Effects of Ramadan Fasting on Physical Performance: A Systematic Review with Meta-analysis

Abstract

Background

It is common that several athletes will fast while training or competing during Ramadan. There is currently no consensus on if or how this might affect physical performance.

Objective

The aim was to conduct a systematic review combined with a meta-analysis to determine what are the effects of fasting during the month of Ramadan on physical performance.

Methods

Three electronic databases were searched: PubMed, ScienceDirect, and Web of Science between from the earliest available date to May 2019. Two authors identified studies that evaluated the effects of Ramadan fasting on physical performance. Risk of bias was assessed using the Downs and Black methodological quality checklist. Pooled effects were reported as standardized mean differences (MDs) and 95% confidence intervals (CIs) using a random effects model.

Results

A total of 11 studies met the inclusion criteria. Results revealed that Ramadan fasting had a deleterious effect on mean power and peak power during a Wingate and/or a repeated sprint test. In the morning, sprint performance was negatively affected by Ramadan fasting. Aerobic performance, strength, jump height, fatigue index, and total work were not affected by the intermittent fasting during the month of Ramadan.

Conclusions

The majority of physical performance parameters were not influenced by Ramadan fasting when tested either in the morning or in the afternoon. Athletes appear able to participate in competition in a fasted state with little impact on physical performance. Sleep and nutrition opportunities should be optimized to minimize likelihood of accumulating fatigue.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Data Availability Statement

Data analyzed during this study are included in this published article (and Electronic Supplementary Material Appendix S1).

References

  1. 1.

    Sadeghirad B, Motaghipisheh S, Kolahdooz F, Zahedi MJ, Haghdoost AA. Islamic fasting and weight loss: a systematic review and meta-analysis. Public Health Nutr. 2014;17(2):396–406.

    PubMed  Google Scholar 

  2. 2.

    Trabelsi K, Rebai H, El-Abed K, Stannard SR, Khannous H, Masmoudi L, et al. Effect of ramadan fasting on body water status markers after a rugby sevens match. Asian J Sports Med. 2011;2(3):186–94.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Trabelsi K, Shephard RJ, Boukhris O, Ammar A, El-Abed K, Khanfir S, et al. Effects of Ramadan fasting on athletes’ hematological indices: a systematic review. Tunis Med. 2019;97(10):1104–13.

    PubMed  Google Scholar 

  4. 4.

    Roky R, Herrera CP, Ahmed Q. Sleep in athletes and the effects of Ramadan. J Sports Sci. 2012;30(Suppl 1):S75–84.

    PubMed  Google Scholar 

  5. 5.

    BaHammam A. Assessment of sleep patterns, daytime sleepiness, and chronotype during Ramadan in fasting and nonfasting individuals. Saudi Med J. 2005;26(4):616–22.

    PubMed  Google Scholar 

  6. 6.

    Waterhouse J, Alkib L, Reilly T. Effects of Ramadan upon fluid and food intake, fatigue, and physical, mental, and social activities: a comparison between the UK and Libya. Chronobiol Int. 2008;25(5):697–724.

    PubMed  Google Scholar 

  7. 7.

    Trabelsi K, Bragazzi N, Zlitni S, Khacharem A, Boukhris O, El-Abed K, et al. Observing Ramadan and sleep-wake patterns in athletes: a systematic review, meta-analysis and meta-regression. Br J Sports Med. 2019; https://doi.org/10.1136/bjsports-2018-099898(Epub ahead of print).

  8. 8.

    Aloui A, Baklouti H, Souissi N, Chtourou H. Effects of Ramadan fasting on body composition in athletes: a systematic review. Tunis Med. 2019;97(10):1087–94.

    PubMed  Google Scholar 

  9. 9.

    Armstrong LE, Costill DL, Fink WJ. Influence of diuretic-induced dehydration on competitive running performance. Med Sci Sports Exerc. 1985;17(4):456–61.

    CAS  PubMed  Google Scholar 

  10. 10.

    Cheuvront SN, Carter R 3rd, Sawka MN. Fluid balance and endurance exercise performance. Curr Sports Med Rep. 2003;2(4):202–8.

    PubMed  Google Scholar 

  11. 11.

    Edwards AM, Mann ME, Marfell-Jones MJ, Rankin DM, Noakes TD, Shillington DP. Influence of moderate dehydration on soccer performance: physiological responses to 45 min of outdoor match-play and the immediate subsequent performance of sport-specific and mental concentration tests. Br J Sports Med. 2007;41(6):385–91.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Hoffman JR, Stavsky H, Falk B. The effect of water restriction on anaerobic power and vertical jumping height in basketball players. Int J Sports Med. 1995;16(4):214–8.

    CAS  PubMed  Google Scholar 

  13. 13.

    Cheuvront SN1, Carter R 3rd, Haymes EM, Sawka MN. No effect of moderate hypohydration or hyperthermia on anaerobic exercise performance. Med Sci Sports Exerc. 2006;38(6):1093–7.

  14. 14.

    Thun E, Bjorvatn B, Flo E, Harris A, Pallesen S. Sleep, circadian rhythms, and athletic performance. Sleep Med Rev. 2015;23:1–9.

    PubMed  Google Scholar 

  15. 15.

    Maughan RJ, Fallah J, Coyle EF. The effects of fasting on metabolism and performance. Br J Sports Med. 2010;44(7):490–4.

    CAS  PubMed  Google Scholar 

  16. 16.

    Farooq A, Herrera CP, Zerguini Y, Almudahka F, Chamari K. Knowledge, beliefs and attitudes of Muslim footballers towards Ramadan fasting during the London 2012 Olympics: a cross-sectional study. BMJ Open. 2016;6(9):e012848.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Roy J, Hwa OC, Singh R, Aziz AR, Jin CW. Self-generated coping strategies among Muslim athletes during ramadan fasting. J Sports Sci Med. 2011;10(1):137–44.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Chaouachi A, Leiper JB, Chtourou H, Aziz AR, Chamari K. The effects of Ramadan intermittent fasting on athletic performance: recommendations for the maintenance of physical fitness. J Sports Sci. 2012;30(Suppl 1):S53–73.

    PubMed  Google Scholar 

  19. 19.

    Chtourou H, Trabelsi K, Boukhris O, Ammar A, Shephard RJ, Bragazzi NL. Effects of Ramadan fasting on physical performances in soccer players: a systematic review. Tunis Med. 2019;97(10):1114–31.

    PubMed  Google Scholar 

  20. 20.

    Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323(7308):334–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Normand SL. Meta-analysis: formulating, evaluating, combining, and reporting. Stat Med. 1999;18(3):321–59.

    CAS  PubMed  Google Scholar 

  22. 22.

    Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

  23. 23.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both randomized and non-randomized studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Davies T, Orr R, Halaki M, Hackett D. Effect of training eading to repetition failure on muscular strength: a systematic review and meta-analysis. Sports Med. 2016;46(4):487–502.

    PubMed  Google Scholar 

  26. 26.

    Aziz AR, Chia MY, Low CY, Slater GJ, Png W, Teh KC. Conducting an acute intense interval exercise session during the Ramadan fasting month: what is the optimal time of the day? Chronobiol Int. 2012;29(8):1139–50.

    PubMed  Google Scholar 

  27. 27.

    Cumming G. Understanding the new statistics effect sizes, confidence intervals, and meta-analysis. New York: Routledge, Taylor and Francis group; 2012.

    Google Scholar 

  28. 28.

    Hopkins WG. A scale of magnitudes for effect statistics. In: A new view of statistics. 2002. http://sportscience.sportsci.org/resource/stats/index.html. Accessed 12 July 2019.

  29. 29.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Aloui A, Driss T, Baklouti H, Jaafar H, Hammouda O, Chamari K, et al. Repeated-sprint training in the fasted state during Ramadan: morning or evening training? J Sports Med Phys Fitness. 2018;58(7–8):990–7.

    PubMed  Google Scholar 

  31. 31.

    Baklouti H, Rejeb N, Aloui A, Jaafar H, Ammar A, Chtourou H, et al. Short versus long small-sided game training during Ramadan in soccer players. Phys Ther Sport. 2017;24:20–5.

    PubMed  Google Scholar 

  32. 32.

    Kordi R, Abdollahi M, Memari AH, Najafabadi MG. Investigating two different training time frames during Ramadan fasting. Asian J Sports Med. 2011;2(3):205–10.

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    Rebaï H, Chtourou H, Zarrouk N, Harzallah A, Kanoun I, Dogui M, et al. Reducing resistance training volume during Ramadan improves muscle strength and power in football players. Int J Sports Med. 2014;35(5):432–7.

    PubMed  Google Scholar 

  34. 34.

    Meckel Y, Ismaeel A, Eliakim A. The effect of the Ramadan fast on physical performance and dietary habits in adolescent soccer players. Eur J Appl Physiol. 2008;102(6):651–7.

    PubMed  Google Scholar 

  35. 35.

    Hammouda O, Chtourou H, Aloui A, Chahed H, Kallel C, Miled A, et al. Concomitant effects of Ramadan fasting and time-of-day on apolipoprotein AI, B, Lp-a and homocysteine responses during aerobic exercise in Tunisian soccer players. PLoS One. 2013;8(11):e79873.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Güvenç A. Effects of ramadan fasting on body composition, aerobic performance and lactate, heart rate and perceptual responses in young soccer players. J Hum Kinet. 2011;29:79–91.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Chtourou H, Hammouda O, Chaouachi A, Chamari K, Souissi N. The effect of time-of-day and Ramadan fasting on anaerobic performances. Int J Sports Med. 2012;33(2):142–7.

    CAS  PubMed  Google Scholar 

  38. 38.

    Bouhlel H, Latiria I, Zarrrouk N, Bigard X, Shephard R, Tabkaa Z, et al. Effect of Ramadan observance and maximal exercise on simple and choice reaction times in trained men. Sci Sports. 2014;29(3):131–7.

    Google Scholar 

  39. 39.

    Abedelmalek S, Denguezli M, Chtourou H, Souissi N, Tabka Z. Does Ramadan fasting affect acylated ghrelin and growth hormone concentrations during short-term maximal exercise in the afternoon? Biol Rhythm Res 2019;46:5691–5701.

  40. 40.

    Aloui A, Chaouachi A, Chtourou H, del Wong P, Haddad M, Chamari K, et al. Effects of Ramadan on the diurnal variations of repeated-sprint performances. Int J Sports Physiol Perform. 2013;8(3):254–62.

    PubMed  Google Scholar 

  41. 41.

    Bouhlel H, Shephard RJ, Gmada N, Aouichaoui C, Peres G, Tabka Z, et al. Effect of Ramadan observance on maximal muscular performance of trained men. Clin J Sport Med. 2013;23(3):222–7.

    PubMed  Google Scholar 

  42. 42.

    Brisswalter J, Bouhlel E, Falola JM, Abbiss CR, Vallier JM, Hausswirth C. Effects of Ramadan intermittent fasting on middle-distance running performance in well-trained runners. Clin J Sport Med. 2011;21(5):422–7.

    PubMed  Google Scholar 

  43. 43.

    Chaouachi A, Coutts AJ, Chamari K, del Wong P, Chaouachi M, Chtara M, et al. Effect of Ramadan intermittent fasting on aerobic and anaerobic performance and perception of fatigue in male elite judo athletes. J Strength Cond Res. 2009;23(9):2702–9.

    PubMed  Google Scholar 

  44. 44.

    Chtourou H, Hammouda O, Souissi H, Chamari K, Chaouachi A, Souissi N. The effect of Ramadan fasting on physical performances, mood state and perceived exertion in young footballers. Asian J Sports Med. 2011;2(3):177–85.

    PubMed  PubMed Central  Google Scholar 

  45. 45.

    Karli U, Guvenc A, Aslan A, Hazir T, Acikada C. Influence of Ramadan fasting on anaerobic performance and recovery following short time high intensity exercise. J Sports Sci Med. 2007;6(4):490–7.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Kirkendall DT, Leiper JB, Bartagi Z, Dvorak J, Zerguini Y. The influence of Ramadan on physical performance measures in young Muslim footballers. J Sports Sci. 2008;26(Suppl 3):S15–27.

    PubMed  Google Scholar 

  47. 47.

    Mirzaei B, Rahmani-Nia F, Moghadam MG, Ziyaolhagh SJ, Rezaei A. The effect of ramadan fasting on biochemical and performance parameters in collegiate wrestlers. Iran J Basic Med Sci. 2012;15(6):1215–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Zerguini Y, Kirkendall D, Junge A, Dvorak J. Impact of Ramadan on physical performance in professional soccer players. Br J Sports Med. 2007;41(6):398–400.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Gandevia SC. Spinal and supraspinal factors in human muscle fatigue. Physiol Rev. 2001;81(4):1725–89.

    CAS  PubMed  Google Scholar 

  50. 50.

    Finch GM, Day JE, Razak, Welch DA, Rogers PJ. Appetite changes under free-living conditions during Ramadan fasting. Appetite. 1998;31(2):159–170.

  51. 51.

    Taoudi Benchekroun M, Roky R, Toufiq J, Benaji B, Hakkou F. Epidemiological study: chronotype and daytime sleepiness before and during Ramadan. Therapie. 1999;54(5):567–72.

    CAS  PubMed  Google Scholar 

  52. 52.

    Dewanti L, Watanabe C, Sulistiawati, Ohtsuka R. Unexpected changes in blood pressure and hematological parameters among fasting and nonfasting workers during Ramadan in Indonesia. Eur J Clin Nutr. 2006;60(7):877–81.

  53. 53.

    Larijani B, Zahedi F, Sanjari M, Amini MR, Jalili RB, Adibi H, et al. The effect of Ramadan fasting on fasting serum glucose in healthy adults. Med J Malaysia. 2003;58(5):678–80.

    CAS  PubMed  Google Scholar 

  54. 54.

    Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J. 2006;47(5):409–14.

    CAS  PubMed  Google Scholar 

  55. 55.

    Bogdan A, Bouchareb B, Touitou Y. Ramadan fasting alters endocrine and neuroendocrine circadian patterns. Meal-time as a synchronizer in humans? Life Sci. 2001;68(14):1607–15.

  56. 56.

    Little T, Williams AG. Specificity of acceleration, maximum speed, and agility in professional soccer players. J Strength Cond Res. 2005;19(1):76–8.

    PubMed  Google Scholar 

  57. 57.

    Roky R, Iraki L, HajKhlifa R, Lakhdar Ghazal N, Hakkou F. Daytime alertness, mood, psychomotor performances, and oral temperature during Ramadan intermittent fasting. Ann Nutr Metab. 2000;44(3):101–7.

    CAS  PubMed  Google Scholar 

  58. 58.

    Png W, Bhaskaran K, Sinclair AJ, Aziz AR. Effects of ingesting low glycemic index carbohydrate food for the sahur meal on subjective, metabolic and physiological responses, and endurance performance in Ramadan fasted men. Int J Food Sci Nutr. 2014;65(5):629–36.

    CAS  PubMed  Google Scholar 

  59. 59.

    Bataineh MF, Al-Nawaiseh AM, Abu Altaieb MH, Bellar DM, Hindawi OS, Judge LW. Impact of carbohydrate mouth rinsing on time to exhaustion during Ramadan: a randomized controlled trial in Jordanian men. Eur J Sport Sci. 2018;18(3):357–66.

    PubMed  Google Scholar 

  60. 60.

    Che Muhamed AM, Mohamed NG, Ismail N, Aziz AR, Singh R. Mouth rinsing improves cycling endurance performance during Ramadan fasting in a hot humid environment. Appl Physiol Nutr Metab. 2014;39(4):458–64.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr Alan McCall for some comments on an earlier version of the manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Abd-Elbasset Abaïdia.

Ethics declarations

Funding

No funding was obtained for the preparation of this article.

Conflicts of Interest

Abd-Elbasset Abaïdia, Wael Daab, and Mohamed Amine Bouzid declare that they have no conflicts of interest with the content of this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (XLSX 64 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Abaïdia, AE., Daab, W. & Bouzid, M.A. Effects of Ramadan Fasting on Physical Performance: A Systematic Review with Meta-analysis. Sports Med 50, 1009–1026 (2020). https://doi.org/10.1007/s40279-020-01257-0

Download citation