POPULATION-SPECIFIC CONCERNS
Participation of Muslim Athletes
During the Month of Ramadan
Angy H. El-Khatib; Timothy A. Tolbert, PhD, ATC; and Gary E. McIlvain, EdD, LAT/ATC •
Marshall University
I
slam, a monotheistic religion based on the
Quran, is the world’s second largest religion
and one of the fastest-growing religions in
the world. One of the most holy Islamic
observances is the month of Ramadan, the
ninth month of the Islamic lunar calendar.
Because the Islamic lunar calendar is slightly
shorter than the typically used Gregorian
calendar, the month of Ramadan shifts by
approximately 10-11 days every year (Table
1). Muslims believe this
month to be the time
when the first ayah, or
Key Point
verse, of the Quran was
Ramadan causes a phase shift in food and
revealed to the Prophet
fluid intake as well as sleep cycle, which
Muhammad. Thus, fastresults in altered exercise and psychomoing during Ramadan,
tor-related performance capabilities.
an act of devotion, is
one of the five pillars of
Islam that every physically and mentally able
Muslim must perform.
Ramadan, the spiritual period of abstaining from eating, drinking, smoking, chewing,
and sexual relations during daylight hours,
seeks to replace aggressive thoughts and
behaviors with ideal principles of reflection,
piety, charity, patience, righteousness, and
restraint. Muslims show their devotion to God
by using self-control to develop a stronger
sense of piousness as well as discipline and
improvement of oneself rather than a mere
exercise of deprivation.
In predominantly Muslim countries,
Ramadan is a time when business, school,
and work slow down to concentrate on the
fast during the day. A typical day in Ramadan
starts with a very early breakfast, or “Suhoor,”
which begins hours before the break of dawn.
Following Suhoor, a Muslim may then go to
the mosque for dawn prayers and to recite
verses of the Quran. Many Muslims then go
back to bed before carrying on with daily
activities. At sunset, the fast is broken with
a meal called “Iftar.” After Iftar, Muslims
complete the regularly scheduled prayers,
along with extra “Taraweeh” prayers and
late-night recitations of the Quran. Therefore,
the impacts of Ramadan include alteration
of sleeping patterns and change in dietary
practice, i.e., no food and fluid consumption
between dawn and sunset.
For Muslim athletes who observe this
month, the combined food and fluid intake
restrictions, as well as the changes in eating
and sleeping patterns, are of obvious importance. As athletics become more popular
among Muslims, an understanding of the
effects of Ramadan on Muslim athletes is
essential. There is limited information available about the responses of athletes who
train through Ramadan, but there have been
several studies pertaining to the nutritional,
metabolic, and body composition changes
that take place during Ramadan.1-11 Dietary
© 2012 Human Kinetics - IJATT 17(5), pp. 41-45
international journal of Athletic Therapy & training
september 2012  41
Table 1. Estimated Ramadan Dates
for the Next 10 Years
Gregorian Calendar
(AD)
Hijri Calendar
(AH)
Ramadan Starts
Ramadan Ends
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
1433
1434
1435
1436
1437
1438
1439
1440
1441
1442
1443
July 20
July 9
June 28
June 18
June 6
May 27
May 16
May 5
April 24
April 13
April 2
Aug 18
Aug 7
July 27
July 16
July 5
June 25
June 14
June 3
May 23
May 12
May 1
intake is unlikely to have a significant impact on
performance, but the phase shift of food intake, fluid
intake, and change in sleep patterns can affect physical
performance,4 as well as level of alertness and mood.12
Dietary and Food Intake During Ramadan Research suggests that neither energy intake nor body
mass change significantly during the Ramadan fasting
period.3,8,11,13-16 There may be regional and cultural
variations in dietary practices, however. Increased
energy intake has been observed among Saudi Muslims,2 but decreased energy intake has been observed
among Indian Muslims.17 Another study documented
significant body fat losses among young elite judo
athletes who had a constant energy intake during the
month of Ramadan.18 A decrease of dietary iron has
been reported in a fasting group and an increase in
dietary iron intake in a nonfasting group.13
The Effects of Fasting
on Metabolism and Performance
Research has demonstrated that carbohydrate, lipid,
and protein metabolism were not significantly affected
during Ramadan.4 Within a few hours of fasting, carbohydrate oxidation decreases and fatty acid oxidation
increases.19 In a fasted state, fat oxidation is favored,
which was indicated by a decreased rate of carbohydrate utilization.6 A glycogen restoration phase lasts
about an hour following an exercise session.20 In the
42  september 2012
absence of carbohydrate feeding following a highintensity exercise, such as that which occurs during
Ramadan practices, high concentrations of lactate
stimulate the recovery of stored glycogen.21 In the
absence of exercise, muscle glycogen content is not
affected by a few days of fasting.6
Research has suggested that submaximal factors
(e.g., heart rate) are hardly affected by fasting, whereas
maximal work declined.1 Psychomotor performance,
alertness, and nocturnal sleep patterns have been
shown to suffer during altered food intake.22 Significant reductions in speed, agility, dribbling speed, and
endurance have been observed in professional Algerian
soccer players,23 as well as Israeli adolescents.7 The
effect of fasting was most notable on vertical jump
performance.4 A 2–4% body mass reduction resulting from change in total body water content reduced
strength by approximately 2%, power was reduced by
approximately 3%, and high-intensity endurance was
reduced by approximately 10%.24 Body mass reduction
of 2–3% had no significant effect on sprint running
performance if the subject was not overweight.24
Endurance 13 and high-intensity 25 exercise performances have been shown to be impaired during
periods of 24–36 hour fasts. Endurance exercise
performance was reduced by a 2–7% reduction in
total body water content, but endurance exercise
performance that lasted less than 90 minutes was
not affected by a 1–2% reduction in total body water
content.26 The results of study of the effects of Ramadan on a 60-minute endurance running performance
international journal of Athletic Therapy & training
demonstrated that participants covered significantly
more distance in the first 30 minutes in a nonfasting
state compared to a fasting state.27 Similar unfavorable
effects of fasting during Ramadan have been reported
for high-intensity submaximal aerobic exercise and
incremental exercise to exhaustion.7,23,28-32
Sleep Patterns
The time of day when exercise takes place seems to
have an effect on performance. Soccer players tested
in the morning were significantly slower in the performance of 10-m sprints than pre-Ramadan times
through the fourth week of Ramadan, whereas players
tested in the afternoon remained consistent.4 Beyond
the fourth week of Ramadan, players tested in the
morning returned to pre-Ramadan times.4 Among the
players tested in the morning, greatest fatigue was
documented at weeks 2 and 4, whereas players tested
in the afternoon only demonstrated fatigue at week 4.
Leg strength and anaerobic power tend to improve in
the afternoon, especially in activities such as sprinting,
vertical jumping, and dribbling.4,33
A significant reduction in nocturnal sleep time
has been observed during the first and third weeks of
Ramadan.12 Alteration of sleep cycle to accommodate
the phase shift of food intake appears to be a more
important factor in the development of performance
difficulties than hunger and thirst.5,34 As little as 2 hours
of cumulative sleep loss in successive days can have
negative effects.12,35
Daytime training during Ramadan is likely to result
in decreased benefit, but a change in the time of training in non-Muslim countries is unlikely. Most literature
pertaining to circadian rhythms suggest that afternoon
training is most beneficial.33 Activities that require high
levels of motor coordination and “explosiveness” tend
to be associated with peak performance around noon
and early afternoon.12
Fluid Intake During and After Exercise
Lack of fluid intake throughout the course of a day has
more significant implications than the lack of food
intake.13 There is evidence that active individuals are
better at maintaining hydration status than sedentary
individuals,8 but the restrictions of Ramadan will obviously increase risk for dehydration during exercise. The
risk may be greatest during the first week of Ramainternational journal of Athletic Therapy & training
dan, during which a state of dehydration probably
exists.10 Changes in bowel and bladder habits during
Ramadan have been recognized as contributors to
mild dehydration, and increases in uric acid have been
documented.13,22
Suggested Guidelines
Delaying the time of training until afternoon would be
advantageous for the Muslim athlete. Although training
immediately after sunrise would have the benefit of
recent feeding and hydration, research has demonstrated that activities requiring high levels of motor
coordination and explosiveness should be performed
in the early afternoon. Training sessions that commence as the break in the fast approaches will allow
for recovery of glycogen stores and rehydration, but a
disadvantage may be alteration of sleep pattern.
The sleep pattern of the Muslim athlete will be most
affected during the second and fourth weeks, which
can decrease speed, agility, and endurance, especially
during daytime training. During this period, training
sessions should be planned in the afternoon hours to
allow Muslim athletes to perform at a higher level than
is possible during morning hours.
Minimizing sweat loss during practice in a hot
environment will be advantageous. Muslim athletes are
most likely to suffer from dehydration during the first
week of Ramadan. Ice baths and cold towels should
be used, and practicing indoors with air conditioning
should be done whenever possible.
Lipid, carbohydrate, and protein metabolism, and
hormone levels are minimally affected by Ramadan
fasting.6 Carbohydrate need for the maintenance of
alertness and mood will vary according to the demands
of an athlete’s exercise program.36 A high carbohydrate
diet may delay gastric emptying and fluid absorption.37,
38 Limiting the amount of carbohydrate consumed
during the break of the fast can increase the speed of
fluid replacement.
Fluid replacement should be achieved after exercise, because exercise-induced dehydration can have
a negative impact on performance.39 Electrolytes that
are lost as a result of sweating must be replaced for
fluid balance to be maintained.40 Administration of a
sports drink may speed the process of rehydration and
reduce physiological stress after an exercise session.39
The 2012 summer Olympics will occur during
Ramadan (Figure 1). Coaches and healthcare providers
september 2012  43
should be aware of the religious practices of Muslim
athletes in order to minimize the possible adverse
effects of dietary restrictions. If possible, scheduling
of practice sessions and competitive events should be
done with consideration for the religious beliefs and
practices of all athletes. With the guidelines and suggestions that have been provided (see sidebar), Muslim
athletes should be able to practice and compete more
effectively during the month of Ramadan. 
Figure 1 Comparison of Ramadan dates and Olympic dates 2012.
Suggested Guidelines for Athletes
During Ramadan
• Change practice times to the early afternoon.
• Observe athletes for increased levels of fatigue
due to changes in nocturnal sleep patterns.
• Have ice baths and cold towels available to athletes suffering from the effects of dehydration
• Limit the consumption of carbohydrate-containing fluids.
• Consume enough fluids and sodium to create a
net deficit that is greater than that of the volume
of sweat lost.
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Angy H. El-Khatib is a student in the Undergraduate Athletic Training
Program at Marshall University in Huntington, WV.
Tim Tolbert is an assistant professor and Clinical Coodinator in the
Undergraduate Athletic Training Program at Marshall University in
Huntington, WV.
Gary McIlvain is with the Athletic Training Program at Marshall University, Huntington, WV.
Patrick McKeon, PhD, ATC, University of Kentucky, is the Report
Editor for this article.
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