Fasting and exercise: A delicate balance between enthusiasm and health

During Ramadan, eating, sleeping, and activity patterns change significantly, directly impacting the body’s physiological balance. While some fasting individuals choose to stop exercising for fear of exhaustion or dehydration, others insist on maintaining their usual training programs.

Between this and that, a fundamental question arises: What does science say about physical activity during fasting? And do the recommendations differ between healthy people and patients, especially those taking chronic medications?

Exercise during Ramadan: Conditional, not prohibited

Physiologically, during fasting the body goes through gradual metabolic stages. After hours of abstaining from food, the blood glucose stores decrease, then the body relies on glycogen stored in the liver and muscles, before gradually switching to using fat as an energy source.

These changes are normal, but they are accompanied by a gradual decrease in fluids, which may limit the ability to withstand physical exertion, especially in hot weather.

Scientific reviews published in databases such as PubMed indicate that fasting does not necessarily lead to an overall decline in physical performance, especially in moderate-intensity exercise, although it may affect some components of extreme performance such as high speed or extreme endurance in the later hours of the day.

Some studies have also shown that maintaining moderate physical activity during Ramadan is associated with improvements in body composition indicators, weight control, and some metabolic indicators.

In contrast, behavioral studies have observed a general decrease in daily activity levels among those who fast compared to those who do not, indicating that the real challenge is not in the danger of exercise itself, but in the tendency to be inactive during the month.

Potential benefits: Improved metabolism and mental health

Clinical studies conducted during Ramadan in various countries indicate that engaging in moderate and regular physical activity may contribute to:

1. Improving insulin sensitivity and blood sugar control in certain groups.
2.  Reducing body fat percentage and improving some blood lipid indicators.
3.  Supporting mental health and reducing stress thanks to the release of endorphins.

Experiments on overweight groups have also shown that incorporating structured physical activity during Ramadan can promote fat loss without significantly impacting muscle mass, provided that the exercise is moderate and accompanied by adequate nutrition after breaking the fast.

However, these positive results remain contingent on crucial factors such as exercise intensity and timing, and the individual’s health status. Furthermore, this is a highly sensitive area for patients taking medication, making the discussion even more complex. Fasting not only affects energy and fluid levels but can also alter the dynamics of medications in the body, in terms of absorption, distribution, and duration of action.

Diabetic patients taking blood sugar-lowering medications are more susceptible to complications during exercise while fasting, as physical activity increases glucose consumption from muscles, and without adequate food intake, a sharp drop in blood sugar may occur. Clinical studies during Ramadan have documented an increased incidence of hypoglycemic episodes in some patients whose medication dosages were not appropriately adjusted.

Patients with high blood pressure or heart disease who take diuretics or blood pressure-lowering medications may be at risk of low blood pressure or dehydration if fasting is combined with strenuous physical activity. Fluid loss through sweating, along with the effects of medication, can lead to dizziness or fainting, especially later in the day.

Even patients taking medications that do not directly affect blood sugar or fluids, such as some thyroid medications or medications for mental disorders, may have their response affected by changes in sleep patterns and dosage schedules, which in turn affects their physical endurance.

Patients not receiving medication: risk of underestimation

Another category that is often overlooked in the discussion is patients with mild or early-stage chronic conditions who are not taking medication.

For a diabetic patient with diet alone, or someone with mild, untreated hypertension, physical activity may seem perfectly safe. However, prolonged fasting combined with fluid deprivation and sleep disturbances can reveal underlying blood sugar or blood pressure imbalances. Therefore, absolute safety should not be assumed simply because medication is absent.

Timing and intensity of exercise: What does the evidence recommend?

Medical literature agrees that the best times to engage in physical activity during Ramadan are:

1. About an hour before breakfast, while adhering to light to moderate intensity exercises.
2. Or two to three hours after breakfast, after fluids and energy have been restored.

High-intensity or long-duration exercise during fasting hours is associated with an increased risk of dehydration, blood pressure or blood sugar disorders, especially among those with pre-existing medical conditions.

Medical decisions are individual, not collective.

The conclusion, confirmed by clinical studies and sports medicine experience, is that fasting does not prevent physical activity, but it does necessitate its reorganization. The benefits are possible, but the risks are real, especially for patients with pre-existing medical conditions. Therefore, the decision remains entirely individual.

The treating physician is the only one authorized to assess the level of risk, adjust medication dosages if necessary, and determine the type, intensity, and timing of exercise. The equation during Ramadan is not between exercise and fasting, but between enthusiasm and knowledge.

Ultimately, maintaining health is part of the purposes of worship, and moderation is the golden rule where science and experience come together.