Hair and Scalp Care in African American Women Who Exercise

There are notable disparities in physical activity (PA) levels among different racial and ethnic groups.¹ African American women comprise a population that deserves special focus because non-Hispanic black women participate in less PA than any other racial or ethnic sex group, yet have the highest prevalence of obesity and obesity-related conditions.^2-4 In a previous study by Hall et al,⁵ 38% of black women avoided exercise at times owing to hair-related issues, and 50% modified their hairstyle to accommodate exercise. This present study sought to survey physically active black women to determine the most common hair care practices used to accommodate exercise, and provide recommendations for ideal regimens for hair and scalp care during and after exercise.

A 70-item questionnaire was administered to women at the completion of a 12-week community PA program consisting of biweekly seminars and group exercise sessions. The study was approved by the Wake Forest Baptist Health institutional review board. Written informed consent was obtained from all participants and they were not compensated for participating. Inclusion criteria included female sex, age of 21 to 75 years, and self-reported African, African Caribbean, or African American race. The questionnaire included sections on demographic information, hair- and scalp-related symptoms, hairstyles worn, and hair care in relation to PA. Descriptive statistics were performed using SAS statistical software (version 9.3; SAS Institute Inc). Analysis was performed from July 1 to December 22, 2015.

Sixty-one women participating in a community PA program were included in the study. The mean (SD) age of participants was 52.3 (8.8) years. Most women classified their hair as normal (64%) or dry (29%). The most common symptoms were scalp itching (52%), hair breakage (41%), and scalp flaking (21%). Most women used over-the-counter (36%) or salon products (28%) to treat symptoms. Only 5 women used prescription topical or oral medications for hair- or scalp-related issues. Most participants washed their hair every 1 to 2 weeks, owing to dirtiness (47%), itchiness (33%), and dryness (16%). No significant differences were noted between women with self-reported dry or normal hair in the frequency of hair washing, hair and scalp symptoms, or hairstyles worn.

The most common hairstyles were natural and relaxed (46%). Nearly one-third of women modified their hair to accommodate exercise with natural hairstyles or braids. To preserve their hair during exercise, women wore a ponytail or bun (38%) or a scarf or hair wrap (31%). After exercise, women used these same hairstyles to style the hair with the most ease or did not style their hair (46%). The Table has more details.

Most women (69%) did not experience worsening of hair or scalp symptoms with PA, but 18% of women stated that they exercised less than they would like because of their hair, because of sweating out hairstyles (18%) and the time needed to restyle hair (13%).

This study surveyed women participating in a PA program, and thus sheds light on the experiences of physically active women. Scalp itching and hair breakage were common complaints and were largely treated with over-the-counter products. Dermatologists may provide a meaningful intervention by evaluating for and treating these symptoms. The Figure demonstrates basic components of an ideal hair care regimen for physically active women, based on their main hair or scalp issues. Even among physically active women, 18% exercised less than they would like because of their hair, but almost half of the women did nothing specifically to preserve their hair during exercise. This may be due to the high percentage of women wearing their hair in natural styles in this study. In our previous study,⁵ older women tended to wear their hair in natural styles compared with younger women. Natural styles may allow for greater flexibility with exercise as long as maintenance routines are minimal. Future studies can further explore which hairstyles are best for preservation during exercise and a detailed postexercise management regimen, such as dry shampoos or other products.

Accepted for Publication: January 17, 2016.

Corresponding Author: Amy J. McMichael, MD, Professor and Chair, Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Rd, Winston-Salem, NC 27104 (amcmicha@wakehealth.edu).

Published Online: March 9, 2016. doi:10.1001/jamadermatol.2016.0093.

Author Contributions: Drs Ahn and McMichael had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Ahn, Suchonwanit, Smith, McMichael.

Acquisition, analysis, or interpretation of data: Ahn, Suchonwanit, Foy, McMichael.

Drafting of the manuscript: Ahn, Smith, McMichael.

Critical revision of the manuscript for important intellectual content: Ahn, Suchonwanit, Foy, McMichael.

Statistical analysis: Ahn.

Administrative, technical, or material support: Ahn, McMichael.

Study supervision: McMichael.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We would like to thank Marion Anderson-Booker, BS, and Cynthia Williams Brown, PhD, both from the Department of Human Performance & Sport Sciences, Winston-Salem State University, for allowing the administration of the survey at the completion of their program. They were not compensated for their contribution.