During the 2023/24 season, we piloted the implementation of a pre-participation evaluation (PHE) questionnaire specifically designed for athletes observing Ramadan fasting (1).
This proposal sought to address the complex challenges facing our Muslim players during the holy month, including balancing energy levels, maintaining hydration and nutrition within limited eating windows, and managing disrupted sleep schedules(2, 3).
Our motivation was rooted in ensuring holistic development of players, encompassing both physical performance and spiritual commitments, particularly given the multicultural nature of our location. This initiative aimed to embody the club’s commitment to individualized, player-centred care, providing an inclusive and supportive environment where athletic and spiritual priorities could coexist harmoniously.
Preparation
For the fasting Academy football player, Ramadan poses distinct challenges that must be navigated including late-evening training sessions, early morning match schedules, and the fluctuating demands of youth development alongside managing restricted eating and hydration Environmental conditions including colder temperatures and increased rainfall introduce further complexities during this period.
A clear need emerged for a structured approach to provide effective support for fasting athletes. We identified the PHE as a tool to bridge this gap and enhance the development of individualized planning and guidance during the month (1). The PHE would address nutritional, hydration, and recovery strategies while alignment of targets between players, coaches, and performance staff.
Implementation
Our previous strategy was based on published guidance and focused on nutritional and general well-being advice related to sleep and fasting plans. However, incorporating the PHE framework enhanced our approach by providing a more structured and systematic process. The idea to adopt the PHE originated from reading a post on BJSM blogs and reaching out to the authors to discuss. This framework outlined six key components: assessing fasting requirements, environmental conditions, and nutritional strategies, alongside considerations for training load, medical history, and individual player goals. These elements provided a structured yet flexible approach to addressing the complex needs of fasting athletes.
Implementation began several weeks prior to Ramadan, involving a collaborative approach between nutritionist, sports scientist, and medical staff. This interdisciplinary approach was pivotal in tailoring individualized plans to each athlete’s unique needs.
One-on-one meetings were conducted with players in the Professional Development Phase to discuss their fasting strategies and prior experiences. These discussions were instrumental in shaping bespoke plans that accounted for each player’s nutritional, recovery, and training requirements. For younger players, educational sessions were held with their families with an emphasis on hydration, balanced nutrition, and the importance of sleep hygiene. Efforts also extended to loan players, ensuring consistency in support across all settings.
Feedback gathered through one-on-one discussions revealed that players appreciated the consideration of their fasting state, though some suggested additional flexibility in scheduling to accommodate individual differences. This feedback was instrumental in refining our approach for future implementation. On matchdays, strategies for breaking fasts were implemented, with monitoring protocols in place to assess hydration status, energy levels, and symptoms such as dizziness. Environmental conditions demanded flexibility, requiring indoor training sessions during adverse weather to minimize additional stress on fasting athletes.
Improvements and Room to Develop
While the PHE significantly enhanced our ability to support fasting athletes, there are areas for further refinement, which were identified through direct feedback from players, observations by staff, and the challenges encountered during implementation. These insights highlighted the need for more comprehensive historical data on fasting practices, better accommodation for variable schedules, and enhanced communication strategies. These athletes have been navigating fasting and athletic demands for many years and so incorporating their experience is imperative. Additionally, integrating specific questions about caffeine consumption and detailed sleep schedules could further strengthen the framework’s focus on recovery and performance.
The need for greater adaptability in managing players transitioning between squads became evident. A macro-level planning approach could address the variability in weekly schedules, ensuring consistency in support. Furthermore, younger players often struggled to articulate Ramadan-specific goals, underscoring the importance of guided discussions to help them set meaningful objectives.
Conclusion
The implementation of the PHE proved to be an asset in addressing the physiological, psychological, and logistical challenges associated with fasting during Ramadan by
- Allowing for a more individualized approach,
- Fostered enhanced collaboration across the academy.
- Reporting increased confidence and from the performance team by players.
By continuing to use and refine this framework, the PHE can become a gold standard for the holistic care for the Muslim athlete in Ramadan.
Authors: Dr Bilal Ladak, Dr Irfan Ahmed & Dr Rifat Hassan
References
- Hassan R. 2023 2023-03-22. Available from: https://blogs.bmj.com/bjsm/?p=10488.
- Chamari K TM, Al Sayrafi O, Karim K, Aziz AR, Bragazzi N, et al. . Aspetar Clinical Guideline: Ramadan Fasting and Exercise for Healthy Individuals: Aspetar; 2021 [Available from: https://www.aspetar.com/AspetarFILEUPLOAD/UploadCenter/637556398121737163_Aspetar%20clinical%20guideline%20for%20Ramadan.pdf
- Ahmed I, Maughan R, J., Iqbal Z, Ali K, Naji O, Awan S, et al. Competing in the Ramadan fasted state: for spirituality, health and performance. British Journal of Sports Medicine. 2022;56(18):1001.