Does Ramadan fasting affect the diurnal variations in metabolic responses and total antioxidant capacity during exercise in young soccer players?

Changes in energy and macronutrient intakes during Ramadan fasting: a systematic review, meta-analysis, and meta-regression

CONTEXT

Ramadan fasting (RF) is associated with various physiological and metabolic changes among fasting Muslims. However, it remains unclear whether these effects are attributable to changes in meal timing or changes in dietary energy and macronutrient intakes. Furthermore, the literature on the associations between RF, meal timing, and energy and macronutrient intakes is inconclusive.

OBJECTIVES

This systematic review aimed to estimate the effect sizes of RF on energy and macronutrient intakes (carbohydrates, protein, fats, dietary fiber, and water) and determine the effect of different moderators on the examined outcomes.

DATA SOURCES

The Cochrane, CINAHL, EMBASE, EBSCOhost, Google Scholar, PubMed/MEDLINE, ProQuest Medical, Scopus, ScienceDirect, and Web of Science databases were searched from inception to January 31, 2022.

DATA EXTRACTION

The studies that assessed energy, carbohydrate, protein, fat, fiber, and water intakes pre- and post-fasting were extracted.

DATA ANALYSIS

Of the 4776 identified studies, 85 relevant studies (n = 4594 participants aged 9-85 y) were selected. The effect sizes for the studied variables were as follows: energy (number of studies [K] = 80, n = 3343 participants; mean difference [MD]: -142.45; 95% confidence interval [CI]: -215.19, -69.71), carbohydrates (K = 75, n = 3111; MD: -23.90; 95% CI: -36.42, -11.38), protein (K = 74, n = 3108; MD: -4.21; 95% CI: -7.34, -1.07), fats (K = 73, n = 3058; MD: -2.03; 95% CI: -5.73, 1.67), fiber (K = 16, n = 1198; MD: 0.47; 95% CI: -1.44, 2.39), and water (K = 17, n = 772; MD: -350.80; 95% CI: -618.09, 83.50). Subgroup analyses showed age significantly moderated the 6 dietary outcomes, and physical activity significantly moderated water intake. There were significant reductions in energy, carbohydrate, and protein intakes during RF.

CONCLUSIONS

The change in meal timing rather than quantitative dietary intake may explain various physiological and health effects associated with RF.

Timing of Resistance Training During Ramadan Fasting and Its Effects on Muscle Strength and Hypertrophy

PURPOSE

During Ramadan month, Muslims often continue training to maintain their muscle performance. However, trainers should stress the importance of the time of day chosen for practicing resistance training (RT) during Ramadan fasting to avoid health and performance alteration. Thus, this study aimed to investigate the effects of the timing of RT during Ramadan intermittent fasting (RIF) on muscle strength and hypertrophy in healthy male adults.

METHODS

Forty men were randomly allocated to 2 matched groups: 20 practicing whole-body RT in the late afternoon in a fasted state and 20 training in the late evening in a fed state (FED). Both groups performed 4 days per week of whole-body RT (∼75%-85% 1-repetition maximum, 12 repetitions/3-4 sets) during RIF. Anthropometric measurements and 1-repetition-maximum test for the squats, deadlift, and bench press were measured. A cross-sectional area of the quadriceps and biceps brachii was examined using ultrasound scans. All measurements were taken at 4 time points: 24 hours before the start of Ramadan, on the 15th day of Ramadan, on the 29th day of Ramadan, and 21 days after Ramadan.

RESULTS

Post hoc tests indicated significant preimprovement to postimprovement in FED at the 29th day of Ramadan for the 1-repetition-maximum test for the squats (P = .02; effect size = 0.21) and deadlift (P = .03; effect size = 0.24) when compared to 24 hours before the start of Ramadan. No significant changes were observed in the fasted-state group or for cross-sectional area for both groups.

CONCLUSIONS

Practicing RT during RIF appears not to have adverse effects on muscle hypertrophy and strength no matter whether it is practiced in FED or fasted state. However, RT had greater effects on muscle strength when applied in FED. Our findings suggest that training sessions should be scheduled after breaking the fast during Ramadan.

Longer Nap Duration During Ramadan Observance Positively Impacts 5-m Shuttle Run Test Performance Performed in the Afternoon

It is well-documented that changes in the rhythm of life during Ramadan affect sleep schedules (i.e., interruption of night sleep patterns) and are likely to have negative effects on physical and cognitive performances. The aim of the present study was to examine the effect of different naps opportunities’ durations during Ramadan on performance of short-duration repetitive maximal exercise and perception of effort. Fifteen physically active men (age: 21 ± 3 years, height: 177 ± 6 cm, body-mass: 73 ± 10 kg) performed a 6 × 30-s shuttle run test after a 25-min nap (N25), a 45-min nap (N45), and in a no-nap condition (NN) during three experimental periods: ∼2 weeks before Ramadan (BR), the last ten days of Ramadan (ER), and ∼3 weeks after Ramadan (AR). During the shuttle run test performed in the late afternoon, the greatest distance (GD), the total distance (TD) and a fatigue index (FI) were assessed. Rating of perceived exertion (RPE) was determined after each 30-s effort. Dietary intake and sleep quality were assessed in each of the three periods. Compared to BR, GD and TD were lower in the ER testing period (p = 0.005; d = 0.54) but returned to BR levels in the AR period. During ER, carbohydrate intake was lower (p = 0.04; d = 0.2), and sleep duration and sleep quality were reduced (d = 0.27 and 0.54, respectively), although other aspects of dietary intake and sleep pattern were not affected. Compared to NN, GD and TD were higher after N25 (d = 0.57 and 0.34, respectively) and N45 (d = 0.93 and 0.88 respectively). RPE was lower in N45 (p = 0.035, d = 0.84). N45 resulted in higher TD (p = 0.021, d = 0.13) and lower RPE (p = 0.004; d = 0.57) compared to N25 during ER. Taking a daytime nap benefits subsequent performance in a shuttle run test, whether sleep the previous night was normal (as in BR) or compromised (as in ER). The benefits of napping were greater after a 45-min nap opportunity than after a 25-min nap opportunity.

The Effects of Ramadan Intermittent Fasting on Football Players and Implications for Domestic Football Leagues Over the Next Decade: A Systematic Review

BACKGROUND

The month of Ramadan will intersect with many football leagues' schedules over the next decade. Understanding the effects of Ramadan intermittent fasting (RIF) on physical performance is necessary to guide considerations for football players.

OBJECTIVE

The aim of this systematic review was to investigate the effects of RIF on physical factors in football players, and secondarily to consider the impact this may have on domestic club football leagues.

DESIGN

We conducted a systematic review using PRISMA guidelines.

DATA SOURCES

The online literature search utilized CINAHL (EBSCO), Cochrane Library, Embase.com, PubMed, and Scopus databases, and grey literature (all from database inception to May 2020).

STUDY SELECTION CRITERIA

Inclusion criteria consisted of studies of football (soccer) players, data collected during and/or around Ramadan, with injury and/or performance data provided.

RESULTS

The search yielded 11,226 studies. Twenty-two studies were included following a review of titles, abstracts, and full texts. Studies included some iteration of before-Ramadan, during-Ramadan, and after-Ramadan data. Common measures observed included ratings of perceived exertion (n = 8), sprinting (n = 7), sleep (n = 7), peak heart rate (n = 6), jumping (n = 5), Yo-Yo intermittent recovery tests (n = 4), Wingate anaerobic test (n = 3), field-specific tests (n = 3), and injury rates (n = 2). Decreased physical performance was commonly observed during late afternoon/evening testing (before breaking the fast) and with high-intensity exercise.

CONCLUSION

There appears to be a performance deficit related to RIF in Muslim football players. Studies should explore the effects of RIF on actual match demands. Due to the month of Ramadan emerging into league calendars, considerations should be made to accommodate Muslim football players who are intermittently fasting.

Ramadan Fasting During the COVID-19 Pandemic; Observance of Health, Nutrition and Exercise Criteria for Improving the Immune System

Fasting is one of the religious rituals of Muslims worldwide who refrain from eating foods and liquids every year during Ramadan. This year (2020), Ramadan is very different from previous years due to the outbreak of a terrible microscopic giant called coronavirus disease 2019 (COVID-19). The pandemic COVID-19 has made Ramadan very important this year because the virus has infected millions of people around the world and killed thousands, especially people with immunodeficiency. In dealing with COVID-19, maintaining good hygiene and supporting the immune system are effective, preventive approaches. Moderate exercise training and proper nutrition are the most important factors to support immune function. Lack of facilities, poor health and many traditions that lead to public community gatherings have made many Islamic countries susceptible to this dangerous virus. In such an unprecedented situation, there are many Muslims who doubt whether they can fast or not. Therefore, the proposal of usable exercise programs and effective nutritional strategies is imperative. In this study, we will look at the proposed health effects of fasting and its impact on the immune system, the effects of Ramadan intermittent fasting on resting values and responses of immunological/antioxidant biomarkers in elite and recreational athletes, together with the important health, nutrition, and exercise advice that fasting people need to follow in the event of a COVID-19 outbreak.

Does red orange juice supplementation has a protective effect on performance, cardiovascular parameters, muscle damage and oxidative stress markers following the Yo-Yo Intermittent Recovery Test Level-1 under polluted air?

This study aimed to investigate the effect of red orange juice supplementation (ROJS) on performance, cardiovascular parameters, muscle damage and oxidative stress markers of athletes following exercise under polluted air. Eleven soccer players performed a Yo-Yo Intermittent Recovery Test Level-1 in polluted area (PA) and non-polluted area (NPA). Participants are invited to drink 500 ml of red orange or placebo (PLA) juice 2.5 h before the test. Blood samples were collected at rest and 3 min after each session to assess creatine kinase (CK), lactate dehydrogenase, malondialdehyde (MDA) and total antioxidant status. Our results showed that, VO_2max, heart rate and systolic blood pressure post-exercise were significantly altered by pollution with both supplements, but the damage was lowered more with ROJS than PLA. Concerning muscle damage and oxidative stress markers, orange juice supplementation blunted the effect of pollution on CK levels post-exercise (p > 0.05) and decreases significantly (p < 0.05) the MDA levels post-exercise in PA and NPA compared to PLA supplementation. In conclusion, ROJS seemed to be an appropriate strategy to reduce the risk of exposure to pollution especially on muscle damage and oxidative stress markers.

Effect of Ramadan intermittent fasting on cognitive, physical and biochemical responses to strenuous short-term exercises in elite young female handball players

The present study aimed to assess the effect of Ramadan intermittent fasting (RF) on cognitive and physical performance and biochemical responses to specific exercises in elite young female handball players. Twelve athletes participated in three experimental sessions: one week before Ramadan (BR), during the first week of Ramadan (FWR) and during the last week of Ramadan (LWR). The present crossover study was carried out in Tunisia during the 2013 Ramadan month lasting from 9 July to 7 august. During each session, a battery of tests was performed as follow: Hooper index, vigilance test (VT), Epworth sleepiness scale (ESS), five jump test (5-JT), modified agility T-test (MAT), maximal standing ball-throw velocity test (MSBVT) and Running-based Anaerobic Sprint (RAST) Test. Rating of perceived exertion (RPE) was recorded immediately after the RAST. Blood samples were collected before and after exercises during each session. The results showed that ESS scores were higher during LWR than BR (p < 0.05). Moreover, MSBVT time decreased (p < 0.05) during LWR, therefore performance enhanced. The power of three final sprints from the RAST decreased significantly only during LWR compared to BR (p < 0.05). RAST fatigue index and RPE scores were higher during LWR more than BR (p < 0.05). The results showed also that hematological measures (i.e., red blood cells, hemoglobin and hematocrit), plasma osmolarity and energetic markers were unaffected by RF. Biomarkers of muscle damage were higher after the RAST only during LWR compared to BR (p < 0.01 for all). In conclusion, RF increased ESS and decreased RAST performances associated with higher muscle damage and fatigue, especially at LWR. These previous alterations could be attributed to disturbances of sleep and circadian rhythms rather than nutritional deficiency or dehydratation.

Effects of Ramadan Observance on Dietary Intake and Body Composition of Adolescent Athletes: Systematic Review and Meta-Analysis

To evaluate the effects of Ramadan observance on dietary intake, body mass and body composition of adolescent athletes (design: systematic review and meta-analysis; data sources: PubMed and Web of Science; eligibility criteria for selecting studies: single-group, pre-post, with or without control-group studies, conducted in athletes aged <19 years, training at least 3 times/week, and published in any language before 12 February 2020). Studies assessing body mass and/or body composition and/or dietary intake were deemed eligible. The methodological quality was assessed using ‘QualSyst’. Of the twelve selected articles evaluating body mass and/or body composition, one was of strong quality and eleven were rated as moderate. Ten articles evaluated dietary intake; four were rated as strong and the remaining moderate in quality. Continuation of training during Ramadan did not change body mass from before to the first week (trivial effect size (ES) = −0.011, p = 0.899) or from before to the fourth week of Ramadan (trivial ES = 0.069, p = 0.277). Additionally, Ramadan observance did not change body fat content from before to the first week (trivial ES = −0.005, p = 0.947) and from before to the fourth week of Ramadan (trivial ES = -0.057, p = 0.947). Lean body mass remained unchanged from before to the fourth week of Ramadan (trivial ES = −0.025, p = 0.876). Dietary data showed the intake of energy (small ES = -0.272, p = 0.182), fat (trivial ES = 0.044, p = 0.842), protein (trivial ES = 0.069, p = 0.720), carbohydrate (trivial ES = 0.075, p = 0.606) and water (trivial ES = −0.115, p = 0.624) remained essentially unchanged during as compared to before Ramadan. Continued training of adolescent athletes at least three times/week during Ramadan observance has no effect on body mass, body composition or dietary intake.

Effects of Ramadan Fasting on Recovery Following a Simulated Soccer Match in Professional Soccer Players: A Pilot Study

Objectives: Assessing the effects of Ramadan fasting on recovery following a soccer match simulation.

Methods: Eight elite soccer players (age: 21.0 ± 0.4 years) performed a modified Loughborough Intermittent Shuttle Test protocol (LIST_mod) on two occasions: 1 week before (BR) and during the fourth week of Ramadan (End-R). At BR and End-R, soccer players performed squat jump, countermovement jump, maximal voluntary contraction, and 20 m sprint, and creatine kinase, uric acid, and subjective ratings (feelings scale, quality of sleep, fatigue, muscle soreness and stress) were assessed at baseline and 0, 24, 48, and 72 h following LIST_mod.

Results: Following LIST_mod, performance in squat jump (48 and 72 h) (p < 0.05), countermovement jump (48 and 72 h), maximal voluntary contraction (0, 24, 48, and 72 h), and 20 m sprint (0 and 48 h) decreased significantly on both occasions. Decreases were higher at End-R than BR. Creatine kinase levels increased significantly at 24 and 48 h at BR and End-R (p < 0.05). Uric acid increased at 0 and 24 h only on BR. Muscle soreness increased throughout the recovery period at both occasions, with a higher level at End-R. Stress rating increased only at 0 h on End-R, while fatigue rating increased at 24 h at BR and at 0, 24, and 48 h at End-R.

Conclusion: Perturbations in physical performance and subjective ratings parameters were higher at the end of Ramadan. However, the results of this study showed that Ramadan fasting did not adversely affect the recovery following soccer match simulation in professional soccer players.

The Yo-Yo Intermittent Tests: A Systematic Review and Structured Compendium of Test Results

Background: Although Yo-Yo intermittent tests are frequently used in a variety of sports and research studies to determine physical fitness, no structured reference exists for comparison and rating of test results. This systematic review of the most common Yo-Yo tests aimed to provide reference values for test results by statistical aggregation of published data.

Methods: A systematic literature search for articles published until August 2017 was performed in MEDLINE, Web of Science, SPORTDiscus and Google Scholar. Original reports on healthy females and males ≥16 years were eligible for the analysis. Sub-maximal test versions and the Yo-Yo Intermittent Recovery Level 1 Children's test (YYIR1C) were not included.

Results: 248 studies with 9,440 participants were included in the structured analysis. The Yo-Yo test types most frequently used were the Yo-Yo Intermittent Recovery Level 1 (YYIR1, 57.7%), the Yo-Yo Intermittent Recovery Level 2 (YYIR2, 28.0%), the Yo-Yo Intermittent Endurance Level 2 (YYIE2, 11.4%), and the Yo-Yo Intermittent Endurance Level 1 (YYIE1, 2.9%) test. For each separate test, reference values (global means and percentiles) for sports at different levels and both genders were calculated.

Conclusions: Our analysis provides evidence that Yo-Yo intermittent tests reference values differ with respect to the type and level of sport performed.The presented results may be used by practitioners, trainers and athletes to rate Yo-Yo intermittent test performance levels and monitor training effects.

Biochemical status, oxidative and antioxidant responses after 3-month specific training in elite karate athletes

Aim To investigate the effects of 3-month-long specific training program on biochemical status, oxidative and antioxidant responses in elite karatekas. Methods Twenty male karatekas [BMI: 21.9 ± 2.4 (kg/m²)] participated in this study. They performed a 3-month specific training to prepare for an international competition. We measured selected biochemical parameters, the oxidative and antioxidant responses before (T0) and after 3 months of intense karate training (T1). Results We found significant increases in catalase activity (26.3% ± 21.3%, p < 0.0005), superoxide dismutase activity (15.9% ± 28.8%, p < 0.05), and a significant decrease in malondialdehyde levels (17.2% ± 13.7%, p < 0.0005) after 3 months of karate training. Moreover, the athletes' biochemical status was significantly improved at T1 compared with T0 (for the majority of parameters, p < 0.0005). Conclusions The specific training program improves the prooxidant-antioxidant balance of elite karate athletes. It could be recommended for athletes having similar physical fitness level.

Ramadan Fasting Exerts Immunomodulatory Effects: Insights from a Systematic Review

Ramadan is the ninth month of the Islamic lunar calendar and is observed by Muslims as a month of fasting. All Muslim adults are expected to fast; nevertheless certain subgroups, including sick, frail subjects, and pregnant women, among others, are exempted. Ramadan fasting has been shown to impact on body systems in different manners. The influence of Ramadan fasting on immune system regulation remains elusive; however, immune system changes, such as the modulation of body response to various infectious, stressful, and other harmful events, are of great interest during fasting. In this paper, we performed an extensive systematic literature review of different scholarly databases (ISI/Web of Science, Scopus, PubMed,/MEDLINE, Google Scholar, Directory of Open Access Journals, EbscoHOST, Scirus, Science Direct, the Cochrane Library, and ProQuest), using the following key words: "fasting," "Ramadan," "Islam," and "immunity." Conclusions drawn from these findings included: (1) Ramadan fasting has been shown to only mildly influence the immune system and the alterations induced are transient, returning to basal pre-Ramadan status shortly afterward. (2) Ramadan fasting during the second trimester of pregnancy was shown to be safe and did not result in negative fetal outcomes, or maternal oxidative status alterations. (3) In cardiac patients, Ramadan fasting can have beneficial effects including lipid profile improvement and alleviation of oxidative stress. (4) In asthmatic patients as well as in patients with human immunodeficiency virus/acquired immunodeficiency syndrome and autoimmune disorders, fasting was safe. (5) In psychiatric patients, such as those suffering from schizophrenia, fasting could increase immunologic markers. (6) Fasting Muslim athletes who maintain intensive training schedule during Ramadan showed fluctuations of immunologic markers.