Identified themselves as practicing yoga at 15 months postintervention, most reported the

Identified themselves as practicing yoga at 15 months postintervention, most reported the integration of yoga elements into their I-CBP112 site everyday life up to 20 months postintervention, adapting particularly meaningful aspects of yoga to fit their needs and lifestyles. What remains unclear is the attainable benefit resulting from the integration of yoga elements as opposed to consistent yoga practice, whether MG516 web privately or in a group. Limitations The current qualitative study findings were based upon 13 participants, which is a small sample with limited generalizability. However, as described earlier, qualitative research is more concerned with trustworthiness than generalizability to other populations.33,34 Stratified purposive sampling based on reported duration of postintervention yoga practice was intended to separate yoga maintainers from nonmaintainers, a difficult task because many individuals had integrated aspects of yoga into their lives, although they reported having stopped yoga months earlier. The measurement of yoga practice may have contributed to this problem; a dichotomous yes/no response limited participant options for description. Moreover, there was no clear distinction between personal yoga practice and group yoga practice on the questionnaire, although the difference between the two became obvious during the interviews. Another limitation of this purely qualitative study is that there was no concurrent examination of objective diabetes-related clinical outcomes, such as A1C. Studies have indicated that improved clinical outcomes may motivate behavior change.37 It is possible that improved A1C values, for example, could enhance motivation for yoga practice, if individuals attribute such improvement to yoga practice. However, the long-term influence of this motivation is uncertain. Implications for Practice Iyengar yoga and other forms of gentle yoga may be an ideal fit for individuals with diabetes or prediabetes who want to increase their physical activity level and their ability to manage stress. However, findings from the current study indicate that maintaining yoga practice presents a challenge similar to that of other forms of lifestyle change. As such, it would be beneficial for diabetes educators to discuss potential maintenance strategies with individuals who express interest in yoga practice. Based on the findings from this study, such strategies would include making arrangements for continued yoga instruction, obtaining the accountability and support of a significant other, and integrating yoga into the established daily routine. Implications for Research Findings from this study underscore the need for further research designed to enhance the long-term maintenance of yoga practice for optimal promotion of health and prevention of disease. While evidence supporting the efficacy of yoga for diabetes prevention and control will likely continue to expand, the other cornerstones of research necessary for translation to practice–namely, the reach, adoption, and maintenance of a given intervention–are relatively scarce in the health literature.38,39 The design of future studies could include sampling among naturally occurring groups of varying sizes, such as significant other dyads, multigenerational families, neighborhoods, or church congregations. Likewise, a select number of participants could receive additionalDiabetes Educ. Author manuscript; available in PMC 2011 July 22.Alexander et al.Pagetraining and resources.Identified themselves as practicing yoga at 15 months postintervention, most reported the integration of yoga elements into their everyday life up to 20 months postintervention, adapting particularly meaningful aspects of yoga to fit their needs and lifestyles. What remains unclear is the attainable benefit resulting from the integration of yoga elements as opposed to consistent yoga practice, whether privately or in a group. Limitations The current qualitative study findings were based upon 13 participants, which is a small sample with limited generalizability. However, as described earlier, qualitative research is more concerned with trustworthiness than generalizability to other populations.33,34 Stratified purposive sampling based on reported duration of postintervention yoga practice was intended to separate yoga maintainers from nonmaintainers, a difficult task because many individuals had integrated aspects of yoga into their lives, although they reported having stopped yoga months earlier. The measurement of yoga practice may have contributed to this problem; a dichotomous yes/no response limited participant options for description. Moreover, there was no clear distinction between personal yoga practice and group yoga practice on the questionnaire, although the difference between the two became obvious during the interviews. Another limitation of this purely qualitative study is that there was no concurrent examination of objective diabetes-related clinical outcomes, such as A1C. Studies have indicated that improved clinical outcomes may motivate behavior change.37 It is possible that improved A1C values, for example, could enhance motivation for yoga practice, if individuals attribute such improvement to yoga practice. However, the long-term influence of this motivation is uncertain. Implications for Practice Iyengar yoga and other forms of gentle yoga may be an ideal fit for individuals with diabetes or prediabetes who want to increase their physical activity level and their ability to manage stress. However, findings from the current study indicate that maintaining yoga practice presents a challenge similar to that of other forms of lifestyle change. As such, it would be beneficial for diabetes educators to discuss potential maintenance strategies with individuals who express interest in yoga practice. Based on the findings from this study, such strategies would include making arrangements for continued yoga instruction, obtaining the accountability and support of a significant other, and integrating yoga into the established daily routine. Implications for Research Findings from this study underscore the need for further research designed to enhance the long-term maintenance of yoga practice for optimal promotion of health and prevention of disease. While evidence supporting the efficacy of yoga for diabetes prevention and control will likely continue to expand, the other cornerstones of research necessary for translation to practice–namely, the reach, adoption, and maintenance of a given intervention–are relatively scarce in the health literature.38,39 The design of future studies could include sampling among naturally occurring groups of varying sizes, such as significant other dyads, multigenerational families, neighborhoods, or church congregations. Likewise, a select number of participants could receive additionalDiabetes Educ. Author manuscript; available in PMC 2011 July 22.Alexander et al.Pagetraining and resources.