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Systematic review
Ramadan intermittent fasting and its association with health-related indices and exercise test performance in athletes and physically active individuals: an overview of systematic reviews
  1. Khaled Trabelsi1,2,
  2. Achraf Ammar2,3,4,5,
  3. Omar Boukhris6,7,
  4. Mohamed Ali Boujelbane2,3,
  5. Cain Clark8,
  6. Mohamed Romdhani5,9,
  7. Jad Adrian Washif10,
  8. Abdul Rashid Aziz11,
  9. Nicola Luigi Bragazzi12,
  10. Jordan M Glenn13,
  11. Karim Chamari14,
  12. Hamdi Chtourou2,9,
  13. Haitham Jahrami15,16
  1. 1Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
  2. 2High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
  3. 3Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg University Mainz, Mainz, Germany
  4. 4Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
  5. 5Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS (Faculty of Sport Sciences), Paris Nanterre University, Nanterre, France
  6. 6Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
  7. 7SIESTA Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
  8. 8Birmingham City University, Birmingham, UK
  9. 9Physical Activity, Sport and Health, UR18JS01, National Observatory of Sports, Tunis, Tunisia
  10. 10National Sports Institute Of Malaysia, Kuala Lumpur, Malaysia
  11. 11Sport Science & Sport Medicine, Singapore Sport Institute, Singapore
  12. 12Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
  13. 13Department of Health, Human Performance and Recreation, University of Arkansas Fayetteville, Fayetteville, Arkansas, USA
  14. 14ISSEP Ksar-Saïd, Manouba University, Manouba, Tunisia
  15. 15Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
  16. 16Government Hospitals, Manama, Bahrain
  1. Correspondence to Dr Khaled Trabelsi, Higher Institute of Sport and Physical Education of Sfax, Sfax 3000, Tunisia; trabelsikhaled{at}gmail.com

Abstract

Objective To systematically review, summarise and appraise findings of published systematic reviews, with/without meta-analyses, examining associations between Ramadan fasting observance (RO), health-related indices and exercise test performances in athletes and physically active individuals.

Design Overview of systematic reviews with assessment of reviews’ methodological quality.

Data sources PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, SPORTDiscus, ProQuest, PsycINFO and SciELO.

Eligibility criteria for selecting studies Systematic reviews with/without meta-analyses examining associations of RO with health-related indices and exercise performances in athletes and physically active individuals.

Results Fourteen systematic reviews (seven with meta-analyses) of observational studies, with low-to-critically-low methodological quality, were included. Two reviews found associations between RO and decreased sleep duration in athletes and physically active individuals. One review suggested athletes may experience more pronounced reductions in sleep duration than physically active individuals. One review found associations between RO and impaired sleep quality in athletes and physically active individuals. RO was associated with decreased energy, carbohydrate and water intake in adult-aged athletes, but not adolescents. One review suggests RO was associated with athletes’ increased feelings of fatigue and decreased vigour. No association was found between RO and athletes’ lean mass or haematological indices. RO was unfavourably associated with changes in athletes’ performance during high-intensity exercise testing.

Conclusion Continuance of training during RO could be associated with athletes’ mood state disturbances, decreased sleep duration and performance decline during high-intensity exercise testing, while preserving lean mass. However, careful interpretation is necessary due to the low-to-critically-low methodological quality of the included reviews.

  • Athletic Performance
  • Sports
  • Health
  • Exercise training

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

https://doi.org/10.1136/bjsports-2023-106826

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Footnotes

    • Twitter @DrCainCTClark, @romdhaniroma, @Jad_AdrianWJ, @ProfChamari

    • Contributors TK, HJ, AA, OB, KC and HC conceived the idea for the review. TK, HJ, AA and OB conducted search, study selection, data extraction and quality assessment. TK, HJ, OB, AA, CC, MAB, JAW, JMG and KC drafted the initial manuscript. NLB, HC and MR contributed to writing the manuscript. All authors reviewed and approved the final manuscript. KT is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.