A review of the literature on the health benefits of Salat (Islamic prayer)

Abstract

Introduction:
Recent studies explored the association between health and religious practice/spirituality. Several studies revealed that religious commitment and spirituality are generally associated with better health outcomes. Throughout the world, millions of Muslims perform salat (prayer) regularly five times a day. Salat is not only a physical activity but involves recitations of various Quranic verses and performance of certain postural positions. Several studies showed that salat does have positive effects on health status. This review aims to investigate the effects of Islamic salat on general health.

Methods:
A series of searches were conducted of Medline databases published in English between 1966 and October 2020 with the following keywords: Prayer, salat, health, and Islam.

Results:
Several positive effects of salat on health were identified. These include: psychological, neurological, cardiovascular, and musculoskeletal effects.

Conclusion:
Salat is a non-pharmacological intervention and resource, and may be included in the holistic care and rehabilitation program aimed at the well-being of patients.

Full text

Med J Malaysia Vol 76 No 1 January 2021 89
ABSTRACT
Introduction: Recent studies explored the association
between health and religious practice/spirituality. Several
studies revealed that religious commitment and spirituality
are generally associated with better health outcomes.
Throughout the world, millions of Muslims perform salat
(prayer) regularly five times a day. Salat is not only a
physical activity but involves recitations of various Quranic
verses and performance of certain postural positions.
Several studies showed that salat does have positive effects
on health status. This review aims to investigate the effects
of Islamic salat on general health.
Methods: A series of searches were conducted of Medline
databases published in English between 1966 and October
2020 with the following keywords: Prayer, salat, health, and
Islam. Results: Several positive effects of salat on health
were identified. These include: psychological, neurological,
cardiovascular, and musculoskeletal effects.
Conclusion: Salat is a non-pharmacological intervention and
resource, and may be included in the holistic care and
rehabilitation program aimed at the well-being of patients.
KEYWORDS:
Prayer, Salat, Islam, Health benefits
INTRODUCTION
Over the last three decades there has been increasing medical
interest in mind and body medicine.1Religion at large has
always lent a useful guide to approach both the physiological
illnesses and psychological maladies. Researchers at the
Mayo Clinic reviewed 350 studies examining the influence of
religion on the physical health of patients and 850 studies
investigating the impact of religion on mental health. Most
studies have shown that religious involvement and
spirituality are associated with better health outcomes,
including greater longevity, coping skills, and health-related
quality of life (even during terminal illness) and less anxiety,
depression, and suicide. They concluded that religion
promotes illness prevention, coping with illnesses, and
recovery.2
High levels of spirituality and religiosity are correlated with
lower morbidity and mortality, enhanced quality of life and
well-being, and lower levels of depression and psychological
stress.3Possible mechanisms by which spirituality and
religiosity may affect health outcomes include healthier
lifestyles (e.g., healthy diets, less smoking and alcoholism,
lower rates of stress and depression, optimism and hope,
enhancement of social ties, lower rates of suicide and a more
favorable immune profile.4,5,6
Recent studies endeavored to explore the health effects of
prayer from a scientific standpoint. In a survey of 4404
Muslim individuals, the investigators found that the
participants who prayed regularly achieved better health,
exhibited more favorable health-related behaviors and use of
preventive services, and reported greater satisfaction with
care.7However, salat (Islamic prayer is different from the
personal prayer or invocation associated with the Christian
faith. In Islam, that is called the “Du`a”, or supplication,
formal and informal.
Islamic prayer, commonly represented by the Arabic term
salat is the second pillar of Islam. As an obligatory
requirement of ritual worship, salat combines the essential
tenets of Islam; worship of one God, remembrance of Allah,
submission to the Allah’s will, supplication, as well as, a
symbol of unity of the Muslim community.1,8 Salat is
performed at five appointed times during a day as
commanded in the Quran, the Holy Book “Verily, Salah is an
obligation on the believers to be observed at its appointed time”
(Qur’an 4:10).
It is preceded by the ritual ablution (wuduˆ’) and it includes
various postures (raq’aas) which involves standing, raising
and lowering of arms, bowing, sitting on shins, prostration
and head rotation. Voluntary prayers in addition to the
above are highly encouraged and are recommended as a
means of turning to divine help, especially at times of
personal grief and distress.9
Regular prayer is emphasised more strongly in Islam than in
Christianity and Judaism. While prayer is very important to
devout Christians, it is usually carried out less than the five
times per day as is required in Islam.10 The five times are
dawn prayer (Fajr), noon (Duhar), early evening (Asr), after
sun set (Magrib) and night prayer (Isha). The form of prayer is
also different between the two faiths, whereas Muslims
become involved with their entire bodies by standing toward
Makkah, reciting verses from the Quran, kneeling and
bowing (Rokoo), bowing down to the ground and touching it
with their foreheads (prostration, Sujood).
A review of the literature on the health benefits of Salat
(Islamic prayer)
Dr. Majed Chamsi-Pasha, SBIM1, Dr. Hassan Chamsi-Pasha, FACC2
1Department of Medicine, GNP Hospital, Jeddah, Saudi Arabia, 2Department of Cardiology, King Fahd Armed Forces Hospital,
Jeddah, Saudi Arabia
REVIEW ARTICLE
This article was accepted: 26 December 2020
Corresponding Author: Dr. Hassan Chamsi-Pasha
Email: drhcpasha@hotmail.com

Review Article
90 Med J Malaysia Vol 76 No 1 January 2021
The Orthodox Jews also stand during their prayers and face
towards Jerusalem, then they bow and finally stand up
swaying their head forward and backward frequently and
quickly. They don’t prostrate to the ground, although it is
mentioned in the Book of Daniel that Daniel prostrated down
to the ground during his prayers. The orthodox Jews pray
three times a day: early morning, afternoon and at night.
Several studies showed that salat has positive effects on the
health status. The objective of this review is to investigate the
current evidence of health benefits of salat, and discuss what
is known regarding these effects.
Health benefits of Salat:
Psychological
Many patients encounter psychological and emotional
distress in the face of illness and possible death. High levels of
anxiety may worsen their physical condition. Several reports
on the application of prayers in psychotherapy illustrate the
positive outcome in an individual exhibiting pathological
symptoms such as tension, anxiety, depression and anti-
social tendencies.11 Yucel12 conducted a study, at Brigham
and Women's Hospital, exploring the effects of salat and Dua
(supplicative prayer)], on sixty adult Muslims aged between
18–85 years. He found that salat reduced stress and
depression while providing comfort and hope. Findings were
consistent with prior studies on prayer-health relationship.
The study also revealed that 75 % of the participants
indicated that Islam was an important factor in their lives.
The mind and body relationship in salat may provide a basis
for overcoming life’s exigencies, decreasing anxiety and
depression while relying on Divine assistance and guidance.12
In a study of 30 healthy Muslim men, Doufesh13 investigated
the effect of Muslim prayer (salat) on the relative power (RPa)
of electroencephalography (EEG) and autonomic nervous
activity. During salat, a significant increase (p <0.05) in the
mean RPa in the occipital and parietal regions of the brain
and a normalized unit of high-frequency (nuHF) power of
HRV (as a parasympathetic index) were observed.
Meanwhile, the normalized unit of low-frequency (nuLF)
power and LF/HF of HRV (as sympathetic indices) decreased.
The increased Electroencephalogram (EEG) occipital and
parietal RPa during salat suggest that prayer produces
positive changes in brain function and human well-being.
These changes are associated with an increase in the
parasympathetic component and a decrease in the
sympathetic component in the autonomic nervous system
(ANS). Therefore, regular salat practices may help promote
relaxation, minimize anxiety, and might reduce
cardiovascular risk.13
Meditaton
Meditation is a practice where a person uses a technique,
such as focusing the mind on a particular object, thought or
activity to train awareness and achieve a mentally clear and
emotionally calm state. Numerous studies have reported the
benefits of meditation. Meditation may be a potentially
attractive cost-effective adjunct to more traditional medical
therapies.14 Almost all religions incorporate some form of
meditation and the Muslim prayer is the meditation of Islam.
From the Islamic point of view, the prayer is not the goal
itself. The real goal is the remembrance of God and the
training of attention during prayer to focus on God ("...and
keep up prayer for my remembrance”) (Quran 20:14).
Studies have shown that salat results in the activation of
parasympathetic nervous system, and a decrease in
sympathetic activity.13 This may explain why salat is often
considered as a form of meditation as it decreases anxiety
and promote relaxation. The majority of studies on
meditation reveals alpha rhythm slowing, and increased
alpha rhythm coherence on the EEG. Doufesh et al15
investigated the concept of relaxation attained when
performing the Muslim prayers by measuring the alpha
activity in the brain. Nine Muslim subjects were asked to
perform the four required cycles of movements of “Dhuha”
prayer, and the EEG was subsequently recorded. Findings
were similar to other studies revealing increased alpha
amplitude in the parietal and occipital regions of the brain
during meditation and mental concentration. The incidence
of increased alpha amplitude suggested parasympathetic
activation, thus suggesting a state of relaxation. More studies
are needed to delineate the role of mental concentration, and
eye focus, on alpha wave amplitude while performing acts of
worship.15
Doufesh et al16 also investigated the difference of mean
gamma EEG power between actual and mimic salat practices
in 20 healthy Muslim subjects. In the actual practice of salat,
the participants were requested to recite and perform the
regular steps of salat; whereas participants mimicking salat
practice were instructed to perform only the physical steps
without Quran recitation. The gamma power during actual
salat was statistically higher than during the mimic salat in
the frontal and parietal regions in all stages. Increased
gamma power during the actual salat, probably related to an
increase in the cognitive processing, in keeping with the
concept of salat as a focus attention meditation.16 Future
research focusing on the medical benefits of salat should be
conducted with an aim of educating Muslim physicians on
salat as a form of mind and body medicine.
Meditation may be considered as an adjunctive to the
guideline-directed cardiovascular risk reduction by lifestyle
modification. Neurophysiological studies reveal that
meditation may have long-standing effects on the brain.14
Achour et al17 examined how salat moderates the relationship
between job stress and life satisfaction among 335 Muslim
nursing staff in Kuala Lumpur, Malaysia. They found that
job stress was associated negatively with life satisfaction.
There was a strong positive correlation between salat and life
satisfaction and salat helped in reducing the stress and might
have improved the life satisfaction of these Muslim nurses.17
Physicians should consider incorporating more mind and
body techniques in view of the dramatic increase in chronic
stress-related disorders throughout the world.1
Neurological
Beside the spiritual and religious aspects of prayer, salat is a
repetitive and/or mentally enhancing activity. It involves
both cognitive and motor components. Prostration (Sujoud) is

A review of the literature on the health benefits of Salat (Islamic prayer)
Med J Malaysia Vol 76 No 1 January 2021 91
the only position in which the head is in a position lower
than the heart and therefore, receives increased blood supply,
which consequently, may have a positive effect on memory,
concentration, psyche and cognitive function (the mental
processes that allow us to carry out any task). There is only
one study that examined the relationship between religiosity
and cognitive function in Muslims. Inzelberge et al18
conducted a door-to-door survey of 935 Arabs in Palestine,
men and women over the age of 65 years, examining the
relationship between the number of praying hours per month
during midlife and cognitive function. Of the 935 individuals
who were approached, 778 [normal controls (n=448),
Alzheimer's disease (n=92) and mild cognitive impairment
(MCI) (n=238)] were evaluated. The results showed that 87%
of cognitively normal persons practiced prayers at midlife,
compared to 71% of those with mild cognitive impairment
and 69% of those with Alzheimer's disease (AD) (p<0.0001).
The study found that prayer during midlife significantly
reduced the likelihood of mild cognitive impairment over the
age 65 in Arabic women in Palestine.18
Alabdulwahab et al19 compared the dynamic balance of 60
healthy male subjects who performed salat regularly with
non-practising individuals using a Balance Master. They
found that individuals who performed salat regularly had a
significantly superior dynamic balance (p<0.05) in terms of
reaction time, movement velocity, end-point excursion, and
directional control than the non-practicing healthy subjects.19
Cardiovascular
Religious involvement is associated with less cardiovascular
disease.2Islamic prayer is performed at least five times a day
and consists of a series of movements entailing standing,
prostrating and sitting. Salat maneuvers were equivalent to
light exercise in terms of their physical exercise value. When
performing prayer, the Qur’an discourages lazily performing
prayer as performed by the Hypocrites; thus, a lethargic and
careless approach to prayer neither obtains any spiritual nor
physical benefit to the state of health. The physical
movements during prayer with repetitive standing-sitting
actions throughout the day may also help in preventing deep
vein thrombi.20
Doufesh et al21reported the effects of the salat, on heart rate
(HR) and blood pressure (BP) while performing and miming
the actions of salat: standing, bowing, prostrating and sitting.
Thirty Muslim subjects were asked to perform the actual and
mimicking salat. HR was measured during actual and
mimicked salat. However, BP was measured immediately
before and 5 minutes after performance of both actual and
mimed salat. There was a significant difference in the HR of
the subjects performing and miming salat. The standing and
prostration positions of salat produced the highest and the
lowest HR, respectively. The systolic BP decreased slightly
after performance (118.0 ± 5.6 Vs 115.0 ± 4.7, p<0.05) and
mime of salat (119.3 ± 4.9 Vs 117.1).21
Religious involvement was associated with lower blood
pressure. Salat is a type of meditation exercise and evidence
shows meditation results in a decrease in both systolic and
diastolic blood pressure, and thus might be of benefit to
mildly hypertensive individuals.21,22
Al-Kandari22 tested the blood pressure of 223 Kuwaitis and
compared the blood pressure of those who pray to those who
do not. He concluded that those who pray were generally
found to have lower blood pressure. Al-Kandari noted that
involvement in religious activities seemed to be a factor in
lowering blood pressure as it provided a social support
network.22
Byrne and Price23 pointed out that two of the most important
functions of religion for human health are providing a sense
of security and a source of strength extracted from an
individual’s social support network and from his/her religious
community.23 Steffen et al24 also found that African
Americans who engage in prayers and religious activities had
lower blood pressure. Among African Americans with higher
levels of religious commitment were associated with lower
awake (p < .05) and sleep (p < .01) ambulatory blood
pressure. Lower 24-hour BP load may be a pathway through
which religious practice and cardiovascular health are
related.24 Further studies to explore the benefits of salat
maneuvers for patients with cardiovascular diseases are
warranted.
Musculoskeletal
Most of the muscles and joints of the body are usually
involved in the performance of salat. This kind of activity will
be convenient for most patients, including the elderly. Prayer
may be considered as a type of stretching exercise. The
physical activities performed during salat are simple and
gentle exercises that are suitable for all ages and different
conditions. During salat, the gentle muscle contraction and
relaxation are done with harmony, resulting in flexibility of
the muscles without over-exhaustion. A small study of seven
adult subjects investigated the electrical activity of two
muscles located at the dorsal surface (the erector spinae and
trapezius muscles) during salat and showed that both muscles
maintain a balance in terms of contraction and relaxation
during bowing and prostration position.25
Salat consists of at least two “rakaats”, and each rakaat
involves a series of seven postures. In the prayer performed
before sunrise, 2 rakaats or 14 consecutive postures must be
performed. Therefore, each Muslim is obliged to perform at
least 119 postures every day, that is 3570 postures monthly,
and 42,840 postures every year. Salat is considered obligatory
at the puberty, and if someone lives up to an average of 60
years, a Muslim would have performed over 1,927,800
compulsory postures during salat in his lifetime.26
The therapeutic aspects of salat in promoting psycho-physical
well-being have been discussed by several authors and
focused on the musculoskeletal benefits of salat which
include maintenance of postural equilibrium, providing
muscle tone, improving circulation, and may have protective
role in reducing osteoarthritis (OA) of the weight bearing
joints.27,28,29
The role of this repetitive action on knee and hip
osteoarthritis and osteoporosis was explored. Forty-six
patients who performed prayers for at least 10 years, and 40
patients who had not performed the prayer, were included in
this prospective study. The authors concluded that the prayer
had no negative effect on knee and hip osteoarthritis.30

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92 Med J Malaysia Vol 76 No 1 January 2021
Chokkhanchitchai31 studied the effect of salat on both the
prevalence and severity of knee osteoarthritis (OA) in a Thai
elderly population with the same ethnicity but different
religions. The study involved 153 Buddhists and 150 Muslims
aged over 50 years. The prevalence of knee pain was
significantly higher among Buddhists than in Muslims (67.1
vs. 55.8, p = 0.02). The prevalence of OA was lower in
Muslims than in Buddhists. It is postulated that the Muslim
way of praying since childhood, forcing the knees into deep
flexion, may stretch the soft tissue surrounding the knees and
decrease the stiffness of the articular cartilage.31
Rehabilitation
It is well known that even moderate intensity activities, when
performed daily, can have some long-term health benefits.
During different positions and transitions of salat, movement
occurs at almost all joints of the body. Salat, with its various
postures and movements, can play a role in increasing
psychological well-being including the self-esteem,
improving musculoskeletal fitness and cerebral blood flow
that may be beneficial in the rehabilitation program of
geriatric and disabled patients.27
The practice of salat may help in the rehabilitation process in
patients with neurological or musculoskeletal impairments
as it involves minimum effort and promotes mental and
physical health. Different postures of salat (standing, bowing,
prostration and sitting) may play a role against the adaptive
postures which the affected patients may adopt after
suffering a neurological insult.32
Salat is concluded by looking over one’s right and left
shoulder, during which, neck rotational movements take
place. This might further contribute to neuromuscular fitness.
These possible therapeutic effects of salat may suggest
incorporating it in rehabilitation as a gentle exercise. More
studies are needed to determine the full beneficial effects of
the salat prayer on the rehabilitative process of disabled
persons.
Benefits in specific conditions:
Cervical Spondylosis
Cervical spondylosis is a common, age-related condition that
affects the joints and discs in the cervical spine, in the neck.
The practice of salat may improve the strength of neck
muscles. Sala’m, turning the head towards both shoulders at
the end of salat, might be a limited gentle neck exercise. A
small pilot study examined the muscle activity of the neck
extensors (NE), sternocleidomastoids (SCM) and biceps
brachii muscles was performed in 14 healthy subjects during
salat and specified exercises using surface electromyography
(EMG). No significant difference between salat and exercise
for NE (p = 0.482) and SCM (p=0.161) was shown and salat
might be considered a useful tool in the warming up exercises
or in the rehabilitation programs.33
Salat may also be beneficial in improving the wellbeing of
patients with cervical spondylosis. In a recent study, 200
participants were divided into two groups, group A: Muslim
males between the age group 40-60 years who performed
salat four times a day or more, and group B: Muslim males
between the age group 40-60 years who performed salat
infrequently (<3/wk).They were followed up for a period of
one and half years. Out of the 118 males who performed
regular salat, only 17 had cervical spondylosis, while among
the 82 males who performed irregular salat, 30 had cervical
spondylosis (P<0.05). They postulated that performing
regular salat might assist in the prevention of cervical
spondylosis.34
Erectile Dysfunction
The leading cause of erectile dysfunction (ED) or impotence is
arterial dysfunction, with cardiovascular disease as the most
common comorbidity. Physical activity has proved to be a
protective factor against erectile problems, and it has been
shown to improve erectile function for men affected by
vascular ED.35 Physical exercise therapy, particularly
involving pelvic floor muscles, has been shown to provide
beneficial effects on ED, boosting blood circulation and
reducing ED symptoms. Salat movements may be a beneficial
form of pelvic floor exercise. A small pilot study including 10
volunteers were divided into two groups. Subjects who were
Muslims (Group I) were asked to perform their daily salat and
a new intervention of an additional 12 movement cycles of
salat three sessions a week for a duration of 4 months. Non-
Muslim subjects (Group II) were taught to mimic salat
movements, and were asked to perform a total of 12
movement cycles without reading the recitation for three
sessions a week. A nocturnal electrobioimpedance volume
assessment (NEVA) device was used to measure the nocturnal
penile tumescence (NPT) parameters. All measured
parameters improved significantly, with the largest change
observed in the maximum percent volumetric change over
the baseline (from 138 to 222%). This preliminary study
suggests that salat and mimicking salat movements, may
have beneficial effects for ED patients.35 A larger study,
however, is required in the future to validate these findings,
particularly in their utility as an adjunct to PDE5 inhibitors.
CONCLUSION
Salat is a spiritual and physical activity during which, nearly
all muscles of the human body become more active than any
kind of exercise without muscle fatigue. It induces serenity on
the body and soul. The interaction between the central
nervous system and autonomic nervous system during salat
promotes relaxation and minimizes anxiety for individuals
who regularly practice salat. Salat involves both cognitive and
motor components. However, only one study is available in
the literature addressing the relationship between religiosity
and cognitive function. Performing salat may slightly reduce
systolic and diastolic blood pressure but the studies available
are very preliminary and more constructive studies on the
effects of salat on cardiovascular system are warranted. Mind
and body medicine as offered in the practice of salat may
assist in the prevention of chronic illnesses such as
degenerative musculoskeletal ailments and alleviate the
symptoms of chronic disease. The physical activities involved
in the performance of salat helps in the rehabilitation process
in disabled geriatric patients by improving blood flow and
increasing musculoskeletal fitness. As noted in this review,
many studies conducted on salat involve small number of
patients. More quantitative and qualitative research is
needed to further examine the medical aspects of salat. Long-
term studies that enroll a larger population should provide
more accurate data.

A review of the literature on the health benefits of Salat (Islamic prayer)
Med J Malaysia Vol 76 No 1 January 2021 93
LIMITATIONS OF THE REVIEW
There are several limitations in this review. There is paucity
of research on this subject and hence there are very few
studies investigating the clinical effects of salat. The majority
of the studies included in this review enrolled a small number
of patients. There is certainly lack of longitudinal long-term
follow up of the studied subjects, and the majority of the
studies were observational and not randomised. No specific
attention was made to the confounding factors such as age or
gender in the majority of the studies reviewed. No
comparative studies were performed on the Islamic prayer
and prayers in other religions. More work needs to be carried
out to explore the biomechanics of salat and the way salat
influences the overall health and wellbeing. For example,
current literature shows that there is some activation of
different muscle groups during salat, but the extent of
activation is inconsistent in the literature and additional
studies need to be carried out.29 More studies enrolling larger
numbers of participants are necessary to further elucidate the
health effects of salat.
ACKNOWLEDGEMENT
We would like to deeply thank Dr. Mohammed Ali Albar for
his constructive comments on the manuscript.
FUNDING
This review was not funded.
CONFLICT OF INTEREST
No conflict of interest.
ETHICAL APPROVAL
This review article does not contain any studies with human
participants or animals performed by any of the authors.
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