The number of practising Muslims in Malta is ever on the increase and this has led to a new challenge that, until now, we only infrequently encountered, namely, how Muslims tackle physical activity during Ramadan. This year Ramadan falls bang in the middle of summer and this can compound certain aspects, especially hydration status.

The daytime fasting will often mean that the food and drink ingestion will often be far from optimal and especially hypo-hydration can be an issue

For the past couple of years I have been working in a Muslim country where we face the Ramadan physical performance issue on a yearly basis. Obviously being born into this culture ensures that all systems are well adapted to this month-long fast that imposes acute starvation and dehydration and can pose a significant obstacle to physical performance, if not tackled appropriately. It was instructive to see how they developed a coping mechanism that serves them well and ensures safe sport participation.

Fasting during Ramadan is one of what are known as the five main pillars of Islam, and therefore is mandatory for all practising Muslims. Fasting in Islam requires healthy adolescents and adult Muslims to refrain from eating and drinking, among other constraints, from dawn to sunset and lasts 29 to 30 consecutive days.

Together with the associated night prayers, Muslims are subject to sudden behavioural modifications that will lead to altered eating and sleep schedules. These in turn will induce acute diurnal dehydration and varied energy availability, sleep pattern variations and even the body’s circadian rhythm (physical, mental and behavioural changes that follow a roughly 24-hour cycle) may be affected.

All of these can easily affect physical performance.

Although fasting can be postponed for some categories of healthy and ill people, the list of allowable reasons do not specifically include sports participation.

Physical activity in adverse environmental conditions is far from rare. Altitude, heat, humidity, cold, time zones, etc. all potentially affect physical performance, and yet athletes take them in their stride, since they devise a strategy that takes into account the environment.

However, the difference during Ramadan in a country like Malta is that usually only a minority of people that are exercising are practising Muslims. The challenge is to combine their religious observations within the training and exercising schedule of the sporting community they belong to.

So how can a Muslim athlete cope during Ramadan with the physical demands of a sport? Ideally, all Muslim athletes should progressively establish a new sleep-wake cycle prior to the start of Ramadan, which is similar to what will be observed in Ramadan. Sleep loss during Ramadan itself must be minimised, and regular daytime naps might be necessary to sustain hard physical activity.

Part of the coping strategy must include healthy and balanced meals, with a high carbohydrate component, sufficient to meet the athlete’s energy and nutritional requirements. At this stage speaking to a nutritionist versed in sports might be beneficial.

However, notwithstanding a well-planned nutritional strategy, the daytime fasting will often mean that the food and drink ingestion will be far from optimal and especially hypo-hydration can be an issue. Adequate hydration, especially before dawn, must be stressed and behavioural adaptations that decrease daytime fluid losses should be encouraged.

Daily fluid intake monitoring should be encouraged, and if an athlete, after regular daily weighing, is found to have incurred a 24 hour weight loss of over three per cent, then it would be advisable to limit his or her athletic participation.

If possible the timing and scheduling of training should be altered for Muslim athletes such that the more strenuous component is held later in the day while the technical and lower intensity components can be held at late afternoon. Some advocate rinsing the mouth with cold water and ice which can help alleviate the thirst reflex without breaking the fast. The athlete must strive to minimise sweat losses by seeking shade or even an air-conditioned environment whenever possible.

Even with all the possible precautions, an athlete’s performance may be negatively affected during Ramadan. The technical staff and athlete must be aware of this and be on the lookout for it. Early recognition can lead to the avoidance of deleterious consequences that can affect the team and athlete.

Although this contribution focused mainly on sporting activity, Ramadan may affect any strenuous physical activity at work, home or during leisure time.

Hence the advice given to the Muslim athlete holds true for any Muslim that is physically active during Ramadan.

sportmedicinedoc@gmail.com

Kirill Micallef Stafrace is a sports and exercise medicine consultant and senior lecturer in sports science. Omar Asfour is a Muslim doctor specialised in health promotion.