the
Western US, although no differences were observed
between groups on body image issues (Dittmann &
Freedman, 2009). These ﬁndings are consistent with lower
body image dysphoria observed among Polish yoga prac-
titioners, compared to Canadian yoga practitioners and
Canadian and Polish yoga aerobic exercisers (Zajac &
Schier, 2011). In a Northeastern US sample, self-rated yoga
expertise was not related to satisfaction with body parts,
but did positively relate to body awareness and shape
(Delaney & Anthis, 2010).
Several studies have also linked length and frequency of
yoga practice to body and eating-related constructs. In yoga
practitioners from the Northeastern US, frequency of
practice was negatively related to objectiﬁed body con-
sciousness but unrelated to eating attitudes or satisfaction
with body parts. Additionally, length of time participants
J Behav Med (2015) 38:460–471 467
had been attending class positively with body awareness
(Delaney & Anthis, 2010). Less self-objectiﬁcation and
greater body satisfaction was linked with yoga experience
(weekly hours practiced and expertise) (Daubenmier,
2005). Similarly, amount of yoga practice was negatively
related to self-objectiﬁcation but unrelated to body esteem
or disordered eating in an Australian sample (Prichard &
Tiggemann, 2008). Frequency of practice also predicted
more positive bodily experience in new practitioners in
Holland (Lafaille, 1997). Finally, length and frequency of
yoga practice have been linked to higher mindful eating
scores (Framson et al., 2009).
Anxiety, depression, distress, subjective well-being, and
life satisfaction Data on mental health and subjective
well-being in relation to yoga is complex. In the 2002
NHIS, yoga practice was inversely related to general
mental health in the entire sample (Birdee et al., 2008) and,
in the subsample with medical conditions, was positively
linked to anxiety and depression (Bertisch et al., 2009). In
cancer survivors in the 2002 NHIS, yoga practitioners had
higher contacts with mental health professionals than did
non-practitioners (Fouladbakhsh & Stommel, 2010).
Convenience samples yield contradictory ﬁndings: In
the German medical patient sample, anxiety was positively
associated with yoga (Cramer et al., 2013a), but a follow-
up of the same sample comparing the sub-sample of yoga
practitioners to well-matched controls, no differences in
anxiety, depression, life satisfaction, or health satisfaction
were observed (Cramer et al., 2013a). Comparisons with
non-practitioners found lower anxiety among yoga practi-
tioners in India (Venkatesh et al., 1994), and lower tension-
anxiety, anger-hostility, fatigue, and overall mental dis-
turbance (but not depression or confusion) in Japan (Yo-
shihara et al., 2011). In the US, yoga practitioners had more
depression than did walkers (Kraemer & Marquez, 2009)
and sedentary individuals, but not runners (Satin et al.,
2014). With respect to dose, in Iyengar practitioners, fre-
quency of philosophy study and meditation positively
correlated with subjective wellbeing and lower fatigue
(Ross et al., 2012).
Relations between mental health and yoga are complex.
Some studies associated yoga practice with elevated rates
of mental health conditions, while others demonstrated the
opposite. Existing data are inadequate to determine whe-
ther relationships are due to initiation of yoga practice to
alleviate distress, yoga practice resulting in distress, or
some underlying third variable. Lending support to the
former, the 2002 NHIS found that one of the most com-
monly-cited reasons for yoga use was treatment of mental
health conditions (Birdee et al., 2008).
Stress These results indicate that yoga practitioners gen-
erally have higher HRQOL, although the samples on which
this conclusion is drawn are highly select. These ﬁndings
contrast with other studies showing higher levels of mental
and physical dysfunction in yoga practitioners. This dis-
crepancy may be due to the tendency of quality of life
measures to tap a subjective sense of satisfaction with
one’s status rather than an objective index of functionality
Health-Related Quality of life (HRQOL) Yoga practitio-
ners generally report better HRQOL. In a large, nationally
representative sample of breast cancer survivors in the US,
yoga practice was associated with higher physical HRQOL
but unrelated to mental HRQOL (Buettner et al., 2006).
The nationally representative HSE also indicated higher
self-reported health in yoga practitioners (Ding & Sta-
matakis, 2014). Consistent with these ﬁndings, a conve-
nience sample of middle-aged adult cancer survivors found
that those who practiced yoga had poorer mental HRQOL
than non-users, although physical HRQOL did not differ
between groups (Park et al., 2013), However, frequency of
yoga practice related positively to mental, but not physical,
HRQOL (Park et al., 2013). Among medical patients in
Germany, yoga practitioners reported better general health
status and higher physical HRQOL (Cramer et al., 2013b).
Finally, a convenience sample found Indian yoga practi-
tioners had better physical functioning, self-care, social
functioning, and cognitive functioning scores than non-
practitioners (Bankar et al., 2013).
These results indicate that yoga practitioners generally
have higher HRQOL, although the samples on which this
conclusion is drawn are highly select. These ﬁndings
contrast with other studies showing higher levels of mental
and physical dysfunction in yoga practitioners. This dis-
crepancy may be due to the tendency of quality of life
measures to tap a subjective sense of satisfaction with
one’s status rather than an objective index of functionality
Summary of physical and mental health of yoga practitio-
ners Findings in this area are contradictory. Yoga prac-
tice often relates to subjective variables such as HRQOL or
life satisfaction, yet also with higher levels of depressive
symptoms, anxiety, and physical impairment. However,
yoga practice favorably relates to most health behaviors.
The few studies examining length or frequency of practice
suggest that a stronger ‘‘dose’’ of yoga might be related to
better health and that cross-sectional studies demonstrating
inverse relations between yoga and health may reﬂect
468 J Behav Med (2015) 38:460–471
turning to yoga in a search for relief from speciﬁc health
In spite of the hundreds of published empirical studies of
yoga, only 55 studies reported correlates of yoga practice
in naturalistic contexts. Of these, a number of nationally
representative studies (of the US and England) have
reported on sociodemographics and health; far fewer have
examined psychosocial correlates, and of these, most used
very select samples, limiting generalizability. In aggregate,
these studies have shown that yoga practitioners are gen-
erally White, of upper socioeconomic status, and middle-
aged. There is evidence of higher levels of mindfulness and
spirituality and lower levels of conventional religiousness.
Yoga use relates to better life satisfaction and HRQOL but
inversely to some indices of physical and mental health.
However, upon closer scrutiny, these studies provide lim-
ited meaningful information on correlates of yoga aside
from basic demographics. The largest and most represen-
tative studies have dichotomously assessed whether
respondents ‘‘use yoga’’ (yes/no) rather than assessing
characteristics of that use (e.g., length, frequency, type of
yoga). Such studies illustrate demographic correlates, but
are less helpful in understanding other important issues,
such as how yoga practice relates to well-being. Smaller
and less representative studies have included a heteroge-
neous array of psychosocial characteristics, limiting
aggregation. Most studies are cross-sectional and report
bivariate relations rather than controlling for potential
confounds. Magnitude of associations between yoga prac-
tice and other variables are often reduced or disappear
when accounting for education or income (Birdee et al.,
2008). Large national studies, which often do control for
demographics, assess yoga use dichotomously and include
few psychosocial variables, and are thus minimally infor-
mative regarding causal models.
Our summary produced a muddy picture not wholly
consistent with intervention research, which may be due to
the many reciprocal inﬂuences of yoga use and well-being.
For example, people commonly begin a yoga practice for
health problems (Birdee et al., 2008). Yoga may be
effective only if practiced regularly; dichotomous measures
capture both regular practitioners and those who tried yoga
once. Mental and physical health problems are often
comorbid, so seeking relief from physical conditions may
partly account for inverse relations with well-being. People
who resolve a particular health condition may discontinue
practice while those with ongoing health problems may
continue to practice. Such complex relationships call
for more complex research methods. The few studies
examining yoga characteristics such as frequency or prac-
tice length suggest that yoga may lead to better health over
time, consistent with much intervention research (e.g.,
Field, 2011). Also encouraging are studies that examined
yoga in a more sophisticated way. Ross et al. (2012,2013)
is exemplary in measuring many components of yoga
practice (e.g., home and class practice; yoga philosophy,
breathwork, meditation, intensity of postures). Many
important questions remain, such as what factors that lead
people to practice yoga or dissuade them from it, or keep
people practicing over time? How do different aspects of
practice relate to physical and mental health? This sum-
mary can serve as a springboard for future research and a
resource for designing and implementing interventions.
Conﬂict of interest Crystal L. Park, Tosca Braun and Tamar Siegel
declare that they have no conﬂict of interest.
Human and Animal Rights and Informed Consent All procedures
followed were in accordance with ethical standards of the responsible
committee on human experimentation (institutional and national) and
with the Helsinki Declaration of 1975, as revised in 2000. Informed
consent was obtained from all patients for being included in the study.
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