This article focuses on changes in Ramadan during the course of the waking day in physical performance, mental performance and gastrointestinal function. Possible explanations of the changes are considered by reference to the roles of the body clock and external factors such as the environment and the individual's lifestyle. The effects of these factors upon training schedules and upon changing the times of training are then discussed in terms of physiology and biochemistry. Delaying the time of training until after sunset has advantages and disadvantages, but it is a regimen that is unlikely to be widely accepted in non-Muslim countries. It is clear that the detailed nature of the problems involved and dealing with them in a manner based upon a fi rm body of knowledge requires far more experimental investigation.
CHANGES IN PERFORMANCE IN RAMADANRamadan requires Muslims to alter the timing of food and fl uid intakes; in addition, their hours of sleep might be curtailed (due to rising earlier and/or retiring later). This combination of factors is likely to affect daytime activities and performance in the mental, physical and social domains.In support of such a prediction, there is evidence of increased incidence of traffi c accidents occurring in Ramadan, 1 and irritability increases. 2 3 Whether these events are related to changes in insulin, blood glucose, low energy levels or mood changes-or some combination-is unclear, but they apply to the population as a whole.Several studies have investigated performance in individuals undertaking training sessions in sports. Aspects of physical performance are compromised, but the deterioration is often not marked, and other aspects are unaffected. For example, in soccer players, a deterioration in Vo 2 max but not sprinting ability or agility, 4 a fall in aerobic capacity, endurance and jumping ability but no change to sprinting or agility, 5 a decreased ability to perform exercise at 75% Vo 2 max, 6 no clear changes in speed, power, agility, endurance and dribbling skills, 7 a marginally reduced (but biologically nonsignifi cant) decrease in maximal heart rate but no change in perceived exertion, 8 and a general decrease in fi tness and tests of skill (speed, agility, dribbling and endurance) 9 have all been reported. In addition, some studies indicated that subjective assessments of performance had been performed less well 9 or that the exertion required to undertake the training sessions was increased. 10 11 When deterioration has taken place, it seems to be temporary and reverses soon after the end of Ramadan. 4 Even if there is deterioration in performance in sports, it is unclear whether there is a systematic decline in physiological variables related to exercise. Ramadan 12 reported no adverse effects on sedentary subjects exercising at about 70% V . o 2 max under thermoneutral conditions, but there were increases in systolic blood pressure in response to exercise by the end of the month of fasting. Bigard et al 13 measured maximal voluntary contraction (...