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During Ramadan, Muslims are required to abstain from all fluid and food intake during the period from sunrise to sunset. There are also rituals involved with breaking of the fast and various prayers and feasts throughout the night. Research has shown that exercise performance could be affected during Ramadan due to energy restriction, sleep deprivation, circadian rhythm perturbation, dehydration, and alterations in the training load. In contrary, well-controlled research suggests that athletes who maintain their total energy and macronutrient intake, training load, body composition, and sleep length and quality are unlikely to suffer any substantial decrements in performance. With this promising finding, this article suggests and discusses some coping strategies to maintain performance during Ramadan which are derived from two latest recommendations (1, 2).

Plan ahead and introduce change gradually

The most significant perturbations that are due to Ramadan fasting have been reported to occur in the first week of Ramadan. Therefore the appropriate coping strategy should be gradually introduced at least two weeks before the start of Ramadan.

Maintain the training stimulus (including both exercise load and/or intensity)

Training loads should be suitable to progress the required fitness and performance levels of the athletes, or should be similar to the training carried out in the lead up to the competition.

Train according to the time of competition

If the time of competition is known, training sessions before a major event should be conducted at the same time of day at which the critical performance is scheduled. However, if the time of competition is not known, training sessions should be programmed in the morning to counteract a possible shift in the sleep wake cycle and its effect on sports performance.

Time training session based on its intensity

Heavy training sessions should be scheduled either in the early evening (after breaking fast) or the late afternoon (close to the time of breaking fast), so that players can replenish their glycogen stores and rehydrate immediately after training. Technical or light training can be carried out at the usual time.

Eat well to train hard

Part of the coping strategies must include a diet that is composed of high carbohydrate (60–70% of total energy intake) foods, with sufficient energy to meet the athletes’ energy and nutrient requirements of their training and competition schedules. The meals should be healthy, balanced and appetizing. However, the timing of food and drink ingestion may not be optimal for the Muslim athletes during Ramadan because of the daylight fast. A dietitian, especially those specialised in sports dietetics, is the right person to be contacted for diet consultation and enquiry. Besides the nutritional strategies discussed in the previous article (http://dietitians.org.my/health-information/food-nutrition/get-the-most-out-of-your-training-this-ramadhan/ ), the table below further elaborate the nutritional strategies to optimize the achievement of sports nutrition goals during Ramadan fasting.

Major changes in the daily timetable of training/ competition, as well as sleep, may be possible in countries that are predominantly Islamic

Issue	Details	Special comments
Where possible, move the schedule of exercise to a time of the day that best provides the appropriate nutrition support	Sessions undertaken in the morning after sunrise Pros: benefit from eating and drinking strategies undertaken during the previous evening and before dawn Cons: Little opportunity to refuel, rehydrate, and recover after these sessions Sessions scheduled to finish just before Iftar (breaking fast) Pros: benefit from ability to eat for recovery at Iftar and during evening Cons: undertaken with minimal pre-exercise support Sessions undertaken 2–3 h after the break of the fast Pros: best opportunities to fuel and hydrate before, during, and after Cons: must be balanced against the importance of sleep
Make the most of important eating times	Breaking of the fast Adapt or supplement meals in quantity/quality to meet specific needs for fluid, carbohydrate, and protein, especially for recovery after recent exercise session The last meal (Sahur) Eat as close as possible to sunrise and choose foods that contribute to sports nutrition needs for the day Food/fluid consumed during or after exercise undertaken in the evening Support needs for performance and recovery Remember that this food/fluid contributes to total day’s nutrient needs Make use of special sports foods to reduce gastrointestinal discomfort from pro-active eating strategies	By delaying training/competition to the evening, Iftar can be used as the pre-exercise meal, and the main evening meal can be delayed until after the exercise Players who must train during the day when fasting should maximize refuelling and hydration during the night and at Sahur, rest after training, and begin replenishing with Iftar
Consider important nutrients	Carbohydrate Consume at break of fast and meal before dawn, and other meals during the evening, especially where these meals represent post-, pre- or in-exercise intake Set targets according to fuel cost of exercise Consume small amounts during exercise undertaken after the fast is broken, even if there is little need for additional fuel. Mouth contact with carbohydrate may promote a ‘‘happier’’ brain for better performance Eat immediately after exercise if possible, to enhance refuelling rate Consume low glycaemic carbohydrate choices at meal consumed before dawn to allow slow release of glucose Protein Consume 20 g ‘‘fast’’ high-quality protein soon after exercise where possible, but note that enhanced protein synthesis from exercise persists for 16–24 h In absence of information on best protein spread over the day, consume protein at each meal opportunity (avoid eating only carbohydrate-rich food choices) Consume ‘‘slow’’ proteins at meal consumed before dawn to help with protein balance over day Add protein to carbohydrate-rich snacks to enhance muscle glycogen storage when carbohydrate targets can’t be met	Many common foods associated with Iftar are rich in carbohydrate (e.g. figs/dates) and high quality protein (milk and laban yoghurt). The substantial meal after prayers typically features savoury dishes with carbohydrate-rich components (rice) and protein (meat or fish) Arab breads and other varieties provide worthwhile amounts of carbohydrate. Other combinations of carbohydrate and protein include Thareed (bread containing), starch pudding (milk), and rice porridge Care should be taken with Ramadan treats, since many are very high in fat. Some recipes can be adapted to promote carbohydrate content and reduce fat (e.g. replace puff pastry in Um Ali with bread) Ma’amoul, dried fruits and nuts are suitable snacks When eating opportunities are limited, drinks with high energy/nutrient density can be useful to meet high-energy requirements. These include special nutrient feeds used in clinical nutrition situations, liquid meal supplements, and fruit/ milk smoothies Many of the special Ramadan drinks (e.g. Jellab) are energy rich and those based on milk/laban also provide high-quality protein Sahur meals that are high in carbohydrate include rice with egg, cheese, and milk. Although beans and foul have good sources of nutrients, they are not suitable to be consumed close to a training session
Consider practical issues	Athletes Identify culturally significant foods that also meet nutrition goals Prepare ahead to have suitable foods available at key times so that opportunities for eating aren’t lost Team support personnel When all athletes are fasting: organise team eating opportunities to support goals When a few athletes are fasting: support special needs of individuals Caterers Provide suitable foods at venues where fast will be broken Organise food service to allow quick access to food in large-scale catering situations	Teams should provide an evening meal of traditional dishes after training sessions if athletes are not able to be with families

Adopted from Burke LM & King C (2012)

Remember to drink enough

Acute hypohydration (dehydration) will occur during daylight hours especially during bouts of strenuous physical activity in the heat. Fluid intake should be monitored daily. Pre-training urine concentration and body mass should be checked in order to ascertain that individual athletes are not significantly dehydrated before training. It is suggested that individuals who are hypohydrated by 3% or more of usual body mass should not undertake strenuous, prolonged (about 60 min) exercise, especially in hot environments. Sensible dietary strategies that ensure adequate fluid intake especially just before dawn, coupled with behavioural adaptations that minimize daytime fluid losses before training will help preserve hydration status and physical performance. Athletes should be allowed cool water to rinse out their mouth, whenever they require, which will alleviate their thirst without breaking their daytime fast. Where possible, sweat loss should be minimised by reducing non-training activity, staying in the shade or air conditioned areas.

Rest well

Sleep deprivation and disruption to the normal circadian cycles can adversely affect physical performance. In this period before Ramadan, athletes should progressively establish a new sleep-wake cycle, with regular sleeping and eating schedules that match that followed during Ramadan. Sleep loss should be minimised, and regular daytime naps may be required to sustain hard physical activity.

Monitor closely and seek for help when necessary

Even modest decrements in performance could seriously affect an individual’s ability during an athletic event, therefore all athletes should be regularly monitored to ensure that mood and/or performance is not progressively deteriorating. These checks should be made on a daily basis from two weeks before Ramadan and throughout Ramadan. Any obvious loss of performance/playing ability should be reported to and investigated by the team scientific expert, doctor, physiotherapist, conditioning coach etc. A trained dietitian could help to monitor the energy and nutrient requirements of the athletes and to suggest suitable meals to be eaten. Athletes will vary greatly in their adaptability to coping strategies during fasting and training during Ramadan, and some may not be able to sustain their exercise performance during the RIF. This may affect team selection for a competition during or immediately following Ramadan.

Reference:

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.
Burke LM, King C. Ramadan fasting and the goals of sports nutrition around exercise. J Sports Sci. 2012;30 Suppl 1:S21-31.

Strategies to Maintain Athletic Performance during Ramadan