Muslim players asking scientists for help

Playing football at competitive level while fasting for religious reasons is a challenge more and more Muslim players see themselves confronted with. Next year’s Olympic Games will be held during Ramadan, affecting around a quarter of participating athletes who are Muslim. The FIFA Medical Assessment and Research Centre, F-MARC, following the initiative of Dr Yacine Zerguini, FIFA Medical Committee member, Algeria, and the Algerian Football Association had already performed research studies on “Ramadan and Football” back in 2004, and continued together with the Tunisian Football Association in 2006. The results of these series had been published in 2008 in the Journal of Sport Sciences, a primary reference for sports physicians. The first consensus conference on Ramadan and Football on 25 and 26 November in Aspetar, Qatar, now brought together scientists and physicians as well as players, to exchange their knowledge and experiences in order to try and develop recommendations for fasting players. All parties agreed that the objective must be to best advise players who consciously decide for themselves to adhere to fasting. Even though there are those who suggest the strict rules could be mitigated in order to accommodate competitive players during the season, there was a general consent that adhering or not to Ramadan is a purely personal decision not to be argued with by scholars, nutritionists or physical trainers. It became clear that the personal experience of individual players does not necessarily comply with what is found in studies. Three well-known Muslim players shared their personal stories with the participants of the meeting. Madjid Bougherra, Algerian national team player, said he always tried to avoid loss of sleep caused by long meals at night and went straight for pasta to fill his carbohydrate stores. High carbohydrate intake complies with current nutritionists’ recommendations for players during Ramadan. Bougherra felt the problem was less for players in Muslim teams than for those playing in Europe or elsewhere when they are but a few or even the only fasting player in a team: “We would indeed be grateful for advice on what to eat and drink and when, also how to best sleep.” Nadir Belhadj, another Algerian professional player, also awaited help on how he could train long and hard despite the fasting. “I feel there are for sure more injuries during fasting.” This impression seems to be confirmed by a study recently done in Tunisia over two seasons showing higher injury rates during Ramadan as compared to the pre- and post-fasting period. It is in fact known that injuries may peak with suboptimal physical preparation, tiredness or lack of training, all situations that might occur with fasting players. Further research is required in this aspect. In contrast to what was found in the studies, which reported the greatest impact of Ramadan was during the first week, Jamal Alioui, Moroccan national player, said that for him the last two weeks were always the most difficult. But he also felt the influences of Ramadan to be a very individual matter, depending further on sleep, hydration and temperature. With Ramadan moving forward in the calendar by ten days annually, players were particularly concerned when it will eventually coincide with pre-season in a few years. “That would be the worst!” One idea discussed with the players was to try to adopt different sleep and eating cycles more gradually over several days, instead of suffering from the sudden radical change from one day to the other. Several speakers suggested introducing fasting in a step-wise manner over a few days prior to the official start of Ramadan. Several studies have shown partly conflicting results with regard to different performance characteristics. Short bouts of high-intensity activities such as sprints do not seem to be impaired. In F-MARC studies, speed, power and endurance did even show slight improvement over three weeks whereas others remained stable. However, all data currently refer to field tests, with actual match performance not yet measured. Sleep a key factor It is important to note that Ramadan also means disturbed sleeping patterns. Time spent on eating might be missed for sleeping, and late meals can further interfere with sleeping. Possible strategies in this regard are to avoid extended long meals and concentrate on high carbohydrate intake within a rather short time, and naps during daytime. Listening to the scientists, there is no single coping strategy yet, but players will need to try what is best for them individually. Whole Muslim teams may choose to move training sessions to late afternoon or early evening to enable refuelling of depleted energy stores right afterwards. Others may reduce training intensity and concentrate on technique instead. This is clearly more difficult for individual Muslim players in a non-fasting team. One of the major insights of the meeting was that we still do not know enough and more investigations are required. Further studies and scientific publications are planned to compile the essence of current evidence, and then extract the best recommendations for daily practice on the pitch, at training grounds and for day- and night-time challenges during Ramadan. The results of the conference as well as the conclusions and recommendations will be published in a scientific journal in early 2012. However, it is likely that coping strategies will remain individual – as is the choice to fast. The following scientists, experts and physicians contributed to the consensus meeting: Dr Mohammed Al Maad’heed, Qatar; Dr Khalifa Jeham Al Kuwari, Qatar; Dr Qanta Ahmed, USA; Aicha Ahmed, UK; Dr Jasem Ramadan AlKandari, Kuwait; Prof. Louise Burke, Australia; Dr Hakim Chalabi, Qatar; Dr KArim Chamari; Anis Chaouachi, Tunisia; Barry Dust, UK; Dr Michel D’Hooghe, Belgium; Prof. Jiri Dvorak, Switzerland; Justin Grantham, Qatar; Umid Karli, Turkey; Don Kirkendall, USA; Prof. RonMaughan, UK; Dr Rachida Roky, Morocco; Prof. Gérard Saillant, Qatar; Dr Abdelmadjid Yacine Zerguini, Algeria; Abderrahman Ziad, Algeria, Prof. Ziad A Memish, Saudi Arabia.