Journal of Religion and Health

, Volume 58, Issue 1, pp 28–40 | Cite as

Ramadan Fasting Effects on Postural Control in the Elderly: A Comparison Between Fallers and Non-fallers

  • Rabeb LaatarEmail author
  • Rym Baccouch
  • Rihab Borji
  • Hiba Kachouri
  • Haithem Rebai
  • Sonia Sahli
Original Paper


Our purpose was to compare the effects of Ramadan fasting on postural control in elderly fallers and non-fallers. The protocol involved twenty-four healthy old volunteer males divided into two groups: fallers (mean age = 75.43 ± 5.26 years, weight = 67.25 ± 5.30 kg and height = 1.65 ± 0.02 m) and non-fallers (mean age = 72.3 ± 6.42 years, weight = 65.5 ± 6.15 kg and height = 1.64 ± 0.03 m). Participants performed a simple reaction time test (SRT) and a postural control protocol on four different occasions: one week before Ramadan (BR), during the second (SWR) and the fourth week (FWR) of Ramadan and three weeks after Ramadan (AR). Center of pressure (CoP) parameters [the CoP medial–lateral length (CoPX), and the CoP antero-posterior length (CoPY)] were assessed using a force platform under two surface conditions: Firm surface and Foam surface. The results showed that Ramadan fasting influences similarly fallers and non-fallers. In fact, for both groups, the CoPX and the CoPY values increased significantly during the SWR and the FWR compared to BR. These CoP parameters decreased significantly in the Firm surface conditions in the FWR. Moreover, the CoP parameters were significantly higher during the FWR and AR in comparison with BR in the Foam surface conditions. However, the amplitude of increase of the CoP[X] % and the CoP[Y] % (ΔCoP[X] % and ΔCoP[Y] %) between BR and the SWR was significantly higher in the fallers than non-fallers. The SRT of elderly fallers and non-fallers was significantly higher in the SWR and in the FWR compared to BR. In conclusion, Ramadan fasting alters similarly postural control of elderly fallers and non-fallers, but the amplitude (ΔCoP[X] % and ΔCoP[Y] %) of this alteration seems to be more pronounced in fallers than non-fallers. A probable beginning of adaptation occurs at the FWR. However, three weeks seems to be insufficient to recover postural control alterations due to Ramadan fasting in difficult sensory conditions in elderly fallers and non-fallers.


Falls Postural control Elderly Ramadan fasting 



We would like to thank the head of the Neurophysiology department of a University Hospital for collaboration and help. We also thank all the participants for their understanding and availability.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights Statement

This study involved human participants.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Agmon, M., Belza, B., Nguyen, H. Q., Logsdon, R. G., & Kelly, V. E. (2014). A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults. Journal of Clinical Interventions in Aging, 9, 477.CrossRefGoogle Scholar
  2. Al Wakeel, J., Mitwalli, A. H., Alsuwaida, A., Al Ghonaim, M., Usama, S., Hayat, A., et al. (2013). Recommendations for fasting Ramadan for patients on peritoneal dialysis. Journal of the International Society for Peritoneal Dialysis, 33, 86–91.CrossRefGoogle Scholar
  3. Bahammam, A. S., Alaseem, A. M., Alzakri, A. A., & Sharif, M. M. (2013). The effects of Ramadan fasting on sleep patterns and daytime sleepiness: An objective assessment. Journal of Research in Medical Sciences, 18, 127–131.Google Scholar
  4. Borel, L., & Alescio-Lautier, B. (2014). Posture and cognition in the elderly: Interaction and contribution to rehabilitation strategies. Neurophysiologie Clinique, 44, 95–107.CrossRefGoogle Scholar
  5. Canavan, A. G. M., Bayer, N., & Lutzenberger, W. (1993). The decline of spatial and temporal abilities with age. In G. E. Stelmach & V. Homberg (Eds.), Sensorimotor impairment in the elderly (pp. 57–72). Dordrecht: Kluwer.CrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention (CDC). (2000). Fatalities and injuries from falls among older adults—United States, 1993–2003 and 2001–2005. MMWR Morbidity and Mortality Weekly Report, 55, 1221–1224.Google Scholar
  7. El Moutawakil, B., Hassounr, S., Sibai, M., Rafai, M. A., Fabrigoule, C., & Slassi, I. (2007). Impact du jeûn du Ramadan sur les fonctions attentionnelles. Revue Neurologique, 163(4), 60.CrossRefGoogle Scholar
  8. Frey, D. J., Badia, P., & Wright, K. P. (2004). Inter and intra individual variability in performance near the circadian nadir during sleep deprivation. Journal of Sleep Research, 13, 305–315.CrossRefGoogle Scholar
  9. Fuller, F. (2000). Falls in the elderly. American Family Physician, 61, 2159–2168.Google Scholar
  10. Gill, D. P., Zou, G. Y., Jones, G. R., & Speechley, M. (2008). Injurious falls are associated with lower household but higher recreational physical activities in community-dwelling older male veterans. Gerontology, 54, 106–115.CrossRefGoogle Scholar
  11. Hakkou, F., Tazi, A., & Iraki, L. (1994). Ramadan, health and chronobiology. Chronobiology International, 11, 340–342.CrossRefGoogle Scholar
  12. Hausdorff, J. M., Doniger, G. M., Springer, S., Yogev, G., Simon, E. S., & Giladi, N. (2006). A common cognitive profile in elderly fallers and in patients with Parkinson’s disease: The prominence of impaired executive function and attention. Experimental Aging Research, 32, 411–429.CrossRefGoogle Scholar
  13. Herrera Christopher, P., Berrichi, H., Chamari, K., & Davenne, D. (2015). Circadian rhythm and sleep disturbances during Ramadan: Implications on sports performance. In H. Chtourou (Ed.), Effects of Ramadan fasting on health and athletic performance. Foster City, CA: OMICS Group.Google Scholar
  14. Lagarde, D., Btejat, D., Boussif, M., Pradellas, S., Girault, S., & Huppe, M. (1996). Ramadan et vigilance. Médecine Aéronautique et Spatiale, 35, 175–182.Google Scholar
  15. Lajoie, Y., Girard, A., & Guay, M. (2002). Comparison of the reaction time, the Berg Scale and the ABC in non-fallers and fallers. Archives of Gerontology and Geriatrics, 35, 215–225.CrossRefGoogle Scholar
  16. Lajoie, Y., Teasdale, N., Bard, C., & Fleury, M. (1993). Attentional demands for static and dynamic equilibrium. Experimental Brain Research, 97, 139–144.CrossRefGoogle Scholar
  17. Laraqui, C. H., Tripodi, D., Laraqui, O., Rahhali, A., Calibet, A., Daoudi, F., et al. (2001). TOPICAL EVENT-The effects of fasting and of the quality of sleep on work during the month of Ramadan. Archives des Maladies Professionnelles et de Médecine de travail, 62, 115–120.Google Scholar
  18. Lazaro, M., Gonzalez, A., Latorre, G., Fernandez, C., & Ribera, J. M. (2011). Postural stability in the elderly: Fallers versus non-fallers. European Geriatric Medicine, 2, 1–5.CrossRefGoogle Scholar
  19. Leigh Gibson, E., & Green, M. W. (2002). Nutritional influences on cognitive function: Mechanisms of susceptibility. Nutrition Research Reviews, 15, 169–206.CrossRefGoogle Scholar
  20. Lieberman, H. R., Bathalon, G. P., Falco, C. M., Kramer, F. M., Morgan, C. A., & Niro, P. (2005). Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration, and under nutrition during simulated combat. Biological Psychiatry, 57, 422–429.CrossRefGoogle Scholar
  21. Liu, Y., Higuchi, S., & Motohashi, Y. (2001). Changes in postural sway during a period of sustained wakefulness in male adults. Occupational Medicine, 51, 490–495.CrossRefGoogle Scholar
  22. Lord, S. R., Clark, R. D., & Webster, I. W. (1991). Physiological factors associated with falls in an elderly population. Journal of the American Geriatrics Society, 39, 1194–1200.CrossRefGoogle Scholar
  23. Lord, S. R., Rogers, M. W., Howland, A., & Fitzpatrick, R. (1999). Lateral stability, sensorimotor function and falls in older people. Journal of the American Geriatrics Society, 47, 1077–1081.CrossRefGoogle Scholar
  24. Lord, S. R., & Webster, I. W. (1990). Visual field dependence in elderly fallers and non-fallers. The Inernational Journal of Aging & Human Development, 31, 267–277.CrossRefGoogle Scholar
  25. Melzer, I., Benjuya, N., & Kaplanski, J. (2004). Postural stability in the elderly: A comparison between fallers and non-fallers. Age and Ageing, 33, 602–607.CrossRefGoogle Scholar
  26. Melzer, I., Kurz, I., & Oddsson, L. I. (2010). A retrospective analysis of balance control parameters in elderly fallers and non-fallers. Clinical Biomechanics, 25, 984–988.CrossRefGoogle Scholar
  27. Menz, H. B., & Lord, S. R. (2001). The contribution of foot problems to mobility impairment and falls in community-dwelling older people. Journal of the American Geriatrics Society, 49, 1651–1656.CrossRefGoogle Scholar
  28. Meo, S. A., & Hassan, A. (2015). Physiological changes during fasting in Ramadan. Journal of the Pakistan Medical Association, 65(5 Suppl 1), S6–S14.Google Scholar
  29. Müjdeci, B., Aksoy, S., & Atas, A. (2012). Evaluation of balance in fallers and non-fallers elderly. Brazilian Journal of Otorhinolaryngology, 78, 104–109.CrossRefGoogle Scholar
  30. Mulder, T., Zijlstra, W., & Geurts, A. (2002). Assessment of motor recovery and decline. Gait & Posture, 16, 198–210.CrossRefGoogle Scholar
  31. Parihar, R., Mahoney, J. R., & Verghese, J. (2013). Relationship of gait and cognition in the elderly. Current Translational Geriatrics Experimental Gerontology Reports, 2, 167–173.CrossRefGoogle Scholar
  32. Patel, M., Gomez, S., Berg, S., Almbladh, P., Lindblad, J., Petersen, H., et al. (2008). Effects of 24-h and 36-h sleep deprivation on human postural control and adaptation. Experimental Brain Research, 185, 165–173.CrossRefGoogle Scholar
  33. Racinais, S., Périard, J. D., Li, C. K., & Grantham, J. (2012). Activity patterns, body composition and muscle function during Ramadan in a Middle-East Muslim Country. International Journal of Sports Medicine, 33, 641.CrossRefGoogle Scholar
  34. Robillard, R., Prince, F., Filipini, D., & Carrier, J. (2011). Aging worsens the effects of sleep deprivation on postural control. PLoS ONE, 6, e28731.CrossRefGoogle Scholar
  35. Roky, R., Chapotot, F., Benchekroun, M. T., Benaji, B., Hakkou, F., Elkhalifi, H., et al. (2003). Daytime sleepiness during Ramadan intermittent fasting: Polysomnographic and quantitative waking EEG study. Journal of Sleep Research, 12, 95–101.CrossRefGoogle Scholar
  36. Roky, R., Chapotot, F., Hakkouk, F., Benchekroun, M. T., & Buguet, A. (2001). Sleep during Ramadan intermittent fasting. Journal of Sleep Research, 10, 319–327.CrossRefGoogle Scholar
  37. Roky, R., Iraki, L., HajKhlifa, R., Ghazal, N. L., & Hakkou, F. (2000). Daytime alertness, mood, psychomotor performances and oral temperature during Ramadan intermittent fasting. Annals of Nutrition & Metabolism, 44, 101–107.CrossRefGoogle Scholar
  38. Rothschild, J., Bates, D., & Lape, L. (2000). Preventable medical injuries in older patients. Archives of Internal Medicine, 160, 2717–2728.CrossRefGoogle Scholar
  39. Shu, Z., Xing-Yu, W., & Li-Ping, H. A. N. (1997). Effect of sleep deprivation up to 48-hour on tracking performance and two-hand accordance. Chine Journal of Aerospace Medicine, 8, 158–162.Google Scholar
  40. Souissi, N., Chtourou, H., Zouita, A., Dziri, C., & Souissi, N. (2013a). Effects of Ramadan intermittent fasting on postural control in judo athletes. Biological Rhythm Research, 44, 237–244.CrossRefGoogle Scholar
  41. Souissi, N., Zouita, A., Chtourou, H., Ferchichi, H., Dziri, C., Abedelmalek, S., et al. (2013b). The effect of Ramadan intermittent fasting on dynamic postural control in judo athletes. Biological Rhythm Research, 45, 27–36.CrossRefGoogle Scholar
  42. Suhr, J. A., Hall, J., Patterson, S. M., & Niinisto, R. T. (2004). The relation of hydration status to cognitive performance in healthy older adults. International Journal of Psychophysiology, 53, 121–125.CrossRefGoogle Scholar
  43. Taoudi, B. M., Roky, R., Toufiq, J., Benaji, B., & Hakkou, F. (1999). Epidemiological study: Chronotype and daytime sleepiness before and during Ramadan. Therapie, 54, 567–572.Google Scholar
  44. Teasdale, N., & Simoneau, M. (2001). Attentional demands for postural control: The effects of ageing and sensory reintegration. Gait & Posture, 14, 203–210.CrossRefGoogle Scholar
  45. Tinetti, M. E. (2003). Clinical practice: Preventing falls in elderly persons. New England Journal of Medicine, 348(1), 42–49.CrossRefGoogle Scholar
  46. Tinetti, M. E., & Speechley, M. (1989). Prevention of falls among the elderly. New England Journal of Medicine, 320, 1055–1059.CrossRefGoogle Scholar
  47. Tinetti, M. E., Speechley, M., & Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319, 1701–1707.CrossRefGoogle Scholar
  48. Vellas, B. J., Wayne, S. I., Romero, L. J., Baumgartner, R. N., & Garry, P. J. (1997). Fear of falling and restriction of mobility in elderly fallers. Age and Ageing, 26, 189–193.CrossRefGoogle Scholar
  49. Waterhouse, J. (2010). Effects of Ramadan on physical performance: Chronobiological considerations. British Journal of Sports Medicine, 44, 509–515.CrossRefGoogle Scholar
  50. Waterhouse, J., Alabed, H., Edwards, B., & Reilly, T. (2009). Changes in sleep, mood and subjective and objective responses to physical performance during the daytime in Ramadan. Biological Rhythm Research, 40, 367–383.CrossRefGoogle Scholar
  51. Woollacott, M., & Shumway-Cook, A. (2002). Attention and the control of posture and gait: A review of an emerging area of research. Gait & Posture, 16, 1–14.CrossRefGoogle Scholar
  52. Zerguini, Y., Kirkendall, D., Junge, A., & Dvorak, J. (2007). Impact of Ramadan on physical performance in professional soccer players. Britisch Journal of Sports Medicine, 41, 398–400.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Rabeb Laatar
    • 1
    Email author
  • Rym Baccouch
    • 2
  • Rihab Borji
    • 1
  • Hiba Kachouri
    • 1
  • Haithem Rebai
    • 1
  • Sonia Sahli
    • 1
  1. 1.Research Unit Education, Motricité, Sport et Santé, UR15JS01, High Institute of Sport and Physical Education of SfaxUniversity of SfaxSfaxTunisia
  2. 2.Faculty of Sciences of BizerteUniversity of CarthageTunisTunisia

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