Professionalization of Exercise Physiologyonline       


ISSN 1099-5862   Vol 6 No 11  November 2003 
 

Spirituality, Faith, and Exercise Physiologists as Healthcare Professionals
Tommy Boone, PhD, MPH, FASEP, EPC
Professor and Chair
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811
 

“Since it doesn’t cost a dime to dream you’ll never short-change yourself when you stretch your imagination.”  
-- Robert Schuller

Traditional exercise physiology is all about jumping higher, running faster, and getting stronger.  It’s not that these are not good goals, but they are a bit shallow as the backdrop to a healthcare profession.  The 21st century exercise physiologist is a member of a new profession, one that is emerging on behalf of the healthcare issues and concerns that face all members of society.  No one is immune to health related concerns.  And, it is clear that the health of the individual is seldom an event separate from society.  Every person needs the encouragement to develop positive beliefs, attitudes, and behaviors just as all nations must work together to help improve global health.

For the past several decades, exercise physiologists have played a critical role in the rehabilitation of heart patients.  Their key role has predominately been in the areas of graded exercise testing, exercise prescription, and education.  Perhaps the biggest challenge is not the aftermath of the disease itself, but the building of the patients’ health from several dimensions.  In other words, the rehabilitative process generally sets the stage for increased efficiency in physical performance.  Yet, factors such as gender, educational level, income, race, ethnicity, cultural customs, sexual orientation, and religious beliefs are seldom evaluated with equal intensity in promoting healthier behaviors.
 

“Health is a delicate balance of physical, psychological, sociocultural, and spiritual dimensions.” 
-- William T. Boone, Jr.

Helping patients to stop smoking is a developed understanding of the students’ education along with physical and social changes.  The ultimate goal is to improve health and quality of life.  The idea is that a successful rehabilitation program helps patients increase their general sense of happiness and satisfaction.  This is another reason that exercise physiologists should be considered healthcare professionals.  Achieving a better life following a myocardial infarction is not always expected but, when it is a measured-reality, the increased opportunities result more from a holistic educational plan than from a career defined by palpating heart rates.

Even though the disease defines the patients’ limitations, increased physical activity and higher rates of optimism often result from an integrated rehabilitation.  This interaction between physical health problems and mental behaviors is good.  The hopeful end result is a better and more active lifestyle, which may prevent or postpone further development of coronary artery disease.  The key word is "hopeful" because both the individual and the disease are complicated entities.  However much healthcare professionals would like to predict factors that correlate with disease and certain behaviors, preventing the development of a specific disease is a risky business.  There are simply too many interactions to account for, and the presence of unknown factors makes the attempt even more challenging if not  essentially impossible at the present time. 

While there are powerful and positive professional-patient policies and interventions that are well recognized, it may be more reasonable to plan for quality of life than out-right prevention (even from a second heart attack).  The determinants of health are mixed.  Many are too unique for our understanding much less a planned implementation.  Our ideas and understanding of coronary artery disease are growing, however.  For example, a very interesting picture is emerging that “spiritual well-being” has a positive and profound effect on the health of individuals and communities.  The purpose of this article is to lay out several basic and important steps to helping exercise physiologists, as healthcare providers, to bridge the gap between monitoring heart rates and increasing the quality and years of life by meeting the patient’s spiritual needs.

Spirituality, Faith, and Well-Being
It is very likely a new idea that exercise physiologists should care for the patient's state of mind as well as his or her physical body.  Understanding mind-body interconnectedness is critical to a patient's success in a rehabilitation program.  Exercise physiologists cannot rely solely on their education, particularly if the course work does not plan for the spiritual needs and values of their clients.  Burkhardt [1] states that spirituality is a belief in some higher power or divine being, which includes finding meaning (purpose) in life, drawing upon inner strength, and having a feeling of being connected with a Higher Being or God.

The spiritual dimension of individual patients will vary in a cardiac rehabilitation program just as any cross section of individuals from the larger society would have different spiritual expressions of their beliefs and faith in an organized system of worship.  Some patients will doubt the existence of God (agnostic), others will deny the existence of God (atheist), and still others will believe in God who created the universe (monotheism) [2].  It will not always be easy to deal with the patient’s spiritual needs.  It will require sensitivity, education, and empathy.  None of the three is taught to exercise physiology students.  This is also the case with sexuality issues that associate with coronary artery disease [3], but it isn’t impossible to make the transition from being predominately a technician to a healthcare professional.

Many patients, if not most, need faith in something that they will get better.   Exercise physiologists can help patients, especially when it is obvious that they are having a bad day.  Sharing thoughts and feelings about spirituality and faith should have a positive effect on the patient's well-being.  Patients want to get better and, often times, they need someone to talk to, to share their feelings, and to express feelings of hope (i.e., things will get better).  Commitment to the program and its sense of community provides patients with the strength (or faith) to keep going.  In other words, faith is critical to the patient's success.  Faith in the staff and the training comments and supervision by the exercise physiologists is very important.  Spiritual faith is similar; although it represents a belief in something that cannot be proven.  Faith in God has a spiritual connection that gives patients the strength and power to survive and the feeling that everything will be okay in the long run.  Hope is directly a result of the patient’s faith; both keep the patient alert, awake, and engaged in behaviors that are likely to hasten mind-body rehabilitation [4, 5].

The Exercise Physiologist: A Spiritual Advisor
Exercise physiologists can help with the patient’s spiritual well-being through planned discussion at the individual level or within small groups to nurture the patient’s beliefs and expressions of spirituality.  Simply by speaking with a patient who is at his or her breaking point, the exercise physiologist helps by providing hope and sustainability.  Not all graded exercise test results, day-to-day exercise sessions, and life’s interactions will be easy following a myocardial infarction.  Continued physiological problems will often and unexpectedly knock the air out of the patient’s desire to laugh or to find reason to work or to go on.  This is why it is so important that exercise physiologists get involved with the patient’s total healthcare.  It may be simply the opportunity to speak about one’s spiritual beliefs, the meaning of life, death, or the mental and/or emotional suffering from associates with coronary artery disease.  Other opportunities include moments when the patient is discouraged or has mixed feelings about continuing in the program for fear that there is no hope. 

As healthcare professionals, exercise physiologists are responsible for open dialogue about issues that may influence the patient’s performance.  For example, expressions of anger or resentment need to be understood for what they are and how each may negatively influence the rehabilitative process.  By no means should an exercise physiologist perform the role of a psychologist.  This is not the intention of this article.  But, under no circumstances is the expression of a person’s spiritual energy defined legally or professionally by a specific group of individuals.  Each of us should be available to help with spiritual issues, prayer, meditation, and reasons for living.  Prayers, in particular, may be exactly what a patient needs to refocus his or her energy towards better health or freedom from pain and suffering.  Other spiritual needs can be ascertained either by open discussion between the exercise physiologist and the patient or by a general spiritual assessment.  The data can be used to organize opportunities to talk about possible interventions to helping patients understand their feelings about spiritual obligations, restoring inner resources, connecting with family members, establishing communications with other patients with similar circumstances, and promoting a positive mind-body condition for better health.

The greatest opportunity to help with spiritual needs is during the exercise sessions.  Being with the patient when he or she needs clarification of beliefs and values is immediate feedback.  It also demonstrates the willingness to share, to listen, and to touch others.  Carson said it best, “Presence itself touches the client’s spirit, just as a cool hand might soothe a fevered brow.” [6, p. 165]  The fact is that many patients don’t have a lot of contact with other individuals outside of a rehabilitation session.  Where possible, exercise physiologists ought to connect at a compassionate level for all human beings.  Everyone has issues with anxiety, fear, and guilt.  Some feel that they may have caused the disease or heart attack.  It isn’t true of course, and they need to be educated to that fact. 

Praying with Patients
When the opportunity arises when a patient should ask an exercise physiologist to pray with him or her, there are several guidelines outlined by Carson [6, p. 169] in 1989, but more recently published in Kozier and colleagues [2].   First, identify the moment for what it is (i.e., the chance to bring the power of prayer into the mental and physical healing of the patient).  Second, ask the patient about his or her praying.  Is there a particular prayer more comforting with personal and/or family significance?  Third, refer to the patient’s concerns in the prayer.  Help relieve the patient’s fears and encourage strength and hope that everything will be okay.  Words that address peace, comfort, understanding, and strength are important. Fourth, share with the patient that his or her concerns and feelings will be remembered in prayers throughout the day and during private times. Fifth, allow for a period of time after praying to talk and work through concerns and needs.  Sixth, encourage the patient’s feelings about his or her spiritual relationship, religious practice, and insight into spiritual health.  Seventh, where indicated and/or appropriate, refer the patient to the program’s psychologist and/or religious counselor.  Every cardiac or cardiopulmonary rehabilitation program should have on staff a religious counselor to encourage the integration of spiritual issues in the rehabilitation process and to work with patients with spiritual distress. 

Summary
Exercise physiologists who avoid the spiritual dimension of health cannot be holistic healthcare professionals.  For additional reading and study on this subject, refer to “The Power Within” book for a demonstrated integration of mind-body interconnectedness [7]. 
 

“It takes faith to touch somebody you don’t know.” – Robert H. Schuller 

References
1. Burkhardt, M. (1993). Characteristics of Spirituality in the Lives of Women in a Rural Appalachian Community. Journal of Transcultural Nursing. 4:12-18.
2. Kozier, B., Erb, G., Berman, A.J., and Burke, K. ( 2000). Fundamentals of Nursing: Concepts, Process, and Practice. Sixth Edition. Upper Saddle River, NJ: Prentice Hall Health., p. 221.
3. Boone, T. (1990). Sexual Issues and Research in Counseling the PostMyocardial Infarction Patient. Journal of Cardiovascular Nursing.  4:65-75.
4. Ellison, C.W. (1983). Spiritual Well-Being: Conceptualization and Measurement. Journal of Psychology and Theology. 11:330-340.
5. Pilch, J.J. (1988). Wellness Spirituality. Health Values. 12:28-31.
6. Carson, V.B. (1989). Spiritual Dimensions of Nursing Practice. Philadelphia, PA: Saunders.
7. Boone, T. (2003   ). The Power Within. [Online]. http://www.thepowerwithin.org/