The Spiritual Care of Patients in Exercise Physiology
Tommy Boone, PhD, MPH, FASEP, EPC
Professor and Chair
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811

“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.”  [1]

Despite the fact that many exercise physiologists have spiritual needs and are obligated to care for their own spirituality, they have historically embraced the physical concerns of their clients in fitness and/or rehabilitation programs.  This is also true with other healthcare professionals.  For example, nurses have written of their neglect of the spiritual needs of their patients [2].  Yet, in today’s world, this is hardly acceptable.  It does not matter whether the person is sick in a hospital bed or walking in a cardiac rehabilitation program, spiritual needs are real.  People want to feel there is hope and meaning to life.  Exercise physiologists must be aware of the spirituality dimension of care.  It is integral to total healthcare, and it is consistent with the 21st century view of exercise physiologists as healthcare professionals.

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 [3, 4].  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 is “…an example of violating the nonmaleficence principle of ethics.” [5]     

Just as it is expected that an exercise physiologist would put aside personal beliefs about the role of exercise in cancer care (or some other disease), s/he would care for the patient in accordance with accepted professional practice.  This is exactly the professional role of the exercise physiologist when it comes to helping the patient find hope and meaning in rehabilitation, even if the exercise physiologist has different personal beliefs and values.  Confidentiality between the exercise physiologist and the patient is a standard legal concept.  Conversations about all aspects of the patient’s life are privileged and therapeutic to help the patient during rehabilitation.  The issue of trust is critical to the professional-patient relationship [2].   

Few would doubt that spiritual care is an important part of the patient’s total care.  A student interested in learning about spirituality and health may ask:  “Are there any scientific studies of spiritual care in exercise physiology?”  It is very likely that the student would benefit from such studies.  A good intellectual background for thinking about the 21st century exercise physiologist requires an understanding of religious teachings.  Here, the reader may ask:  “But, isn’t exercise physiology all about oxygen consumption, sports training, and research?”  In other words, what does the research oriented exercise physiology perspective have to do with religion and health matters?  This may be exactly the problem faced by exercise physiologists.

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.  

As new students tackle the place of exercise physiology in spiritual matters, they will learn of the timeless interconnectedness between the mind and the body.  Seldom has this topic been approached by exercise physiologists, yet there are reasons both proven and believed that need scientific analysis.  The brave new world of the American Society of Exercise Physiologists is charged with the responsibility to capture the depth and creativity of all exercise physiologists as new, critical thinkers.  Knowledge and experience about spiritual care are important to the total well being of the patient.  The argument, therefore, that the scientific study of spiritual care should be a planned part of the students’ education is not difficult.  Its simplicity is linked to exercise physiology in the spiritual insights that bear directly on the health and welfare of the public.  

Exercise physiology is no longer about just physiology, as it was defined by exercise physiologists of the past several decades.  The truth is that the ASEP perspective [6] has changed the meaning of exercise physiology.  It is better to think of exercise physiology as a profession of different individuals with different academic degrees, although there is only one entry level.  Hence, today, it is no longer true that only the PhD person can call him- or herself an exercise physiologist.  The ASEP Board of Certification is evidence for all to see that a person with an undergraduate degree in exercise physiology can refer to him- or herself as an exercise physiologist.  For some, of course, this is a serious disappointment.  For others, it is progress.  Among those who are attracted to the new thinking that has evolved from the ASEP leadership [7], they are not limited by the past thinking [8].  It is therefore easier for them to draw the conclusion that spiritual care is also part of the total care of exercise physiologists.   

For more information about exercise physiologists as spiritual advisors, refer to the PEPonline, November 2003 article [1].  Exercise physiologists who educate their students to the importance of the integration of spiritual issues in rehabilitation can think of themselves as holistic healthcare professionals.  Those who do not should think of themselves are exercise specialists or fitness instructors.  The ethics of less than an academic education to access the exercise physiology title should be evaluated.  Exercise physiology cannot stay locked in the past.  Groupthink is never a good idea [9].  Fortunately, the emerging focus on the holistic care of patients continues to reinforce the role of exercise physiologists as providers of spiritual care.   
 

References
1. Boone, T. (2003). Spirituality, Faith, and Exercise Physiologists as Healthcare Professionals.  Professionalization of Exercise Physiologyonline. 6:11:1-5 [Online]. http://www.asep.org/asep/asep/SpiritualityFAITHexercisePhysiologists.html
2. Wright, K.B. (1998). Professional, Ethical, and Legal Implications for Spiritual Care in Nursing. Image: Journal of Nursing Scholarship. 30:1:81-83.
3. Reed, P.G. (1986). Religiousness in Terminally Ill and Healthy Adults. Research and Nursing and Health. 9:35-41.
4. Stiles, M. (1990). The Shinning Stranger: Nurse-Family Spiritual Relationship. Cancer Nursing. 13:235-245.
5. Pettigrew, J. (1990). Intensive Nursing Care: The Ministry of Presence. Critical Care Nursing Clinics of North America. 2:3:503-508.
6. Boone, T. (2002). Exercise Physiology of the Future: Thinking Out of the Box. Professionalization of Exercise Physiologyonline. 5:11 [Online]. http://www.asep.org/asep/asep/ThinkingOutsideTheBoxExercisePhysiology.html
7. Boone, T. (2003). The COURAGE to QUESTION What is Exercise Physiology in the 21st Century. Professionalization of Exercise Physiologyonline. 5:1 [Online]. http://www.asep.org/asep/asep/COURAGEtoQUESTION.html
8. Boone, T. (2003). You Are Not a Healthcare Professional. Professionalization of Exercise Physiologyonline. 6:12 [Online]. http://www.asep.org/asep/asep/ExercisePHYSIOLOGISTasHEALTHCAREprofessional.html
9. Boone, T. (2004). Indifference to Professional Standards is Irresponsible Behavior. Professionalization of Exercise Physiologyonline. 7:2 [Online]. http://www.asep.org/asep/asep/IndifferenceToProfessionalStandards.html