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Clinical Review

Cardiac rehabilitation

BMJ 2015; 351 doi: (Published 29 September 2015) Cite this as: BMJ 2015;351:h5000

Spirituality and Religiosity in Cardiac Rehabilitation

Spiritual and religious practices are often used to cope with illness across adult populations and may be associated with positive clinical outcomes and less disease progression.1

Strong spiritual experiences in life may be a protective and positive factor in cardiovascular diseases. However, spirituality is often neglected in cardiac rehabilitation (CR) programs.2 Some CR patients rely on their religious practices and spiritual beliefs to deal with the onset of and recovery from cardiac disease.3 Yet, the R/S of patients with heart disease and the role of R/S in coping with the illness are rarely discussed during participation in CR programs. 2, 3

A recently published study was set to evaluate the role of R/S in 105 individuals with a first-time myocardial infarction or coronary artery bypass surgery who were referred to a 12-week CR program.4 The demonstrated relationships between R/S and outcomes in cardiac patients support the development of spiritual care interventions for cardiac patients and evaluation of the impact of these interventions on medical, and psychological outcomes in these patients.4

Spiritual care interventions may not be a universal intervention for CR programs and may not be applicable, or even appropriate for some patients. It is obvious that some patients may not be religious or consider their religious beliefs a personal issue to be dealt with outside of their medical management. Thus, spiritual care interventions must be individualized as a matter of voluntary choice by the patients.4 There is a need for controlled clinical trials that use rigorous research design to test well-formulated spiritual interventions on patients’ outcome and determine the efficacy of such approaches.

Patients with stronger religious beliefs tend to be more meticulous about their lifestyle changes and adherence to recommended practices.5 Although not outwardly mentioned in the Qur’an and Prophet Muhammad traditions, the lifestyle that the Qur’an encourages, drastically decreases the chances of individuals developing cardiovascular diseases via the following ways: engaging in spiritual activities, moderate eating, physical labor, and abstention from forbidden foods and drinks.6 Overeating has been strongly condemned and prohibited in the Qur’an. Though we do not find much in the Qur’an about specific exercise recommendation, the Islamic prayer is performed at least five times a day and consists of a series of movements entailing standing, prostrating and sitting. The lifestyle prescribed by these Islamic traditions promotes longevity of life, prevention of cardiovascular diseases, and discourages risk factors associated with such diseases.8

Hassan Chamsi-Pasha, FRCP, FACC. Cardiac department, King Fahd Armed Forces Hospital, Jeddah, Saudi-Arabia. (
Majed Chamsi-Pasha, MBBS. Medical department, King Fahd Armed Forces Hospital, Jeddah, Saudi-Arabia.

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3. McConnell TR, Trevino KM, Klinger TA. Demographic differences in religious coping after a first-time cardiac event. J Cardiopulm Rehabil Prev. 2011; 31: 298-302.
4. Trevino KM, McConnell TR. Religiosity and Spirituality During Cardiac Rehabilitation: A LONGITUDINAL EVALUATION OF PATIENT-REPORTED OUTCOMES AND EXERCISE CAPACITY. J Cardiopulm Rehabil Prev. 2015 Jul-Aug; 35(4):246-54.
5. Nabolsi MM, Carson AM. Spirituality, illness and personal responsibility: the experience of Jordanian Muslim men with coronary artery disease. Scand J Caring Sci. 2011; 25: 716-724.
6. Turgut O, Yalta K, Tandogan I. Islamic legacy of cardiology: inspirations from the holy sources. Int J Cardiol. 2010; 145(3):496.
7. Chamsi-Pasha H. Islam and the cardiovascular patient – pragmatism in practice (Editorial). Br J cardiol.2013;20 (3):1-2

Competing interests: No competing interests

03 October 2015
Hassan Chamsi-Pasha
Head of Non-Invasive Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi-Arabia
Majed Chamsi-Pasha
King Fahd Armed Forces Hospital, Jeddah, Saudi-Arabia