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.
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.
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.
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.
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.
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Data Availability Statement
Data analyzed during this study are included in this published article (and Electronic Supplementary Material Appendix S1).
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.
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.
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.
Roky R, Herrera CP, Ahmed Q. Sleep in athletes and the effects of Ramadan. J Sports Sci. 2012;30(Suppl 1):S75–84.
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.
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.
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).
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.
Armstrong LE, Costill DL, Fink WJ. Influence of diuretic-induced dehydration on competitive running performance. Med Sci Sports Exerc. 1985;17(4):456–61.
Cheuvront SN, Carter R 3rd, Sawka MN. Fluid balance and endurance exercise performance. Curr Sports Med Rep. 2003;2(4):202–8.
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.
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.
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.
Thun E, Bjorvatn B, Flo E, Harris A, Pallesen S. Sleep, circadian rhythms, and athletic performance. Sleep Med Rev. 2015;23:1–9.
Maughan RJ, Fallah J, Coyle EF. The effects of fasting on metabolism and performance. Br J Sports Med. 2010;44(7):490–4.
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.
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.
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.
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.
Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323(7308):334–6.
Normand SL. Meta-analysis: formulating, evaluating, combining, and reporting. Stat Med. 1999;18(3):321–59.
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.
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.
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.
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.
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.
Cumming G. Understanding the new statistics effect sizes, confidence intervals, and meta-analysis. New York: Routledge, Taylor and Francis group; 2012.
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.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Gandevia SC. Spinal and supraspinal factors in human muscle fatigue. Physiol Rev. 2001;81(4):1725–89.
Finch GM, Day JE, Razak, Welch DA, Rogers PJ. Appetite changes under free-living conditions during Ramadan fasting. Appetite. 1998;31(2):159–170.
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.
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.
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.
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.
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.
Little T, Williams AG. Specificity of acceleration, maximum speed, and agility in professional soccer players. J Strength Cond Res. 2005;19(1):76–8.
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.
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.
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.
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.
The authors would like to thank Dr Alan McCall for some comments on an earlier version of the manuscript.
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.
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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