Download Assessment of Heart Rates and Blood Pressure in

Assessment of Heart Rates and Blood Pressure in
Different Salat Positions
J. Phys. Ther. Sci.
25: 211–214, 2013
Hazem Doufesh, MSc, BEng1), Fatimah Ibrahim, PhD, MScE, BScEE1),
Noor Azina Ismail, PhD, MStats, BSC2), Wan Azman Wan Ahmad, MRCP, MBBS3)
1)Medical
Informatics and Biological Micro-electro-Mechanical Systems (MIMEMS) Specialized Lab,
Department of Biomedical Engineering, Faculty of Engineering, University of Malaya: 50603 Kuala
Lumpur, Malaysia. E-mail: [email protected]
2)Department of Applied Statistics, Faculty of Economics and Administration, University of Malaya
3)Department of Medicine, Faculty of Medicine, University of Malaya
Abstract. [Purpose] This study reports the effects of the Muslim prayer, known as Salat, on heart rate (HR) and
blood pressure (BP) while performing and miming the actions of Salat: standing, bowing, prostrating and sitting.
[Subjects] Thirty Muslim subjects were asked to perform the actual and mime Salat. [Methods] HR and BP were
measured using a Schiller AT-102 Electrocardiograph and an Omron SEM-1 Automatic Blood Pressure Monitor.
[Results] The findings revealed that there was a significant difference in the HR of the subjects between performing
and miming Salat. The standing and prostration positions of Salat produced the highest and the lowest HR, respectively. A lower HR may be of potential benefit to an individual’s health. The systolic and the diastolic BP decreased
significantly after performance and mime of Salat, and a greater reduction in BP was observed during performance
of Salat. [Conclusion] This is the first study of HR and BP in relation to Salat positions. The findings will encourage
further studies to explore the benefits of Salat maneuvers for patients with cardiovascular diseases.
Key words: Salat positions, Blood pressure, Heart rate
(This article was submitted Sep. 14, 2012, and was accepted Oct. 19, 2012)
INTRODUCTION
Salat is a Muslim prayer, it is a form of meditation1), and
it is obligatory in Islam to pray and to show one’s respect
and worship the Almighty. It is a religious activity that
involves recitations and specific positions: standing (qiyam),
bowing (rukuk), prostration (sujud), and sitting (tahiyyat).
Muslims are required to perform Salat five times daily in
addition to voluntary prayers (Sunnah, Nafla) Salat begins
with the takbir, raising one’s hands to face level, and ends
with the salam, turning the head to the right then to the left
shoulder2).
Salat serves many purposes. For example, it teaches the
Muslims how to discipline themselves, by practicing good
time management, and complying with the assigned time for
the prayers.
Meditation is known to influence physiological parameters such as heart rate3), blood pressure and respiration
rate4). Therefore meditation can be used as a therapy for
patients who have heart problems such as hypertension or
problems with their musculoskeletal system5).
Heart rate (HR) is an indicator of cardiac function and
a parameter of the heart’s performance. It can be observed
non-invasively using an ECG (electrocardiogram). HR is the
number of heartbeats per unit of time, typically expressed
as beats per minute (bpm). It is the response of the heart to
the demands of the body in many situations and positions6).
HR changes due to many factors such as biological and
physiological responses (sympathetic, parasympathetic
and endocrine)6–8), physical activities (exercises), behavioral and psychosocial factors9), environment (temperature
and altitude)6), body positions and postures10), and others
(medication, drugs, chemical substances and diseases).
All the factors that are mentioned above also affect blood
pressure11).
Blood pressure (BP) is one of the important physiological parameters to be considered in assessing a patients’
health status. BP is the force of the blood pushing against
the walls of the blood vessels as blood flows through the
body. This pressure is generated by the heart pumping blood
around the body and by the resistance of the arteries to the
flow of blood12). Studies have provided strong evidence
that meditation may help decrease BP of the persons who
are moderately hypertensive13–15). Many studies have also
revealed that this positive effect disappears when meditation
is discontinued16, 17).
There are many studies that describe the correlation
between meditation and its body positions or physical
activities and their effects on HR, BP, and other hemodynamic parameters10, 18–22). For example23), a previous study
compared three styles of yoga asana practice: the yoga
posture, breathing exercises, and relaxation or resting
posture. Some studies have reported that the heart rate
decreases during meditation and while performing other
212 J. Phys. Ther. Sci. Vol. 25, No. 2, 2013
Fig. 1. Description and illustration of Salat positions during HR measurement
meditation techniques24, 25). Nonetheless, long time practitioners of meditation have been shown to have a marked
decrease in heart rate25, 26).
While changes in HR in relation to Salat positions have
been reported27), the changes of HR and BP during performance of Salat relative to its positions have not been studied.
Understanding these changes would help enhance the understanding of the dynamic response of the cardiovascular
system during Salat. Thus the aim of this study was to assess
the changes in HR and BP during and after performance of
actual and acting Salat, and to reveal the effect of Salat on
the human body. We also investigated at the effect of HR
and BP during prayer recitations while performing the Salat.
SUBJECTS AND METHODS
Thirty male Muslim volunteers between the ages of 20
and 30 years old were recruited for this study. All of them
were free from cardiac, pulmonary, metabolic and other
diseases. These subjects had a decent knowledge of Salat,
including the various positions and movements. They were
asked not to perform any strenuous physical activity or take
any meal for at least two hours prior to the experiment.
Electrocardiography (ECG) data were recorded by three
electrodes that were attached to a subjects’ chests in the
standard Lead II configuration10) and connected to a Schiller
AT-102 electrocardiograph. BP was measured using an
Omron SEM-1 Automatic Blood Pressure Monitor.
The experimental protocol was divided into two sections,
the actual performance and the mime action of Salat. Each
session commenced and ended with the subjects lying on a
bed to rest in the supine position for 5 minutes before their
HR and BP were recorded.
In the first session, the subjects performed Salat in two
cycles. The first cycle began with standing (qiyam) for 60–90
seconds, then the bowing (rukuk) at 90-degrees for 5–10
seconds; it is obligatory to bend at the waist until the palms
can reach the knees. The subjects then stood up from this
bowing position to standing for 2–5 seconds, before going
down on their knees, and placing the forehead on the floor
about 1–2 feet in front of the knees in prostration (sujud)
for approximately5–10 seconds. After that, they sat up from
the prostration position for 2–5 seconds, then performed a
second prostration from the sitting position. This prostration
is similar to the first prostration, and is followed by standing
Table 1 . Mean ± SD of the heart rate of actual and mimed Salat
Pair
Position
1
2
3
4
Standing
Bowing
Prostrating
Sitting
Mean ± SD Heart Rate (bpm)
Actual Salat
Mimed Salat
85 ± 8
80 ± 7
69 ± 6
74 ± 5
82 ± 5*
78 ± 5*
67 ± 4*
71 ± 4*
* Significant difference (p<0.05) from actual Salat
up for the second cycle. The only difference between the first
and the second cycle exists after the second prostration in the
second cycle, when the subjects remain in the sitting position
(tahiyyat) for 20–30 seconds to finish Salat. A subject must
recite Quranic verses or specific supplications during each
of Salat positions.
In the second session (miming Salat), the subjects were
asked to perform the four different Salat positions in the
proper sequence (standing, bowing, prostration, and sitting),
without reciting any Quranic verses or supplications. This
sequence was repeated in two cycles of 15 s. The Salat
positions during the measurement are illustrated in detail in
Figure 1.
Statistical analyses were performed using SPSS version
15 (SPSS Inc. USA). The Paired t-test was used to compare
thepre and post-experimental measurements. A probability
value of less than 5% was accepted as significant.
RESULTS
Table 1 shows a comparison between the positions
of actual and mimed Salat . The results of the actual and
mimed Salat reveal that the prostrate positions had recorded
the lowest HR, while the standing positions had the highest
HR. This shows that HR of the prostration position lower
than that of the supine position. The Paired t-test indicates
that there were significant differences in the means of HR
between actual and mimed Salat for all positions (p<0.05).
The paired t-test, also indicates that there were significant
differences (p< 0.05) in HR between the supine and standing,
the supine and bowing, the supine and prostrating, and
between the supine and sitting positions in both the actual
and mimed Salat positions.
Table 2, shows the systolic and the diastolic blood
213
Table 2. Mean ± SD of blood pressure before and after actual and mimed Salat
Systolic
Actual salat
Mimed salat
Before
After
118.0 ± 5.6
119.3 ± 4.9
115.0 ± 4.7*
117.1 ± 4.2*
Diastolic
Before
After
72.2 ± 5.2
73.3 ± 3.8
70.2 ± 4.0*
72.1 ± 3.2*
* Significant difference (p<0.05) from the mean value obtained before Salat, unit-mmHg
pressures of both the actual and mimed Salat practice. The
average systolic and diastolic blood pressures in actual Salat
were lower than their respective values in mimed Salat:
systolic BP was reduced by 2.5% after actual Salat and by
1.7% after the mimed Salat; diastolic BP was reduced by
2.8% after actual Salat and by 1.6% after mimed Salat.
DISCUSSION
In this study, HR was measured during actual and mimed
Salat. However, BP was measured immediately before and
5 minutes after performance of both actual and mimed Salat.
We note that in both performance of actual and mimed
Salat, the change of heart rate was associated with postural
change. The results of this study show that when the subjects
stood, the highest HR was recorded and that HR decreased to
the lowest rate in the prostrate position compared to the supine
baseline, the results show that the mean HR in the standing,
bowing, and sitting positions increased significantly, while
HR in the prostrate position reduced significantly. We
hypothesise that in the standing position, venous return
decreased due to “venous pooling” in the lower limbs arising
from the gravitational effects28). This decrease in venous
return would have lead to a reduced cardiac output, leading
to a reduction in baroreceptor stimulation in the aorta and
carotid arteries29). This reduction in baroreceptor response
would have produced a decrease in parasympathetic nervous
activity and an increase in sympathetic nervous activity30,
31), directly affecting the cardiovascular center, consequently
increasing HR. Whereas, in the prostrate position, the venous
return would have increased to the highest level. In this
position the brain, and head, are lower than the heart, hence,
for the first time, the blood would flow towards the brain
with the maximum gravitational pull. In this position, due
to an increase in the amount of blood reaching the head, the
amount of oxygen in the brain cells would have increased32).
The brain depends on oxygen to function, and brain cells
die without oxygen. High blood oxygen in the brain leads to
enhances concentration, memory, vision and hearing33). This
is the reason why people who practice Salat on a regular
basis can overcome many physical and mental problems.
They have fewer headaches, psychological problems, and
other cognitive difficulties32). Our findings are in accord
with Ibrahim and Ahmad 2008 and Jones et al. 2003 who
have reported a decrease in heart rate, with decrease in the
distance of the heart from the ground and the position of the
head relative to the heart27, 38).
The difference in the results between the actual and
mimed Salat in all the positions were statistically significant
at the 5% level (Table 1). The actual Salat positions often had
higher HR than the corresponding mimed Salat positions.
As indicated in the introduction, Salat is a worshipping
procedure involving movements and recitations. In this
study subjects recited verses from the Holy Quran during
actual Salat, but not during mimed Salat. Various muscles
and joints of the body are exercised byrecitation. There is
also a need to increase the blood flow to the face, tongue,
the sensory and motor areas of the mouth, and the upper
pre-motor cortex of the brain during recitation. Thus, heart
rate would have increased during creative speech, but once
the recitation had finished, the pulse rate would have slowly
returned to its resting heart rate (set point). The set point
is established and modulated by lifestyle and the physiological processes of the internal organs over the years20).
A temporal increase of the load on the heart during actual
Salat, if practiced is daily over a long period, would decrease
the set point level and strengthen the heart muscles, as well
as improve the blood circulation within the heart muscles20).
A similar effect was achieved by miming Salat, but it was
not as great as actual Salat, and subjects performing actual
Salat had a higher HR. This result is in agreement with the
findings of Cacippo39).
BP before and after actual and mimed Salat were also
measured (Table 2). The results of the paired sample t-test
indicate that there was a significant reduction in both systolic
and diastolic BP fter actual and mimed Salat. These significant reductions in systolic and diastolic blood pressures
indicate a trend of gradual shift in autonomic equilibrium
toward relative parasympathodominance due to a reduction
in sympathetic activity34).
Salat as a physical exercise is quite similar to the tai
chi and yoga. It involves the movement of the whole
body. Recent studies of yoga35) show that a decrease in the
systolic pressure is observed when an individual performs
yogic relaxation and meditation. Our study showed that
Salat decreased systolic BP. This reduces the sympathetic
discharge resulting in and predominance of the parasympathetic system14).
Salat is a gentle exercise, which is regularly performed
by Muslims. It is similar to other aerobic exercises such as
tai chi and yoga, and as such may improve physical fitness.
A study covering 17,000 Harvard alumni who entered
college from 1916 to 1950 provides strong evidence that
moderate aerobic exercise is equivalent to jogging about 3
miles a day36). Ibrahim et al. 200837) suggests that subjects
who perform Salat regularly, five times a day, would have a
healthy body composition, increase the basal metabolic rate
and reduced body fat mass. Elevated cholesterol increases
the risk of cardiovascular disease. It has been shown that
people in professions where physical exertion is required,
214 J. Phys. Ther. Sci. Vol. 25, No. 2, 2013
have lower cholesterol in their bodies37).
In conclusion we found that Salat maneuvers are
equivalent to moderate exercise in terms of their physical
exercise value. Salat also contributed towards increased in
the cardiovascular system capability. The low value of HR
in the prostrating position decreased systolic BP in both
actual and mimed Salat. Salat, in this sense, can be used
as a therapy for patients who have heart problems such as
hypertension or problems in the musculoskeltal system.
HR in actual Salat was slightly higher than in mimed
Salat, due to its recitation activity, providing good additional
physiological benefits for the body. This pilot study will thus
motivate further studies to discover the benefits of Salat on
human health.
Future work, can be enhanced by taking into consideration other parameters such as the electroencephalography
(EEG), electromyography (EMG), and respiration rate
(RSP) in correlation to HR and BP.
ACKNOWLEDGEMENTS
This research was supported and funded by the Prime
Minister’s Department, project no (66–02-03–0061/H00000–37039).
REFERENCES
1) Alwasiti HH, Aris I, Jantan A: EEG activity in Muslim prayer: a pilot
study. Maejo Int J Sci Technol, 2010, 4: 496–511.
2) Yucel S: The effects of prayer on Muslim patients’ well-being [microform];
Phd thesis. Boston: Boston University School of Theology, 2007, pp 9–16.
3) Sarang P, Telles S: Effects of two yoga based relaxation techniques on heart
rate variability (HRV). Int J Stress Manag, 2006, 13: 460–475. [CrossRef]
4) Lee MS, Kim BG, Huh HJ, et al.: Effect of Qi-training on blood pressure,
heart rate and respiration rate. Clin Physiol, 2000, 20: 173–176. [Medline]
[CrossRef]
5) Reza MF, Urakami Y, Mano Y: Evaluation of a new physical exercise taken
from salat (prayer) as a short-duration and frequent physical activity in the
rehabilitation of geriatric and disabled patients. Ann Saudi Med, 2002, 22:
177–180. [Medline]
6) Wilmore JH, Costill DL: Physiology of Sport and Exercise; 3rd ed. Human
Kinetics Publishers, 2004, pp 224–225.
7) Glick G, Braunwald E: Relative roles of the sympathetic and parasympathetic nervous systems in the reflex control of heart rate. Circ Res, 1965,
16: 363–375. [Medline] [CrossRef]
8) Ogoh S, Fisher JP, Dawson EA, et al.: Autonomic nervous system influence
on arterial baroreflex control of heart rate during exercise in humans. J
Physiol, 2005, 566: 599–611. [Medline] [CrossRef]
9) Britton A, Shipley M, Malik M, et al.: Changes in heart rate and heart
rate variability over time in middle-aged men and women in the general
population (from the Whitehall II cohort study). Am J Cardiol, 2007, 100:
524–527. [Medline] [CrossRef]
10) Watanabe N, Reece J, Polus BI: Effects of body position on autonomic
regulation of cardiovascular function in young, healthy adults. Chiropr
Osteopat, 2007, 15: 19.
11) Hassan MK, Mashor MY, Mohd Nasir NF, et al.: Measuring of systolic
blood pressure based on heart rate, 4th Kuala Lumpur International Conference on Biomedical Engineering, 2008, pp 595–598.
12) Mahmood NH, Jalaludin SN, Zakaria NA, et al.: In relationship study of
heart rate and systolic blood pressure for healthy people, 6th World Congress of Biomechanics (WCB 2010) CT Lim and Goh JCH) Springer Berlin
Heidelberg, 2010, pp. 1358–1361.
13) Wallace RK, Silver J, Mills PJ, et al.: Systolic blood pressure and long-term
practice of the transcendental meditation and TM-sidhi program: effects
of TM on systolic blood pressure. Psychosom Med, 1983, 45: 41–46.
[Medline]
14) Patel CH: Yoga and biofeedback in the management of hypertension.
Lancet, 1973, 2: 1053–1055. [Medline] [CrossRef]
15) Benson H, Rosner BA, Marzetta BR, et al.: Decreased blood pressure in
borderline hypertensive subjects who practiced meditation. J Chronic Dis,
1974, 27: 163–169. [Medline] [CrossRef]
16) McGrady A: Effects of group relaxation training and thermal biofeedback
on blood pressure and related physiological and psychological variables
in essential hypertension. Biofeedback Self Regul, 1994, 19: 51–66.
[Medline]
17) Patel C: 12-month follow-up of yoga and bio-feedback in the management
of hypertension. Lancet, 1975, 1: 62–64. [Medline] [CrossRef]
18) Kanani M, Elliott M: Applied surgical physiological vivas- a change in
posture. Cambridge: Cambridge University Press, 2004, 0521683203: 1–8.
19) Acharya R, Kannathal N, Sing OW, et al.: Heart rate analysis in normal
subjects of various age groups. BioMedical Eng Onlin, 2004, 3: 24.
[CrossRef]
20) Stanley G, Verotta D, Craft N, et al.: Age effects on interrelationships
between lung volume and heart rate during standing. Am J Physiol Heart
Circ Physiol, 1997, 273: 2128–2134.
21) Zhang J: Effect of age and sex on heart rate variability in healthy subjects.
J Manipulative Physiol Ther, 2007, 30: 374–379. [Medline] [CrossRef]
22) Zhang J: Effects of exercise and custom-made orthotics on blood pressure
and heart rate variability: a randomized controlled pilot study. J Chiropr
Med, 2007, 6: 56–65. [Medline] [CrossRef]
23) Cowen VS, Adams TB: Heart rate in yoga asana practice: a comparison of
styles. J Bodyw Mov Ther, 2007, 11: 91–95. [CrossRef]
24) Wenger MA, Bagchi BK: Studies of autonomic functions in practitioners
of yoga in India. Behav Sci, 1961, 6: 312–323. [Medline] [CrossRef]
25) Delmonte MM: Electrocortical activity and related phenomena associated
with meditation practice: a literature review. Int J Neurosci, 1984b, 24:
217–231. [Medline] [CrossRef]
26) Jevning R, Wallace RK, Beidebach M: The physiology of meditation: a
review. A wakeful hypometabolic integrated response. Neurosci Biobehav
Rev, 1992, 16: 415–424. [Medline] [CrossRef]
27) Ibrahim F, Ahmad W: Study of heart rate changes in different Salat’s positions, 4th Kuala Lumpur International Conference on Biomedical Engineering Biomed. 2008, pp 687–690.
28) Borst C, Wieling W, van Brederode JF, et al.: Mechanisms of initial heart
rate response to postural change. Am J Physiol, 1982, 243: H676–H681.
[Medline]
29) Mohrman DE, Heller LJ: Cardiovascular Physiology; 4th ed, New York:
McGraw-Hill Health Professions Division, 1997.
30) Ewing DJ, Hume L, Campbell IW, et al.: Autonomic mechanisms in the
initial heart rate response to standing. J Appl Physiol, 1980, 49: 809–814.
[Medline]
31) Shamsuzzaman AS, Sugiyama Y, Kamiya A, et al.: Head-up suspension
in humans: effects on sympathetic vasomotor activity and cardiovascular
responses. J Appl Physiol, 1998, 84: 1513–1519. [Medline]
32) Beebani MK: The medical benefits of sujood. The muslim world weekly
2000. http://www.reciteislam.com/index.php?option=com_content&view
=article&id=456&Itemid=110 (Accessed Jul. 7, 2000).
33) John J, Ratey EH: The Revolutionary New Science of Exercise and the
Brain; 1st ed. New York: Little Brown and Company, 2008.
34) Harinath K, Malhotra AS, Pal K, et al.: Effects of Hatha yoga and Omkar
meditation on cardiorespiratory performance, psychologic profile, and
melatonin secretion. J Altern Complement Med, 2004, 10: 261–268.
[Medline] [CrossRef]
35) Herur A, Kolagi S, Chinagudi S: Effect of yoga on cardiovascular and
mental status in normal subjects above 30 years of age. Am J Med Sci,
2010, 3: 337–344.
36) Syed I: The Medical Benefits of Taraweeh Prayers. http://www.radianceweekly.com/217/5912/kashmir-restore-peace-through-autonomy/2010–08-15/traweeh/story-detail/the-medical-benefits-of-taraweehprayers.html (Accessed Aug.16, 2010).
37) Ibrahim F, Abas WA, Cheok NS: Salat: benefit from the science perspective; Kuala Lumpur: University of Malaya, 2008, pp 24–25.
38) Jones A Y, Kam C, Lai K W, et al.: Changes in heart rate and r-wave
amplitude with posture. Chin J Physiol, 2003, 46: 63–69. [Medline]
39) Cacioppo JT: Effects of exogenous changes in heart rate on facilitation
of thought and resistance to persuasion. J Pers Soc Psychol, 1979, 37:
489–498. [Medline] [CrossRef]