IntegratingSpirituality

To many exercise physiologists, they are likely to think I’m off my rocker. Spirituality is confusing enough, and I’m suggesting exercise physiologists ought to include spirituality in their work. Well, that is exactly what I’m suggesting. Why? Because, as Viktor Frankl said, “The spiritual dimension cannot be ignored….” Yet, this is the point, especially given the ASEP perspective that exercise physiologists are healthcare professionals.

Healthcare is more than athletics or fitness. It concerns itself with the three dimensions Viktor Frankl identified, “…the somatic, the mental, and spiritual.” Obviously, exercise physiologists deal with the somatic and, yes, even the mental is accounted for (although not as well as the body dimension). It is the spiritual dimension that exercise physiologists overlook when caring for clients. Perhaps, they don’t do so intentionally. Rather they do not know that it is their right, if not, the responsibility of professionals who work to heal the whole of man (and woman) to deal with the spiritual.

While it is true that traditional exercise physiology programs, few as there are, given that most are exercise science or kinesiology programs of study, have ignored the opportunity to do something about the spiritual dimension, it doesn’t always have to be this way. It is rather important that exercise physiologists focus on the “beginning” steps of implementation in the academic setting and the significance of the spiritual dimension and what it brings to the client’s health in the public sector.

None of this is foolish thinking, as Frankl pointed out in his 1983 book. As healthcare professionals, exercise physiologists must keep open to the idea of treating the total client. In fact, as Bolletino [1] pointed out in Advances in Mind-Body Medicine, extraordinary work has been done in recognizing the importance of integrating religion with psychology. This is also true with the integration of spirituality with nursing [2-5]. Less has been done in exercise physiology, although two articles were published in the Professionalization of Exercise Physiologyonline in 2003 [6] and in 2004 [7]. The following is a quote from the 2003 paper:

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). 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, 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.

Without commitment to the spiritual dimension of healing, the question is: “What kind of healthcare professionals do exercise physiologists want to be?” The answer to this question is rather obvious, given the non-spiritual tradition of professional exercise physiology. This is partly the focus of the 2004 [7] article published in the PEPonline journal:

The public has come to think of exercise physiology as a scientific foundation of published works to help athletes jump higher, run faster, and get stronger. Well, while these objectives are important, athletics per se is just one of four major areas of education and career options. Health, fitness, and rehabilitation complete the picture, and scientific research and critical thinking are the foundation of each of the four. The trouble with the 20th century view of exercise physiology is the imposed nature of work only within athletics (e.g., strength, conditioning, and performance). The public is yet to understand the exercise physiologist as a healthcare professional. Properly conceived, it allows for the integration of science with the communication of hope and meaning to spiritual experiences. This thinking is particularly relevant given the interconnectedness of the mind and body. Spiritual care is at the center of psychophysiology, if not the very essence of mind-body health. The therapeutic effects of spirituality are well documented. Yet, despite a long history of society embracing a spiritual dimension of life, many professionals do not feel they have the skills to provide spiritual care. They understand how to restore the physical dimension of their work. Some are even comfortable with discussing a limited number of mental and emotional concerns. Talking about spiritual matters is difficult, however. Without nurses or other healthcare professionals to embrace the spiritual dimension of care, it is imperative that exercise physiologists take the lead. In fact, it is very likely an ethical obligation since it is recognized that spiritual care benefits patients. Since “care” is now a holistic expression, the reluctance to care for the patient’s spirituality may be viewed as a violation of the nonmaleficence principle of ethics.

Perhaps, at this point it would be useful to acknowledge the differences between religion and spirituality. And, I might add that the description by Bolletino [1] is likely the best I’ve read lately. For example, “Spirituality and religion are not the same. Spirituality is the basis or core of religion; religion is the systemization or codification of spirituality…religion can, and often does, exist without spirituality. While spirituality sometimes takes the form of a religious commitment, it can, and often does, exist without religion. While there are a variety of religions, spirituality is common to all human beings.”

Embedded in the content of mind-body medicine is the notion that the client’s beliefs can influence their health. However, there is an important distinction between a person creating cancer and a lifestyle that increases the statistical incidence of cancer. Exercise physiologists ought to help clients understand that they didn’t cause, for example, cancer from their emotional problems, personality characteristics, or the trauma they experienced while growing up [8]. As Bolletino [1] says, “This idea that we are responsible for our illness is often used against people who are ill and by people who are ill against themselves.”

Today, it is well understood that disease and illness are multifactorial in origin. It is not as simple as failing to handle stress at one’s work and, then, cancer pops up next week. There are genetic factors, psychological factors, environmental factors, and factors beyond our present knowledge that trigger some type of cancer but doesn’t in another person who requires a different combination of factors to act together to cause cancer.

Clients, who are often patients as well, should not have to carry the burden that they caused their disease. This idea is simply wrong, and is bad medicine. Similarly, it isn’t a good idea to teach clients or patients to “get beyond” (i.e., deny or suppress) their feelings (emotions). Putting aside feelings regarding a heart attack and what it means to the patient’s personal life is not the same as dealing with the feelings. Here, dealing with the feelings is “the” essential function of acknowledging one’s lost of strength and energy, the burden on one’s family, the sadness and even grieving that takes places with the diagnosis.

Unfortunately, many students of “exercise physiology” do not get a solid education in the behaviors and attitudes that run the course with patients in cardiac rehabilitation programs. The scientific basis for this type of study for exercise physiology students has emerged from the recent founding of the American Society of Exercise Physiologists. As we learn more about the overall importance of an accredited academic program for exercise physiology, as has undoubtedly been known for decades in other healthcare professions, an explosion of interest in interdisciplinary education will not only be justified but required as well.

This is a powerful expectation, if not a vision. Sad to say, until more academic exercise physiologists get on board with the ASEP message, it will be a fairly slow process though. In truth, it is just a matter of time (however it may take). There is no need to worry about what is already 21st century reality. In other words, there is no reason to worry about something that already exists.

Worry isn’t a concern within the leaders of the ASEP organization. Growth and full acceptance of the ASEP principles and concepts will follow. Each day has enough challenges of its own. So, what is critical is the client’s growth and health as an integrated human being. That is, exercise physiologists should be more concerned about the health of the whole person. The health of the organization will take care of itself.

In summary, it is the thesis of this article that the use of “exercise as medicine” requires bringing spirituality into the practice of exercise physiology. Although we may not realize it yet, both are inextricably entwined. This changes the traditional focus and thinking of exercise physiology from exercise for fitness or athletics only to exercise as medical treatment -- a 21st century treatment that is mind-body medicine. This is critical in dealing with disease, given the client’s increased sense of meaning and purpose in life that spirituality brings to it.

Finally, the importance of this topic cannot be overestimated. It is perhaps one of the more inseparable parts of our lives, even with the clash of cultures and values. And, even though spirituality is a personal practice, it has huge professional implications in healthcare. This distinctive point is profound and sobering because every healthcare professional has the client’s interest and welfare at heart.