Aspetar clinical guidelines: Ramadan fasting and exercise for healthy individuals


Karim Chamar
Fatma Guezguez
Karim Khalladi¹
Hamdi Chtourou
Tajdine Moumen Jamai
Anis Chaouachi
Omar Al Sayraf
Abdul Rashid Aziz
Nicola Luigi Bragazzi
Helmi Ben Saad


Healthy adult Muslims who practice Ramadan fasting (RF) follow strict religious rules regarding their lifestyle. RF influences several parameters, including nutrition, hydration, and sleep habits, and can potentially reduce physical performance. It seems that RF prevents athletes from training and participating in competitions, and prevents the general community from engaging in physical exercise.  This places practicing Muslim athletes at a competitive disadvantage. Therefore, the goal of this guide was to provide practical recommendations, based on expert panel consensus, for healthy athletes and their support staff on how to adopt appropriate behavioral, social, and psychological strategies to cope with the changes and constraints resulting from RF. The recommendations developed in this guide are not limited to prescribing appropriate exercise during the month of Ramadan (ie; schedule, frequency, intensity, duration, type of exercise, and training load), but cover different aspects of lifestyle such as nutrition, hydration, and sleep, and address psychosocial and cognitive aspects related to RF. These recommendations are intended for healthy individuals. Patients with chronic illnesses should refer to their doctor to ensure an eventual safe practice.


Athletes, Chronobiology, Exercise, Hydration, Nutrition, Sleep



  1. Adawi M, Watad A, Brown S, Aazza K, Aazza H, Zouhir M, et al. Ramadan fasting exerts immunomodulatory effects: Insights from a systematic review. Front Immunol. 2017;8:1144.
  2. Ahmed I. Ramadan fasting in extreme latitudes. J Soc Health Diabetes. 2014;2:53-4.
  3. Aziz A, Png W. Practical tips to exercise training during the Ramadan fasting month. ISN Bull. 2008;1:13-9.
  4. 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(sup1):S53-73.
  5. Damit N, Lim V, Che Muhamed A. Exercise responses and training during daytime fasting in the month of Ramadan and its impact on training-induced adaptations. In: Chtourou H, ed. Effects of Ramadan fasting on health and athletic performance. California, USA: OMICS Group eBook, OMICS Group Incorporation; 2015:188-203.
  6. Maughan RJ, Fallah J, Coyle EF. The effects of fasting on metabolism and performance. Br J Sports Med. 2010;44(7):490-4.
  7. Mujika I, Chaouachi A, Chamari K. Precompetition taper and nutritional strategies: special reference to training during Ramadan intermittent fast. Br J Sports Med. 2010;44(7):495-501.
  8. Waterhouse J. Effects of Ramadan on physical performance: chronobiological considerations. Br J Sports Med. 2010;44(7):509-15.
  9. Aloui A, Chaouachi A, Chtourou H, Wong del 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.
  10. Chamari K, Briki W, Farooq A, Patrick T, Belfekih T, Herrera CP. Impact of Ramadan intermittent fasting on cognitive function in trained cyclists: a pilot study. Biol Sport. 2016;33(1):49-56.
  11. Chaouachi A, Coutts AJ, Chamari K, Wong del 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.
  12. Chaouachi A, Leiper JB, Souissi N, Coutts AJ, Chamari K. Effects of Ramadan intermittent fasting on sports performance and training: a review. Int J Sports Physiol Perform. 2009;4(4):419-34.
  13. 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.
  14. Shephard RJ. The impact of Ramadan observance upon athletic performance. Nutrients. 2012;4(6):491-505.
  15. Shephard RJ. Ramadan and sport: minimizing effects upon the observant athlete. Sports Med. 2013;43(12):1217-41.
  16. 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.
  17. Kirkendall DT, Chaouachi A, Aziz AR, Chamari K. Strategies for maintaining fitness and performance during Ramadan. J Sports Sci. 2012;30 Suppl 1:S103-8.
  18. Lim W, Damit N, Aziz A. Recommendations for optimal competitive exercise performance and effective training-induced adaptations when Ramadan fasting. In: Chtourou H, ed. Effects of Ramadan fasting on health and athletic performance. California, USA: OMICS Group eBook, OMICS Group Incorporation; 2015:204-21.
  19. Maughan RJ, Zerguini Y, Chalabi H, Dvorak J. Achieving optimum sports performance during Ramadan: some practical recommendations. J Sports Sci. 2012;30 Suppl 1:S109-17.
  20. Chamari K, Roussi M, Bragazzi NL, Chaouachi A, Abdul RA. Optimizing training and competition during the month of Ramadan: Recommendations for a holistic and personalized approach for the fasting athletes. Tunis Med. 2019;97(10):1095-103.
  21. 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.
  22. Chaouachi A, Coutts AJ, Wong del P, Roky R, Mbazaa A, Amri M, et al. Haematological, inflammatory, and immunological responses in elite judo athletes maintaining high training loads during Ramadan. Appl Physiol Nutr Metab. 2009;34(5):907-15.
  23. Rebai 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.
  24. Chtourou H, Chaouachi A, Driss T, Dogui M, Behm DG, Chamari K, et al. The effect of training at the same time of day and tapering period on the diurnal variation of short exercise performances. J Strength Cond Res. 2012;26(3):697-708.
  25. Guvenc 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.
  26. Aziz AR, Png W, Che Muhamed AM, Chaouachi A, Chong E, Singh R. Effects of Ramadan fasting on substrate oxidation, physiological and perceptual responses during submaximal intensity running in active men. Sport Sciences for Health. 2014;10(1):1-10.
  27. Moro T, Tinsley G, Bianco A, Marcolin G, Pacelli QF, Battaglia G, et al. Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males. J Transl Med. 2016;14(1):290.
  28. Kurdak SS, Shirreffs SM, Maughan RJ, Ozgunen KT, Zeren C, Korkmaz S, et al. Hydration and sweating responses to hot-weather football competition. Scand J Med Sci Sports. 2010;20 Suppl 3:133-9.
  29. Maughan RJ, Bartagi Z, Dvorak J, Zerguini Y. Dietary intake and body composition of football players during the holy month of Ramadan. J Sports Sci. 2008;26 Suppl 3:S29-38.
  30. 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.
  31. Chua MT, Balasekaran G, Ihsan M, Aziz AR. Effects of pre-exercise high and low glycaemic meal on intermittent sprint and endurance exercise performance. Sports (Basel). 2019;7(8).
  32. Maughan RJ, Shirreffs SM. Hydration and performance during Ramadan. J Sports Sci. 2012;30 Suppl 1:S33-41.
  33. Funnell MP, Mears SA, Bergin-Taylor K, James LJ. Blinded and unblinded hypohydration similarly impair cycling time trial performance in the heat in trained cyclists. J Appl Physiol (1985). 2019;126(4):870-9.
  34. 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.
  35. 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.
  36. Van Cutsem J, De Pauw K, Marcora S, Meeusen R, Roelands B. A caffeine-maltodextrin mouth rinse counters mental fatigue. Psychopharmacology (Berl). 2018;235(4):947-58.
  37. Cherif A, Meeusen R, Ryu J, Taylor L, Farooq A, Kammoun K, et al. Repeated-sprints exercise in daylight fasting: carbohydrate mouth rinsing does not affect sprint and reaction time performance. Biol Sport. 2018;35(3):237-44.
  38. Copenhaver EA, Diamond AB. The value of sleep on athletic performance, injury, and recovery in the young athlete. Pediatr Ann. 2017;46(3):e106-e11.
  39. Aziz AR, Wahid MF, Png W, Jesuvadian CV. Effects of Ramadan fasting on 60 min of endurance running performance in moderately trained men. Br J Sports Med. 2010;44(7):516-21.
  40. Romyn G, Lastella M, Miller DJ, Versey NG, Roach GD, Sargent C. Daytime naps can be used to supplement night-time sleep in athletes. Chronobiol Int. 2018;35(6):865-8.
  41. Almeneessier AS, BaHammam AS. How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights. Nat Sci Sleep. 2018;10:439-52.
  42. Cherif A, Meeusen R, Farooq A, Briki W, Fenneni MA, Chamari K, et al. Repeated sprints in fasted state impair reaction time performance. J Am Coll Nutr. 2017;36(3):210-7.
  43. 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.
  44. Aziz AR, Che Muhamad AM, Roslan SR, Ghulam Mohamed N, Singh R, Chia MYH. Poorer intermittent sprints performance in Ramadan-fasted Muslim footballers despite controlling for pre-exercise dietary intake, sleep and training load. Sports (Basel). 2017;5(1).
  45. Aziz AR, Che Muhamed AM, Ooi CH, Singh R, Chia MYH. Effects of Ramadan fasting on the physical activity profile of trained Muslim soccer players during a 90-minute match. Sci & Med Football. 2018;2(1):29-38.
  46. 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.
  47. Fenneni MA, Latiri I, Aloui A, Rouatbi S, Chamari K, Ben Saad H. Critical analysis of the published literature about the effects of Ramadan intermittent fasting on healthy children's physical capacities. Libyan J Med. 2015;10(1):28351.
  48. Fenneni MA, Latiri I, Aloui A, Rouatbi S, Chamari K, Saad HB. Effects of Ramadan intermittent fasting on North African children's heart rate and oxy-haemoglobin saturation at rest and during sub-maximal exercise. Cardiovasc J Afr. 2017;28(3):176-81.
  49. Miladi A, Ben Fraj S, Latiri I, Ben Saad H. Does ramadan observance affect cardiorespiratory capacity of healthy boys? Am J Mens Health. 2020;14(3):1557988320917587.
  50. Fenneni MA, Latiri I, Aloui A, Rouatbi S, Saafi MA, Bougmiza I, et al. Effects of Ramadan on physical capacities of North African boys fasting for the first time. Libyan J Med. 2014;9(1):25391.
  51. Aloui A, Briki W, Baklouti H, Chtourou H, Driss T, Chaouachi A, et al. Listening to music during warming-up counteracts the negative effects of Ramadan observance on short-term maximal performance. PLoS One. 2015;10(8):e0136400.
  52. Mahjoob M, Nejati J, Hosseini A, Bakhshani NM. The effect of holy Quran voice on mental health. J Relig Health. 2016;55(1):38-42.
  53. Aloui A, Chtourou H, Briki W, Tabben M, Chaouachi A, Souissi N, et al. Rapid weight loss in the context of Ramadan observance: recommendations for judokas. Biol Sport. 2016;33(4):407-13.
  54. Hammouda O, Chtourou H, Chahed H, Ferchichi S, Kallel C, Miled A, et al. Diurnal variations of plasma homocysteine, total antioxidant status, and biological markers of muscle injury during repeated sprint: effect on performance and muscle fatigue--a pilot study. Chronobiol Int. 2011;28(10):958-67.
  55. Chamari K, Haddad M, Wong del P, Dellal A, Chaouachi A. Injury rates in professional soccer players during Ramadan. J Sports Sci. 2012;30 Suppl 1:S93-102.
  56. Eirale C, Tol JL, Smiley F, Farooq A, Chalabi H. Does Ramadan affect the risk of injury in professional football? Clin J Sport Med. 2013;23(4):261-6.
  57. World Health Organization. Global recommendations on physical activity for health. Téléchargeable via ce lien: (dernière visite: 17 Avril 2023)