Optimizing training and competition during the month of Ramadan: Recommendations for a holistic and personalized approach for the fasting athletes.

During the month of Ramadan, Muslim believers of adult-aged and healthy, restrain themselves from food consumption and liquid intake from dawn to sunset (fasting duration varying according to the geographical location and time of the year). Differently from other fasting regimens such as caloric restriction, Ramadan fasting is a unique kind of fasting, being total (i.e., absolute abstain from food as well as fluid), time-restricted, intermittent, and circadian (following the circadian rhythm and the human biological clock). As such, the fasting athletes could potentially suffer from hypohydration, altered sleep pattern and architecture, sleep disturbances, mood swings, immunological alterations, impaired psychomotor performance and overall perceived physical and perhaps, mental fatigue, among others. Hence, Muslim athletes who continue to train and compete during Ramadan faced many challenges. Research has shown that depending on the level of effort, Ramadan fasting could have diverse effects on physical performance; from no effect to marked effects. The present review aims to provide practical recommendations based on an updated, evidence-based synthesis of the existing scholarly literature and/or experts opinions on the topic and subsequently, some useful tips for athletes, coaches, medical and scientific support, and sports managers, in order to guide them on how to promote appropriate behavioral, social and psychological strategies to cope with the changes and potential constraints induced by the observance of Ramadan fasting. These recommendations should be adjusted and coped with, utilizing a holistic approach, rather than focusing on the single alterations/perturbations. Moreover, the implemented strategies should not be "one size fits it all" approach, but should rather take into account the variability among athletes and their specific needs (biological, psychological, cognitive-behavioral), and their social and living environment; as it is clearly more challenging when the individual is performing the Ramadan fasting in a predominantly non-Muslim majority country.