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Effect of salat prayer and exercise on cognitive functioning of Hui Muslims aged sixty and over.

The proportion of the population of the world that is composed of adults in the age group of 60 years or older is unprecedented in the history of humanity. The proportion of older persons was 8% in 1950 and 10% in 2000, and it is projected to reach 21% in 2050 (Population Division, Department of Economic and Social Affairs, United Nations, 2002). How to maintain or enhance cognitive functioning in later life and slow down the process of aging has become an important issue for those responsible for public health policy.

Cognitive functioning refers to abilities such as perception, memory, verbalizing, and thinking. Researchers have shown that the cognitive functioning of older adults could be improved by systematic training, and the level of improved functionality could even be retained to some extent-a phenomenon called cognitive plasticity or neural plasticity (Baltes & Lindenberger, 1988; Willis et al., 2006). As a form of training, physical exercise has become a focus of great interest for current researchers (Erickson & Kramer, 2009), who have found that physical activities, such as t'ai chi ch'uan and yoga, are beneficial to cognitive functioning. In a recent study Kasai et al. (2010) reported that among a group of people who had been diagnosed with a mild cognitive impairment, completing a six-month program of t'ai chi ch'uan led to a significant improvement in memory.

It has been hypothesized that the mechanism by which the practice of physical exercise or mind-body exercise may benefit cognitive functioning is cardiovascular fitness. It has been suggested that the gains in cardiovascular fitness achieved by regular participation in physical exercise mediate the cognitive performance benefits that result (Etnier, Nowell, Landers, & Sibley, 2006). Additionally, through the practice of mind-body exercises body awareness is emphasized and the attention of the individual is focused on breathing or specific muscles or parts of the body, so it is possible that mind-body exercises improve general ability to maintain concentration and length of attention span (Chang, Nien, Tsai, & Etnier, 2010). Given this mechanism, it is understandable that physical or mind-body exercise might exert an influence on cognitive outcomes.

Although the notion of physical exercise preventing or halting cognitive decline seems to be well supported, most of these findings have been based on studies of cardiovascular exercise and mind-body exercises such as jogging, swimming, or t'ai chi ch'uan. The study of the cognitive benefits of salat prayer, a specific form of physical activity long performed in the Muslim population, is a new field. Salat is the Arabic word for prayers offered by Muslim worshippers and it is the second pillar of the Islamic faith. Muslims are called to perform salat prayer five times a day, a process consisting not only of prayer recitation and meditation, but also of body movements and positions. The main body positions involved in salat prayer are standing (qiyyam), bowing (rukuk), prostration (sujud), and sitting (tashahhud). The movements are performed repeatedly, in accordance with the ordained prayer regulations (Reza, Urakami, & Mano, 2002).

This type of mind concentration has a tranquilizing effect and is different from conventional meditation. Moreover, the salat prayer is classified as a short duration exercise with similar physical benefits to other physical activities of this type. For example, researchers have found that salat prayer helped rehabilitate patients with age-related disabilities by improving blood flow and increasing musculoskeletal fitness (Reza et al., 2002). By using electrocardiograms, Ibrahim and Wan Ahmad (2008) also found that the heart rate of people who were practicing salat prayer differs in the various salat positions. Thus, the physiological influence of salat prayer has been studied, but the psychological effects have not yet been explored. Therefore, this study was designed to enable us to compare the cognitive functioning of Hui Muslims aged 60 and over who regularly practiced salat prayer and/or who exercised regularly, with people in the same age group who neither practiced salat prayer nor exercised regularly.

On the basis of the preceding discussion, we proposed the following hypotheses:

Hypothesis 1: Hui Muslims aged 60 and over who practice salat prayer (SP) and/ or do physical exercise (PE) regularly will have superior cognitive performance to those who neither practice SP nor do PE.

Hypothesis 2: Hui Muslims aged 60 and over who both practice SP and do PE regularly will have superior cognitive performance to those who only practice SP or only do PE.

Method

Participants

During 2005 and 2006 we selected a group of Hui Muslims aged between 60 and 96 years from communities in Yinchuan, the capital of the Ningxia Hui Autonomous Region in China. After excluding people who had a history of psychiatric, neurological, or other serious health problems, the group comprised 205 participants (98 females, 107 males) aged between 60 to 86 years, for whom the number of years of education ranged from 0 to 14.

Materials

Physical Activities Questionnaire. The participants reported the frequency and duration of exercise they took and salat prayer that they practiced and provided demographic information.

The Scale of Cognitive Functioning in Older People (SCFOP). We used the SCFOP (Hong, 1990) to assess cognitive functioning. This scale was modified and expanded from the Mini Mental State Examination (MMSE) and the Modified MMSE (3MS; Teng & Chui, 1987) so that it could be applied in the Chinese context. It consists of 11 subscales, including orientation to time and place, memorization, digit span, recall I, long-term memory, animal naming, write-off and calculation, classification and similarity, copy, speech, and recall II. The SCFOP is used in a clinical setting for measuring the level of cognitive functioning in older Chinese adults. It has been shown to have relatively good reliability and validity (Hong, 1990). The subscales demonstrated four-week test-retest reliabilities ranging between 0.588 and 0.839 (p < .01), and the test-retest reliability coefficient of the total score was 0.934 (p < .01). The SCFOP thus has high reliability.

Procedure

We interviewed and assessed the participants who had given their written informed consent. The research ethics committee of the Chengdu Sport University approved the study. According to whether or not they took regular exercise and/or regularly practiced salat prayer, the participants were divided into four groups: salat prayer and physical exercise (SP+PE), physical exercise (PE), salat prayer (SP), and neither physical exercise nor prayer (NO).

Statistical Analyses

Analyses of variance (ANOVAs) were performed to explore group differences in demographic and exercise/prayer characteristics. When group differences were found, Tukey honestly significant difference (HSD) post hoc analyses were performed. Partial eta squared was computed to measure the effect sizes, which ranged from very small (<0.01) to small (0.01-0.05) to moderate (0.06-0.13) to large ([greater than or equal to]0.14) (Cohen, 1988).

Results

Demographic Characteristics and Physical Activity Frequency

As shown in Table 1, the four groups were matched in terms of gender, age, and education.

Salat Prayer, Physical Exercise, and Cognitive Performance

A one-way ANOVA was performed to examine the subscale and total scores obtained by the participants on the SCFOP. Table 2 shows details of the performances of the four groups of participants on the SCFOP. The subscales of digit span, recall I, write-off and calculation, copy, recall II, and total score showed significant differences among the four groups (p < .01). Post hoc Tukey analyses showed that the SP+PE group, the SP group, and the PE group achieved significantly higher scores than did the NO group. These findings support Hypothesis 1. Moreover, the SP+PE group achieved higher scores than did the PE group in the subscales of recall I and write-off and calculation. This partly supports Hypothesis 2.

Discussion

Based on scores obtained on the SCFOP, our findings revealed a significant association between regularly practicing SP and/or PE and better cognitive functioning in Hui Muslims aged 60 and over, compared with those who did not take part in either of these activities. In particular, the performance on the SCFOP of the group of participants who regularly practiced SP was not statistically different from that of their counterparts who regularly performed PE. This similarity suggests that exercise, whether it is SP or PE, might help older adults maintain their cognitive ability. Hillman et al. (2006) suggested that physical activity may be beneficial to both general and selective aspects of cognition, particularly among older adults in American populations. Our findings revealed the positive effects of physical exercise on late-life cognitive performance in a Chinese Muslim population, whose diet, living habits, and social structures differ greatly from those of American populations. Hence, it seems that, regardless of their cultural background, older adults benefit from physical exercise. In addition, given that our findings suggest that SP activity produces an effect similar to that of PE, SP can be considered an alternative type of PE for older Muslim adults who cannot exercise vigorously because of the risk of injuries and/ or cardiac hazards.

In the subscale of recall I, the performance of the participants in the study who were both practicing SP and doing PE was better than that of those who only did PE or those who neither prayed nor took physical exercise. According to findings in a recent study, doing both mind-body and cardiovascular exercises appears to have a combined effect that might help to maintain memory in older adults (Chan et al., 2005). Our results are, in some ways, consistent with that study. Furthermore, in the subscale of write-off and calculation, the SP+PE, SP, and PE groups all achieved significantly higher scores than did the NO group. The score of the SP+PE group was higher than that of the PE group, which suggests a combined effect that might help maintain concentration in older adults. Our findings are similar to those of Taylor-Piliae et al. (2010) who found that when people practiced t'ai chi ch'uan this led to improvement in an indicator of cognitive functioning that was maintained for 12 months. When a Muslim is practicing salat prayer, as well as physical activity, this entails a series of accompanying mind activities consisting of reciting, concentration, and so forth. Also, because Muslims are obliged to perform salat five times a day, the long duration of salat prayer could have an effect on cognitive functioning.

However, in our study there were no significant differences among the groups of participants in the subscales of orientation, memorization, long-term memory, animal naming, classification and similarity, and speech. There was no positive effect found for the group who did PE and also practiced SP in other subscales or in the total score. A possible explanation for these results is that the memorization subscale does not have a significant coefficient of variation (Hong, 1990) in that this subscale was used to examine both recall I and recall II. We chose to use the SCFOP in this study because no Chinese scale has yet been developed for use with healthy older adults. However, the SCFOP is a clinical screening tool for diagnosis of dementia and the participants in our study were healthy people aged 60 and over; hence, no statistical differences were found in these subscales.

Although the findings from this study are encouraging in terms of the benefits of both physical exercise and salat prayer for maintaining cognitive functioning in healthy people aged 60 and over, there are several limitations. First, the data on the frequency and duration of exercise and prayer were gained from the participants' self-reports which, being subjective judgments, can result in bias. Second, as a cross-sectional study, these findings cannot reveal causal relationships, although age, gender, years of education, and details of salat prayer or exercise were controlled. Third, in this study we did not explore how salat prayer influences cognition in general. That is, the effect of salat prayer as both a physical and a spiritual exercise was not discussed. Finally, the focus in our study was only on the effect of Muslim prayer. The possible health effects of the other four pillars of the Islamic faith have not been explored.

Future researchers could consider using objective measures of physical exercise or proxy reports of physical activity (Middleton, Kirkland, Mitnitsk, & Rockwood, 2010). Further longitudinal or experimental studies are needed in which the possible effects of these cross-sectional observations are tested and the potential of practicing salat prayer as a form of protection against cognitive decline and dementia is explored. Further experimental studies are also needed to explore how salat prayer influences the cognition of older adults and how memorizing God's words (the Holy Qur'an) might itself impact the cognition of older adult Muslims.

10.2224/sbp.2012.40.10.1739

References

Baltes, P. B., & Lindenberger, U. (1988). On the range of cognitive plasticity in old age as a function of experience: 15 years of intervention research. Behavior Therapy, 19, 283-300. http:// doi.org/b42t5g

Chan, A. S., Ho, Y., Cheung, M., Albert, M. S., Chiu, H. F. K., & Lam, L. C. W. (2005). Association between mind-body and cardiovascular exercises and memory in older adults. Journal of the American Geriatrics Society, 53, 1754-1760. http://doi.org/bgwgqf

Chang, Y.-K., Nien, Y.-H., Tsai, C.-L., & Etnier, J.-L. (2010). Physical activity and cognition in older adults: The potential of Tai Chi Chuan. Journal of Aging and Physical Activity, 18, 451-472.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

Erickson, K. I., & Kramer, A. F. (2009). Aerobic exercise effects on cognitive and neural plasticity in older adults. British Journal of Sports Medicine, 43, 22-24. http://doi.org/csrm4c

Etnier, J. L., Nowell, P. M., Landers, D. M., & Sibley, B. A. (2006). A meta-regression to examine the relationship between aerobic fitness and cognitive performance. Brain Research Reviews, 52, 119-130. http://doi.org/dtsvkk

Hillman, C. H., Motl, R. W., Pontifex, M. B., Posthuma, D., Stubbe, J. H., Boomsma, D. I., & de Geus, E. J. C. (2006). Physical activity and cognitive function in a cross-section of younger and older community-dwelling individuals. Health Psychology, 25, 678-687. http://doi.org/dntjvc

Hong, W. (1990). Design and primary assessment of the Scale of Cognitive Function in Older People (SCFOP). Chinese Mental Health Journal, 4, 109-114.

Ibrahim, F., & Wan Ahmad, W. A. (2008). Study of heart rate changes in different Salat positions. Paper presented at the 4th Kuala Lumpur International Conference on Biomedical Engineering, Kuala Lumpur. http://doi.org/bpmfhh

Kasai, J. Y. T., Busse, A. L., Magaldi, R. M., Soci, M. A., de Morraes Rosa, P., Curiati, J. A. E., & Filho, W. J. (2010). Effects of Tai Chi Chuan on cognition of elderly women with mild cognitive impairment. Einstein, 8, 40-45.

Middleton, L. E., Kirkland, S. A., Mitnitsk, A., & Rockwood, K. (2010). Proxy reports of physical activity were valid in older people with and without cognitive impairment. Journal of Clinical Epidemiology, 63, 435-440. http://doi.org/fv59gm

Population Division, Department of Economic and Social Affairs, United Nations. (2002). World population ageing: 1950-2050. New York: Author.

Reza, M. F., Urakami, Y., & Mano, Y. (2002). 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. Annals of Saudi Medicine, 22, 177-180.

Taylor-Piliae, R. E., Newell, K. A., Cherin, R., Lee, M. J., King, A. C., & Haskell, W. L. (2010). Effects of Tai Chi and Western exercise on physical and cognitive functioning in healthy community-dwelling older adults. Journal of Aging and Physical Activity, 18, 261-279.

Teng, E. L., & Chui, H. C. (1987). The Modified Mini-Mental State Examination (3MS). The Journal of Consultant Clinical Psychology, 48, 314.

Willis, S. L., Tennstedt, S. L., Marsiske, M., Ball, K., Elias, J., Koepke, K. M., ... Wright, E. (2006). Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA: Journal of the American Medical Association, 296, 2805-2814. http://doi.org/bngvd5

RONG BAI

Shaanxi University of Technology

PING YE

Chengdu Sport University

CAIFANG ZHU

Yu Xin Yuan Psychological Counseling Center and Renmin University of China

WEI ZHAO AND JINFU ZHANG

Southwest University

Rong Bai, School of Education Science, Shaanxi University of Technology; Ping Ye, Chengdu Sport University; Caifang Zhu, Yu Xin Yuan Psychological Counseling Center and International Center for Buddhist Studies, Renmin University of China; Wei Zhao, School of Foreign Languages, Southwest University; Jinfu Zhang, School of Psychology and the Key Laboratory of Cognition and Personality, Research Institute for Education and Psychology of Southwestern Ethnic Groups, Southwest University.

This work was supported in part by Chengdu Sport University. The authors thank all the participants, as well as Associate Professor Zhi-Ming Lu and Dr. Hui-Yong Fan for their encouragement and help throughout this study.

Correspondence concerning this article should be addressed to: Rong Bai, School of Education Science, Shaanxi University of Technology, Hanzhong 723001, People's Republic of China. Email: ayshabai@hotmail.com
Table 1. Demographic Characteristics and Salat Prayer
Practice/Physical Exercise of Participants

Characteristic          Salat prayer    Physical
                        and physical    exercise
                          exercise
                          (n = 50)      (n = 45)

Female                     n = 18        n = 22
Male                       n = 32        n = 23

Characteristic             Salat       No physical
                           prayer       exercise
                                        or prayer
                          (n = 56)      (n = 54)

Female                     n = 27        n = 31
Male                       n = 29        n = 23

                        Salat prayer    Physical
                        and physical    exercise
                          exercise
                          (n = 50)      (n = 45)

                              M [+ or -] SD

Age                     67.78 [+ or    68.60 [+ or
                          -] 6.497      -] 5.990
Education (years)        5.36 [+ or    4.96 [+ or
                          -] 3.355      -] 3.542

Number of times         31.16 [+ or
  per week for prayer     -] 9.838
Total hours per          6.17 [+ or
  week for prayer         -] 2.128
Duration in years for   18.26 [+ or
  regular prayer         -] 16.627

Number of times per      6.76 [+ or    6.60 [+ or
  week for exercise       -] .916       -] 1.156
Total hours per          9.94 [+ or    11.82 [+ or
  week for exercise       -] 4.264      -] 5.131
Duration in years for    7.78 [+ or    8.71 [+ or
  regular exercise        -] 5.758      -] 4.718

                           Salat       No physical
                           prayer       exercise
                                        or prayer
                          (n = 56)      (n = 54)

                               M [+ or -] SD

Age                     68.98 [+ or    68.33 [+ or
                          -] 6.832      -] 6.280
Education (years)        3.75 [+ or    4.22 [+ or
                          -] 4.122      -] 2.840

Number of times         33.75 [+ or
  per week for prayer     -] 4.028
Total hours per          6.73 [+ or
  week for prayer         -] .863
Duration in years for   16.54 [+ or
  regular prayer         -] 12.785

Number of times per                      2.37293
  week for exercise
Total hours per
  week for exercise
Duration in years for
  regular exercise

                            F/t         df         P

Age                         .323       3.201      .809

Education (years)          2.223       3.201      .087

Number of times            -1.744       104       .087
  per week for prayer
Total hours per            -1.736       104       .086
  week for prayer
Duration in years for      2.893        104       .548
  regular prayer

Number of times per         .127
  week for exercise
Total hours per            2.788        93        .098
  week for exercise
Duration in years for      3.005        93        .086
  regular exercise

Table 2. Comparisons of Cognitive
Functioning on the SCFOP

Subscale             Salat prayer         Physical
                     and physical         exercise
                       exercise
                       (n = 50;           (n = 45;
                     male n = 32,       male n = 23,
                    female n = 18)     female n = 22)

                              M [+ or -] SD

Orientation          14.10 [+ or        13.91 [+ or
                       -] .863            -] .996
Memorization          2.00 [+ or         2.00 [+ or
                        -] .00             -] .00
Digit span            1.02 [+ or         1.07 [+ or
                       -] 1.801           -] 1.468
Recall I              5.49 [+ or        4.256 [+ or
                      -] 2.3134          -] 2.0355

Long-term memory      9.20 [+ or         8.73 [+ or
                       -] 1.010           -] 1.232
Animal naming         8.00[+ or          7.49 [+ or
                       -]1.245            -] 1.804
Write-off and         7.36 [+ or         6.07 [+ or
  calculation          -] 1.687           -] 1.970
Classification        9.34 [+ or         9.60 [+ or
  and similarity       -] 1.507           -] 1.304
Copy                  7.52 [+ or         7.31 [+ or
                       -] 1.854           -] 1.893
Speech               16.80 [+ or        16.78 [+ or
                       -] .495            -] .471
Recall II            7.590 [+ or        6.956 [+ or
                      -] 2.0094          -] 1.8148
Total score        97.4200 [+ or -]   93.1667 [+ or -]
                       9.40384            9. 50717

Subscale             Salat prayer       No physical
                                          exercise
                                      or salat prayer
                       (n = 56;           (n = 54;
                     male n = 29,       male n = 23,
                    female n = 27)     female n = 31)

                             M [+ or -] SD

Orientation          14.27 [+ or        13.98 [+ or
                       -] 1.053           -] .901
Memorization          2.00 [+ or         2.00 [+ or
                        -] .00             -] .00
Digit span            9.32 [+ or         7.81 [+ or
                       -] 2.116           -] 1.065
Recall I             4.607 [+ or        3.130 [+ or
                      -] 2.2698          -] 1.3002

Long-term memory      8.77 [+ or         8.63[+ or
                       -] 1.388           -]1.263
Animal naming         7.68 [+ or         7.48 [+ or
                       -] 1.770           -] 1.611
Write-off and         6.88 [+ or         4.89 [+ or
  calculation          -] 2.216           -] 1.176
Classification        9.34 [+ or         8.94 [+ or
  and similarity       -] 1.687           -] 1.774
Copy                  7.59 [+ or         5.87 [+ or
                       -] 2.279           -] 1.505
Speech               16.73 [+ or        16.54 [+ or
                       -] .486            -] .665
Recall II            7.009 [+ or        5.259 [+ or
                      -] 1.9737          -] 1.2913
Total score        94.1875 [+ or -]   84.5370 [+ or -]
                       11.35364           5.16962

Subscale

                          F            df               p

Orientation             1.381         3, 201           .250

Memorization             ---           ----            ----

Digit span              2.472         3, 201           <.001

Recall I                12.252        3, 201           <.001

                                                  PE>NO, SP+PE>PE
Long-term memory        2.103         3, 201           .101

Animal naming           1.119         3, 201           .342

Write-off and           18.924        3, 201           <.001
  calculation                                     PE>NO SP+PE>PE
Classification          1,451         3, 201           .229
  and similarity
Copy                    9.662         3, 201           <.001

Speech                  2.594         3, 201           .054

Recall II               16.598        3, 201           <.001

Total score             19.111        3, 201           <.001

Subscale

                       Post hoc         Effect size

Orientation            .20 (a)

Memorization

Digit span         SP+PE, SP, PE>NO       .234 (a)

Recall I              SP+PE, SP,          .155 (a)

Long-term memory                          .030 (c)

Animal naming                              .016 (c)

Write-off and         SP+PE, SP,          .220 (a)
  calculation
Classification                             .021 (c)
  and similarity
Copy               SP+PE, SP, PE>NO       .126 (b)

Speech                                     .037 (c)

Recall II          SP+PE, SP, PE>NO       .199 (a)

Total score           SP+PE, SP,          .222 (a)
                        PE>NO

Note: SP+PE = salat prayer and physical exercise;
SP = salat prayer; PE = physical exercise;
NO = no salat prayer or physical exercise.
Partial eta squared was used to compute effect
size: a) large, b) moderate, c) small;
SCFOP = Scale of Cognitive Functioning of Older People.
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Author:Bai, Rong; Ye, Ping; Zhu, Caifang; Zhao, Wei; Zhang, Jinfu
Publication:Social Behavior and Personality: An International Journal
Article Type:Report
Geographic Code:9CHIN
Date:Nov 1, 2012
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