A Christian Perspective on Returning to Health and Wellness
Lacie Webb, PT, DPT1
Physical Therapist, SporTherapy
Colin G. Pennington, PhD
Assistant Professor, Tarleton State University – Fort Worth
Abstract: Religion, medicine, and healthcare are related. Research states that religiosity and spirituality have a positive effect on a patient’s health. There is a high belief in God in the United States, but clinicians are not inquiring about religion and spiritual aspects in patients’ healthcare today as patients would prefer. In the case of some physical therapy preparatory programs, the concepts of health and Christ-like values are related, if not, dependent on one another. This sparks intrigue into research exploring the intersectionality between faith, spirituality, and physical recovery. The purpose of this article is to (a) discuss what the medical and physical therapy community states are their broad missions and where those missions overlap with faith, (b) provide examples in the literature where faith and the pursuit of health have been connected and successful in terms of positive healing, and (c) express the benefit of spiritually-charged preventative health and physical therapy returning to healthcare.
Keywords: Physical Therapy, Faith Intervention, Occupational Therapy, Spirituality, Physical Activity.
Statement of Original Unpublished Work: By submitting this document to the Editor in Chief of CJSCF I am making a Statement of Original Unpublished Work not submitted to another journal for publication.
Religion, medicine, and healthcare have all been related in one way or another in all population groups since the beginning of recorded history (Koenig, King and Carson 2012). The departure from the history of linking health, religion, and spirituality is currently taking place in most cultures. This departure has been particularly prevalent in American culture for a number of decades. Research denotes that the religious and spiritual practices and beliefs of patients are powerful factors in coping with serious illnesses, making ethical choices about treatment options and decisions about end-of-life care (Puchalski 2001; McCormick et al. 2012). In a collection of 2013 polls, 56% of individuals asked claimed that ‘religion is important in their own lives’ and 22% stated that religion is ‘fairly important’ (Gallup 2013). It is shown that, in the United States, 77% of medical patients would like to have their spiritual issues discussed as a part of their medical care, but less than 20% of clinicians discuss these issues with their patients (King and Bushwick 1994). These polls indicate there is a high belief in God in the United States, but clinicians are not inquiring about religion and spiritual aspects in healthcare today as patients would prefer.
Therefore, the purpose of this article is to (a) discuss what the medical and physical therapy community states are their broad missions and where those missions overlap with faith, (b) provide examples in the literature where faith and the pursuit of health have been connected and successful in terms of positive healing, and (c) express the benefit of spiritually-charged preventative health and physical therapy returning to healthcare.
The Mission of Medical Care and Physical Therapy
There has been an increased call for attention to various aspects of spiritual challenges as part of whole-person or holistic care. The National Consensus Project for Quality Palliative Care has established standards for clinical practice that include the spiritual, religious, and existential aspects of care as among the core domains (VanderWeele, Balboni and Koh 2017). Spirituality is defined as a multidimensional part of the human experience and includes cognitive, behaviour, and philosophic aspects. The cognitive and philosophic aspects include searching for meaning, purpose, and truth in life, and the behavioural aspect as the way an individual externally manifests spiritual beliefs and inner spiritual state (Anandarajah and Hight 2001). Religion is defined as an attempt to respond to mankind’s spiritual questions and that each has developed a specific set of beliefs, practices, and teachings (Anadarajah and Hight 2001). However, action to include these aspects in the core domains of care is, at best, limited. Over half of medical schools in the United States provide opportunities for instruction in spiritual care to their students, but most practicing physicians did not receive spiritual training while in medical school despite research-based evidence that including chaplain involvement improved patient satisfaction in the hospital setting (VanderWeele et al. 2017). Official collaboration between spiritual educators and clinicians is absent.
In accordance with the American Physical Therapy Association (APTA), promoting health and wellness is an integral responsibility of the therapist. Because therapists often educate their clients on the benefits of a variety of health-enhancing behaviours, and provide a variety of movement opportunities, physical therapists may be in an ideal position to promote overall health and wellness in their patients and clients (Benzer 2015). Movement is a key to optimal living and quality of life for all people that extends beyond health to every person’s ability to participate in and contribute to society (APTA 2014). With the broad goal of physical therapy to allow individuals the opportunity to reach their full potential of health and wellness, it is practical that physical therapy schools would be considerate of individual’s religiosity and spirituality in this process. The correlation between health outcomes and religious commitment has been evaluated, and while some disagree, most authors report that positive relationships between religious commitment and mental and physical health were found in up to 84% of studies that involved a measure of religious commitment (Anadarajah and Hight 2001). Therefore, a spiritual history could – if not should – be incorporated in a school’s curriculum.
For example, one Christian-affiliated, accredited physical therapy doctoral program emphasized that their overall mission and vision is to promote the following:
[The program aspires to…] prepare graduates in an interprofessional, Christ-centered learning community to promote and improve the health and well-being of individuals and communities. … [The program] emphasizes healing the body, nurturing the mind and inspiring the spirit through rigorous academics, local and global service and innovative scholarship… Our mission is to prepare leaders in a Christian environment who promote health, wellness and quality of life through excellence in professionalism, scholarship and service. (Samford University 2019)
In the case of this physical therapy preparatory program, the concepts of health and Christ-like values are related, if not, dependent on one another. This sparks intrigue into research exploring the intersectionality between faith, spirituality, religiosity, and physical recovery.
The Healing Power of Faith
Research has stated that religiosity and spirituality have a positive effect on a patient’s health. Religious and spiritual commitment tends to lead to a quicker recovery from illness and surgery. In a study of heart transplant patients, it was found that patients who participate in religious activities and expressed that their religious beliefs were important complied better with follow-up treatment, had improved physical functioning at the 12-month follow-up visit, reached higher levels of self-esteem, and experienced less anxiety and fewer health worries than patients who did not view their religious beliefs as important (Harris et al. 1995). As a result, within the medical field, interest is rising concerning the role of religion as preventative medicine and an alternative (or supplementary) treatment to physical ailments (Koenig, King and Carson 2012; Price 2018). Prayer and being a member of a religious community has been shown to have physical, mental, and economical benefits for patients and physicians alike (Bopp, Peterson and Webb 2012; Campbell et al. 2007).
Many health professionals recognize that spirituality plays an important role in the adjustment of individuals and their families after traumatic injuries. However, spirituality is not always proactively addressed during rehabilitation efforts. Spirituality, and specifically religious belief, is perceived to sometimes raise difficulties for clients and staff (Jones, Dorsett, Briggs and Simpson 2018). There is potential for better incorporation of religion and spirituality into practice. The spiritual needs of clients and their family members during physical rehabilitation are important and could be better addressed. For example, Jones and colleagues (2018) suggested a range of initiatives including staff training and the use of standardized spiritual assessment tools.
Patients can uncover strength and peace in spirituality, by both deep connections with family and friends, as well as through religious communities (VanderWeele et al. 2017). However, modern day practicing clinicians often miss opportunities to include aspects of spirituality when assessing the health of their patients or even themselves. This recent neglect demonstrates the departure from history linking health, religion, and spirituality which is currently common in most cultures (Koenig, King and Carson 2012).
Clinicians can start to acknowledge spiritual health and wellness by incorporating religious/spirituality-focused questions within the routine social history interview. Brown University School of Medicine has developed a teaching tool to help begin the process of incorporating a spiritual assessment into the patient interview in which they employed the acronym of HOPE questions. The ‘H’ pertaining to the individual’s basic life spiritual resources such as hope, ‘O’ as organized religion, ‘P’ as practices that are most helpful for the individual, and ‘E’ as the effects of the individual’s perspective on end-of-life discussions (Anadarajah and Hight 2001). These religious/spirituality-focused questions do not need to immediately focus on words such as religion and spirituality, but can allow for open-ended exploration in the individual’s spiritual resources and concerns. For example, a question phrased, “Do you feel a positive presence while being physically active while in nature?” meets this objective.
Other example questions may include “Is faith and spirituality important to you?” and “In your times of need, do you have a religious or spiritual support system you could reach out to?” Questions such as these maintain respect for the patient while learning important information that might impact present or future care. In appropriate times, clinicians can also ask if a patient attends regular religious services, and how attending these services might affect the patients’ physical and emotional well-being outside of treatment (VanderWeele et al. 2017). Clinicians might also benefit from attending to their own spiritual health (VanderWeele et al. 2017), as pressing professional issues related to burnout, avoidable medical errors, attrition, and higher suicide rates among physicians than among the general population are an increasing concern (Balboni et al. 2013; Yoon, Daley and Curlin 2017). More opportunities to spiritual resources and practices for medical students and practicing clinicians could decrease these concerns. Just the act of clinicians providing spiritual care to patients may encourage clinicians to search for their own internal spiritual resources (VanderWeele et al. 2017).
Enacting Preventative Medicine
Preventative health is a personal passion of mine (Webb). Along that theme, it has also been noted that preventative health-measures (e.g., decreasing tobacco use, increasing physical activity and exercise, improving nutritional intake, engaging in safe sexual practices) also appear to be linked to religion and spirituality (Koenig et al. 2012). Research has suggested the importance of community leaders (e.g., physical therapists), while demonstrating healthy behaviours, can increase the chances of on-looking community members to also adopt healthy behaviours and to adhere to exercise programs (Webb and Bopp 2017).
Paradoxically, generally speaking, key leaders within faith-based organizations (e.g., ministers, pastors, preachers) are disproportionately affected by obesity and chronic disease (Bopp, Baruth, Peterson and Webb 2013). The effectiveness of preventative faith-based health and wellness programs can be strongly influenced by the attitudes, perceptions, and participation of key leaders within faith-based organizations. As a form of preventative medicine, physical activity programs endorsed by leaders in the faith community could potentially influence health-enhancing behaviours of those who look to them as examples for direction (Webb, Bopp and Fallon 2013).
Connecting to God through physical activity is a route many individuals may choose to take. For example, ‘prayer walking’ and ‘walking meditation’ have been shown to serve the dual purposes of spending time with God and achieving physical activity thorough movement (Koenig et al. 2012). Many Christians pursue to be active and connect with their faith, while maintaining a balanced approach to exercise, health, and physical well-being. That said, a balanced approach can be achieved when healthcare clinicians recognize different spiritual and religious values and beliefs, and integrate those values and beliefs in the development of the ‘care’ plan for patients. If done responsibly, healthcare clinicians can incorporate religious and spiritual aspects in their practice as patients would prefer. Respect for patient values and beliefs can be maintained by returning to the linkage of health, religion, and spirituality.
American Physical Therapy Association. 2014. “Vision Statement for the Physical Therapy Profession”. Retrieved from http://www.apta.org/Vision (March 21, 2019).
Anandarajah G. E. Hight. 2001. “Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment”. American Family Physician. 81-88.
Balboni, Michael J., Adam Sullivan, Adaugo Amobi, Andrea C. Phelps, Daniel P. Gorman, Angelika Zollfrank, John R. Peteet, Holly G. Prigerson, Tyler J. VanderWeele, and Tracy A. Balboni. 2013. “Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training.” Journal of Clinical Oncology 31, no. 4: 461.
Benzer, Janet R. 2015. “Promoting health and wellness: implications for physical therapist practice.” Physical Therapy, 95, no. 10: 1433–1444.
Bopp, Melissa, Jane A. Peterson, and Benjamin L. Webb. 2012. “A comprehensive review of faith-based physical activity interventions.” American Journal of Lifestyle Medicine, 6, no. 6: 460-478.
Bopp, Melissa, Meghan Baruth, Jane A. Peterson, and Benjamin L. Webb. 2013. “Leading their flocks to health? Clergy health and the role of clergy in faith-based health promotion interventions.” Family & community health 36, no. 3: 182-192.
Campbell, Marci Kramish, Marlyn Allicock Hudson, Ken Resnicow, Natasha Blakeney, Amy Paxton, and Monica Baskin. 2007. “Church-based health promotion interventions: evidence and lessons learned.” Annual Review of Public Health, 28: 213-234.
Gallup. 2019. Poll – “How important would you say religion is in your own life?” In Religion. Retrieved from http://www.gallup.com/poll/1690/religion.aspx (March 21, 2019).
Harris, Ronna Casar, Mary Amanda Dew, Ann Lee, Michael Amaya, Laurie Buches, Deborah Reetz, and Greta Coleman. 1995. “The role of religion in heart-transplant recipients’ long-term health and well-being.” Journal of Religion and Health 34, no. 1: 17-32.
Jones, Kate Fiona, Pat Dorsett, Lynne Briggs, and Grahame Kenneth Simpson. 2018. “The role of spirituality in spinal cord injury (SCI) rehabilitation: exploring health professional perspectives.” Spinal Cord Series and Cases 4, no. 1: 54.
King D. E., B. Bushwick. 1994. “Beliefs and attitudes of hospital inpatients about faith, healing and prayer”. Journal of Family Practice, 39: 349-352.
Koenig, Harold, Dana King, and Verna B. Carson. 2012. Handbook of religion and health. Oxford University Press. USA.
McCormick, T.R., Hopp, F., Nelson-Becker, H., Ai, A., Schlueter J.O., Camp J.K. 2012. “Ethical and Spiritual Concerns Near the End of Life”. Journal of Religion, Spirituality and Aging, September: 301-313.
Price, Harry. 2018. “More than medicine: the role of physical activity, psychological interventions, and religion and culture in a primary care medical setting.” Kent State University Conference. Kent, OH.
Puchalski C. M. 2001. Spirituality and Health: The Art of Compassionate Medicine. Hospital Physician, March: 30-36.
Samford University. 2019. “School of Health Professions: About”. Retrieved from
https://www.samford.edu/healthprofessions/default (March 21, 2019).
VanderWeele, Tyler J., Tracy A. Balboni, and Howard K. Koh. 2017. “Health and spirituality.” Journal of the American Medical Association, 318, no. 6: 519-520.
Webb, Benjamin L., and Melissa J. Bopp. 2017. “Results of walking in faith: A faith-based physical activity program for clergy.” Journal of Religion and Health 56, no. 2: 561-574.
Webb, Benjamin, Melissa Bopp, and Elizabeth A. Fallon. 2013. “A qualitative study of faith leaders’ perceptions of health and wellness.” Journal of Religion and Health, 52, no. 1: 235-246.
Yoon, John D., Brendan M. Daley, and Farr A. Curlin. 2017. “The association between a sense of calling and physician well-being: a national study of primary care physicians and psychiatrists.” Academic Psychiatry 41, no. 2: 167-173.
Author Bio: Lacie M. Webb (PT, DPT) is a recent physical therapist graduate from Samford University in Birmingham, AL and received a B.S. in Biology from The University of Alabama in 2016. Lacie has a variety of clinical experiences including post-operative orthopedic surgery rehabilitation, acute care in cardiac intensive care unit, sports medicine rehabilitation, and rehabilitation to individuals with neurological impairments. She has served as volunteer, technician, and student physical therapist in numerous cities, and has experience working with patients possessing a wide-range of functional abilities. The majority of Lacie’s clinical interests have focused on sport-related injuries, and return-to-sport and injury preventative programs. Preventative health is one of Lacie’s passions and she incorporates all aspects of preventative health in her clinical practice. Outside of work, one of Lacie’s passions is involvement in medical mission trips. Her mission is to live out the message in 1 Peter 4:10, “Each of you should use whatever gift you have received to serve others, as faithful stewards of God’s grace in its various forms.”
Author Bio: Colin G. Pennington (PhD) is an Assistant Professor of Kinesiology at Tarleton State University where he works with Exercise Science majors and carries out research on physical education teacher effectiveness and other pedagogical and health-related applications of the kinesiology sub-disciplines. Colin currently teaches courses including Physiology of Exercise, Anatomical Kinesiology, Capstone in Kinesiology, and formally a number of courses within the sport pedagogy sub-discipline of kinesiology. His interests and research focus on teacher socialization, physical education teacher training, character development programs within physical education and sport, and health and wellness.
 Furthermore, and providing attention to the bio-psycho-social-spiritual model, a patient’s spiritual history could be included in their personal medical records for reference.