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Effect of fed- versus fasted state resistance training during Ramadan on body composition and selected metabolic parameters in bodybuilders

Authors:
  • High Institute of Sport and Physical Education of Sfax, Tunisia

Abstract and Figures

Background Muslim bodybuilders often continue training during Ramadan. However, the effect of resistance training in a fasted versus a fed state during Ramadan on body composition and metabolic parameters in bodybuilders is not well known. The aim of this study was to evaluate the effects of resistance training in a fasted versus a fed state during Ramadan on body composition and metabolic parameters in bodybuilders. Methods Sixteen men were allocated to two groups: Eight practicing resistance training in the late afternoon in a fasted state (FAST), and eight training in the late evening in an acutely fed state (FED) during Ramadan. All visited the laboratory in the morning two days before the start of Ramadan (Bef-R) and on the 29th day of Ramadan (End-R) for anthropometric measurement, completion of a dietary questionnaire, and provision of fasting blood and urine samples. Results Body mass and body fat percentage remained unchanged in FAST and FED during the whole period of the investigation. Both FAST and FED experienced an increase in the following parameters from Bef-R to End-R: urine specific gravity (1%; p = 0.028, p = 0.004 respectively), serum concentrations of urea (4%, p = 0.006; 7%, p = 0.004 respectively), creatinine (5%, p = 0.015; 6%, p = 0.04 respectively), uric acid (17%; p < 0.001, p = 0.04 respectively), sodium (1%; p = 0.029, p = 0.019 respectively), chloride (2%; p = 0.039, p = 0.004 respectively), and high-density lipoprotein cholesterol (11%, p = 0.04; 10%, p = 0.04 respectively). Conclusion Hypertrophic training in a fasted or in a fed state during Ramadan does not affect body mass and body composition of bodybuilders. Additionally, Ramadan fasting induced changes in urinary and some biochemical parameters, but these changes were not different according to when the training occurred.
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RES E AR C H A R T I C L E Open Access
Effect of fed- versus fasted state resistance
training during Ramadan on body composition
and selected metabolic parameters in
bodybuilders
Khaled Trabelsi
1*
, Stephen R Stannard
2
, Zohra Ghlissi
1
, Ronald J Maughan
3
, Choumous Kallel
4
, Kamel Jamoussi
5
,
Khaled M Zeghal
1
and Ahmed Hakim
1
Abstract
Background: Muslim bodybuilders often continue training during Ramadan. However, the effect of resistance
training in a fasted versus a fed state during Ramadan on body composition and metabolic parameters in
bodybuilders is not well known. The aim of this study was to evaluate the effects of resistance training in a fasted
versus a fed state during Ramadan on body composition and metabolic parameters in bodybuilders.
Methods: Sixteen men were allocated to two groups: Eight practicing resistance training in the late afternoon in a
fasted state (FAST), and eight training in the late evening in an acutely fed state (FED) during Ramadan. All visited
the laboratory in the morning two days before the start of Ramadan (Bef-R) and on the 29th day of Ramadan
(End-R) for anthropometric measurement, completion of a dietary questionnaire, and provision of fastin g blood and
urine samples.
Results: Body mass and body fat percentage remained unchanged in FAST and FED during the whole period of
the investigation. Both FAST and FED experienced an increase in the following parameters from Bef-R to End-R:
urine specific gravity (1%; p = 0.028, p = 0.004 respectively), serum concentrations of urea (4%, p = 0.006; 7%,
p = 0.004 respectively), creatinine (5%, p = 0.015; 6%, p = 0.04 respectively), uric acid (17%; p < 0.001, p = 0.04 respectively),
sodium (1%; p = 0.029, p = 0.019 respectively), chloride (2%; p = 0.039, p = 0.004 respectively), and high-density
lipoprotein cholesterol (11%, p = 0.04; 10%, p = 0.04 respectively).
Conclusion: Hypertrophic training in a fasted or in a fed state during Ramadan does not affect body mass and body
composition of bodybuilders. Additionally, Ramadan fasting induced changes in urinary and some biochemical
parameters, but these changes were not different according to when the training occurred.
Keywords: Resistance training, Dehydration, Renal function, Body fat percentage, Islamic fasting
Introduction
Most Muslims fast during the holy month of Ramadan
from dawn till sunset, when they neither eat nor drink,
as it forms one of the fundamental obligations of the
Muslim faith [1]. The Ramadan month occurs eleven
days earlier every year and thus over time may occur in
any of the four sea sons [2]. Therefore, the length of the
daily fast during Ramadan varies from 1118 hours in
tropical countries [3].
Not only is the eating pattern by necessity altered dur-
ing Ramadan, the type of food eaten during the night
may also be different from that usually consumed during
the rest of the year [4]. Energy and water intake are
often reduced during this month [5,6], which may result
in reduced body mass [5,6] and changed hydration
status.
Participants of Ramadan often maintain physical
activity during the holy month for recreation and health
* Correspondence: trabelsikhaled@gmail.com
1
University of Sfax, Laboratory of Pharmacology, Faculty of Medicine, Sfax
3029, Tunisia
Full list of author information is available at the end of the article
© 2013 Trabelsi et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Trabelsi et al. Journal of the International Society of Sports Nutrition 2013, 10:23
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purposes, and this has the potential to further affect
body mass and produce dehydration. The few investiga-
tions that have examined the effect of Ramadan fasting
on the hydration status of sportsmen report conflicting
findings. For example , while urine osmolarity increased
in Emirates soccer players [7] indicating a state of dehy-
dration, the absence of change in urine specific gravity
has been reported in Turkish [8] and Tunisian [9] soccer
players. Further, the interaction between participation in
Ramadan and exercise and subsequ ent effects on circu-
lating metabolites are also poorly understood. Resting
serum glucose has been reported to decrease during
Ramadan in moderately trained runners [10], soccer and
basketball players [11] and runners [12], but not to
change in elite rugby players [5], weight lifters [13] and
physically active men [1,2]. Part of this conflict in find-
ings may be due to the difference in time of the day,
during which the training was conducted. For example,
if the training was performed in the afternoon or early
evening towards the latter part of the daily fast, the
physiological stresses would be quite different to those if
training was undertaken soon after breaking the fast.
Certainly it is now well established that training after a
12 hour fast induces significantly different metabolic
adaptations than training performed immediately after a
meal [13].
Muslim athletes, including strength athletes, employ a
variety of coping strategies to deal with the challenges
of training and/or competing during the month of
Ramadan [14,15]. Some Muslim athletes train at night to
prevent dehydration, hypoglycemia and possible decre-
ments in performance. However, it has been demon -
strated that resistance training (weight lifting) in a fasted
state affects the post-workout anabolic response to
weight training more favorably than training after a
fed-state, but only when a carbohydrate/protein/leucine
mixture was ingested following a heavy resistance train-
ing session [16]. There is an ample amount of evidence
that ingestion of protein after exercise will stimulate net
muscle protein synthesis [17]. This begs the question
as to whether the daytime resistance training during
Ramadan (i.e. fasted state training), might accelerate
adaptations to training and ultimately result in increas-
ing muscle mass, although risk of dehydration and
hypoglycemia may be increased.
Published data describing the effe cts of Ramadan
on body composition and biochemical parameters
following resistance training are scarce. The only
published studies that have observed the effect s of
resistance exercise during R amadan have lacked the
control group performing equivalent exercises in the
acutely fasted state [18,19], therefore, no specific
effects of resistance training while fasted were
identified.
It is clear that well designed scientific studies, investi-
gating the effect of resistance training in the fasted state
during Ramadan on body composition and markers of
renal function, inflammation and immunity, are cur-
rently lacking. The aim of this study was to evaluate the
effects of resistance training during Ramadan on body
composition and markers of renal function, inflamma-
tion and immunity of bodybuilders as well as to ascer-
tain whether there is a difference between daytime
resistance training in a fasted state and nighttime resist-
ance training in a fed state. We hypothesized that
resistance training could be safely practiced during
Ramadan with decrements in body composition and cir-
culating markers of health (renal function, immunity
and inflammation). It was also hypothesized that resist-
ance training in the fasted state would lead to increased
levels of markers of dehydration, while positively affect-
ing the change in lean body mass when compared to
nighttime training after the fast was broken.
Methods
Subjects
Sixteen male bodybuilders were recruited into the study
and randomly allocated to two groups : Eight participants
trained in a fasted state (FAST), and 8 trained in a fed
state (FED) during Ramadan. Each of the subject s regu-
larly performed bodybuilding (hypertrophic program) for
recreational purposes at least 3 times/week but did not
participate in national or international bodybuilding
competitions. The subjects descriptive characteristics
are provided in Table 1.
To qualify as subjects the men a) were nonsmokers
b) had no current or past history of an abolic steroid use
(according to self-report); c) had at least 1 year of body-
building training experience; d) had not ingested any
ergogenic supplement for an 8-week period prior to the
start of the study; and e) agreed not to ingest any other
nutritional supplements, or non-prescription drugs that
might affect the study parameters.
Prior to enrolling in the study, subjects were informed
of the experimental procedures as well as the potential
risks and benefits associated with the study; however,
subjects were not informed of the studys purpose. To be
included in the study, each subject provided written con-
sent in accord ance with the Decla ration of Helsinki. The
study was approved by the research ethics committee of
the Faculty of Medicine of the University of Sfax, Sfax,
Tunisia.
Experimental design
Ramadan began on August 1 and ended on August 30,
2011. The average duration of the fast was approximately
15 h. The study was conducted in Tunisia, where daytime
temperatures were 34 ± 1°C and relative humidity was
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57 ± 4%. Subjects visited the laboratory on two separate
occasions: two days before Ramadan (Bef-R) and on the
29th day of Ramadan (End-R). In the morning of each visit
(approximately 10:30 a.m.), they underwent anthropomet-
ric measurements, completed a dietary questionnaire, and
provided fasting blood and urine samples. They were
instructed not to consume any food or energy-containing
beverage after 11:00 p.m. on the day before each visit. Be-
cause of the time of sunset, this meant that the fasting
subjects had only four hours (between 7:00 and 11:00 p.
m.) on the evening before the test at End-R in which to
consume food and fluid. Seventeen days before the begin-
ning of Ramadan, subjects underwent a test of 10 repeti-
tions maximum (10 RM) for the following exercises:
bench press, barbell squat, biceps curl, lying triceps curl,
seated shoulder press behind the neck and barbell row.
During the 10 RM testing, the mass of all weight plates
and bars that were used was determined with a precision
scale. The actual mass of all plates and bars was then used
to calculate the 10 RM of each exercise. During the 10
RM tests, each subject had a maximum of 5 attempts on
each exercise with 2- to 5-minute intervals between at-
tempts. After each attempt, subjects add or remove weight
as required. After the 10 RM load in a specific exercise
was determined, an interval no shorter than 10 minutes
was allowed before the 10 RM determination of the next
exercise. Standard exercise techniques were followed for
each exercise. No pause was allowed between the eccen-
tric and the concentric phase of a repetition or between
repetitions. For a repetition to be successful, a complete
range of motion as is normally defined for the exercise
had to be completed. The testing procedures met the cri-
teria proposed by Kraemer and Fry [20].
To avoid potential confounding effects of prior exer-
cise on blood circulating biochemical and hematological
parameters, subje cts were instructed to practice only a
light training session within the 36-h period before they
undertook the laboratory assessments.
During the two weeks before and during Ramadan,
subjects recorded their exercise sessions along with their
rating of perceived exertion (RPE) on the Borg scale [21]
(Table 2) in a training journal. All subjects were familiar-
ized with the use of the RPE scale before the commence-
ment of the study. During Ramadan, exercise sessions of
FAST occurred in the late afternoon (between 4:00 and
6:00 p.m.) and those of FED occurred at night (between
9:00 and 10:00 p.m.) after the break of fasting. The
number of training sessions, sets, repetitions in each set,
total training volume and RPE did not change in either
FAST or FED during the duration of the study (Table 2).
Additionally, no differences in the number of training
sessions, number of sets, the number of repetition in
each set, total training volume and RPE existed between
FAST and FED at any time period.
Bodybuilding training program
The resistance training program employed both free
weights and machin es. The primary goal of the program
was to increase muscle mass (hypertrophic program), so
closely followed the principles documented by the
American College of Sports Medicine (ACSM) for
producing effective gains in muscle hypertrophy [22].
Briefly, four training sessions each week were conducted
by each subject, and each training session was composed
of four to six specific exercises. Each exercise was
performed in four sets with a load of 10 RM and inter-
vals of 23 min between sets. The exercises were
conducted first with the major muscle groups and, then,
with the smaller muscle groups. Training intensity was
increased progressively as needed, by adding weight
lifted, to ensure that target intensity was maintained as
subjects got stronger and set workloads became easier.
The first day of the weeks training program was devoted
to the development of quadriceps, hamstring and calves
using barbell squat, hack squat, leg extensions, lying leg
curl and seated calve raise. The second day was devoted
to the development of back and triceps using barbell
row, one-arm dumbbell row, wide-grip lat pulldown, dip
machine, lying triceps curl and standing dumbell triceps
extension, and the third devoted to the development of
shoulders using seated shoulder press behind the neck,
side lateral raise, front dumbbell raise and seated bent-
over rear deltoid raise. The fourth day was devoted to the
development of chest and biceps using barbell bench press
(medium grip), barbell incline bench press (medium grip),
Table 1 Descriptive characteristics, M ± SD
FAST FED
Age (y) 25 ± 3 25 ± 2
Mass (kg) 79.9 ± 5.5 79.1 ± 3.2
Height (cm) 176 ± 3 174 ± 5
BMI (kg · m
-2
) 25.8 ± 0.4 26.0 ± 1.7
BF% 15 ± 2 14 ± 1
LBM (kg) 68.2 ± 3.5 68.3 ± 2.6
Years of resistance training 1.6 ± 0.6 1.5 ± 0.5
Number of training session/week 3.8 ± 0.5 3.6 ± 0.7
Back squat 10 RM (Kg) 98.7 ± 25.3 104.4 ± 26.4
Bench press 10 RM (Kg) 63.7 ± 11.3 60.1 ± 8.1
Barbell row 10 RM (Kg) 50.1 ± 8.9 55 ± 8.9
Seated shoulder press behind the
neck 10 RM (Kg)
44.4 ± 5.6 46.2 ± 9.2
Biceps curl 10 RM (Kg) 30.6 ± 4.9 35 ± 5.3
Lying triceps curl 10 RM (Kg) 30.6 ± 4.2 33.7 ± 3.5
Note: FAST = subjects training in a fasted state; FED = subjects training in a fed
state. BMI = body mass index; BF% = body fat percentage; LBM = lean body
mass; RM = repetition maximum.
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decline barbell bench press, barbell curl, one arm dumb-
bell preacher curl and hammer curls. Other exercises were
incorporated in the training program each week. A certi-
fied strength and conditioning specialists closely super-
vised all subjects perform each training session. The
total training volume was estimated using the following
equation: training vol ume = total number of sets × total
number of repetitions [22].
Body composition
Body weight was measured to the nearest 10 g using
a calibrated electronic scale (Seca Instruments Ltd.,
Germany), and height was measured to the nearest 5
mm using a stadiometer. Body mass index (BMI) was
then calculated. Skinfold thickness was measured by an
experienced (trained) anthropometrist in triplicate using
calibrated Harpenden calipers (Harpenden, UK) at four
standardized sites (biceps, triceps, subscapular, and
suprailium). Those measurements followed the protocol
of the International Society for the Advancement of
Kinanthropometry [23]. The level of technical error
measurements of the anthropometrist was 6%.
Body fat percentage (BF%) was estimated from skinfold
measures using a previously published algorithm [24].
Lean body mass (LBM) was calculated as body weight
minus body fat mass.
Dietary intake analysis
Subjects were instructed to record the estimated quan-
tities of all food and beverages consumed during the
week before Ramadan and the n three days/week during
Ramadan. Dietary records were analyzed using the
Bilnut program (Nutrisoft, Cerelles, France) and the
food-composition tables of the National Institute of
Statistics of Tunis (1978). Total water intake was defined
as the fluid volume of consumed beverages plus the
water content of consumed foods.
Urine specific gravity
Urine specific gravity was assessed from 30 ml of urine
collected from eac h subject immediately before the
anthropometrical measurement. It was measured to the
nearest 0.001 unit with a hand refractometer (Atago,Japan).
Serum biochemistry
During each session, venous blood samples (~7 ml) were
taken from an antecubital vein and collected into a plain
blood tube in a seated position in a room controlled
temperature and relative humidity (23 ± 3°C and 47% ± 5%
respectively). An aliquot of blood was immediately re-
moved and mixed with ethylene diaminetetraaceticacid
(EDTA) as an anticoagulant. These blood samples were
analyzed for total leucocytes, neutrophils, lymphocytes
and monocytes using an automated analyzer (Beckman
coulter, Coulter LH 750 Analyzer, UK) according to the
manufacturers protocol. The remaining blood was
allowed to clot and was then centrifuged at 1500 g for 10
min at 4°C. An aliquot of the serum was used to measure
serum glucose immediately after the centrifugation step;
the remainder was then stored at 20°C for subsequent
analysis. An automated analyzer (Beckman Coulter DXC
600, UK) measured the concentrations of biochemical pa-
rameters using the appropriate reagents (Beckman
Coulter, UK). Glucose, uric acid, total cholesterol (TC)
and triglycerides (TG) were determined using an enzym-
atic colorimetric method (glucose oxidase, uricase, lipo-
protein lipase-glycerol kinase reactions, cholesterol
esterase-cholesteroloxidase reactions, respectively). Urea
was determined using an enzymatic method. Urea is first
converted by urease into ammonia which is then
estimated by the reaction with α-ketoglutarate catalyzed
by glutamic dehydrogenase. Creatinine concentrations
were determined by the Jaf method in which creatinine
directly reacts with alkaline picrate resulting in the forma-
tion of a red colour. Creatinine clearance was determined
using the formula of Cockroft and Gault. [25]: Creatinine
clearance (mlmin
-1
) = 1.25 × body mass (kg) × (140 - age
(y)): creatinine (μmoll
-1
). Sodium, potassium and chloride
concentrations were determined by potentiometry. C-
reactive protein concentrations were determined using a
turbidimetric method. In the reaction, C-reactive protein
combines with specific antibody to form insoluble
antigen-antibody complexes. High-density lipoprotein
cholesterol (HDL-C) concentrations were determined by
immuno-inhibition. Low-density lipoprotein cholesterol
(LDL-C) was calculated using the Friedewald formula
[26]: LDL-C (mmoll
-1
)=TC HDL-C TG: 2.2. The
Table 2 Training data before and during Ramadan, M ± SD
Before Ramadan During Ramadan
FAST FED FAST FED
Number of training session/week 3.8 ± 0.5 3.7 ± 0.6 3.6 ± 0.4 3.6 ± 0.5
Number of sets /training session 20 ± 1 20 ± 1 20 ± 1 20 ± 1
Number of repetition/sets 9.68 ± 0.76 9.42 ± 0.69 9.37 ± 0.92 9.78 ± 0.87
Total training volume 4047 ± 463 3940 ± 373 3914 ± 440 4091 ± 498
RPE 8±1 8±1 8±1 8±1
Note: FAST = subjects training in a fasted state; FED = subjects training in a fed state. RPE = rating of perceived exertion.
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ratios TC: HDL-C and LDL-C: HDL-C were derived from
the respective concentrations. Creatine kinase (CK),
lactatedehydrogenase (LDH), alanine aminotransferase
(ALT), a spartate aminotransferase (AST ), alkaline
phosphatase (AP) and γ-glutamyl transfera se (γ-GT )
activity were determined using an enzymatic method.
Statistical analyses
All statistical tests were performed using STATISTICA
Software (StatSoft, Paris, France). The distribution of
all dependent variables was examined by the Shapiro-
Wilk test and wa s found not to differ significantly from
normal. A 2 (periods) × 2 (FAST or FED) repeated-
measures analysis of variance (ANOVA) was applied. If
a significant interaction was present, a B onferroni
post-hoc test was performed where appropriate. If a
non-significant interaction was present, a paired or in-
dependent t-test was preformed where appropriate.
Effect sizes were calculated a s partial eta-squared η
p
2
to estimate the meaning fulness of significant findings.
Partial eta squared values of 0.01, 0.06 and 0.13
represent small, moderate, and large effe ct sizes , re-
spectively. Statistical significance wa s set at P <0.05.
All d ata are expressed as mean ± standard deviation
(M ± SD ).
Results
Dietary intake
Dietary intake before and during Ramadan is presented
in Table 3. Estimated mean daily energy intake Bef-R
was similar between FAST and FED. Calculated daily
energy intake during Ramadan did not significantly
change in either group compared with Bef-R. Carbohy-
drate and fat consumption inc reased by 9% (p = 0.003)
and 5% (p = 0.05) respectively in FED during Ramadan,
though consumption of these macronutrients did not
significantly change in FAST during the month. Protein
consumption during Ramadan did not change in either
group compared with Bef-R. Expressed as a percentage
of daily macronutrient intake, protein, carbohydrates,
and fat consumption did not change in FAST and FED
during Ramadan. Further, the proportion of total energy
expressed as grams per kilogram body mass per day
from carbohydrates increased in FED (p = 0.006); and
remained unchanged in FAST during Ramadan. Both fat
and protein intakes (expressed as grams per kilogram
body mass per day) did not change during Ramadan in
either group. Potassium intake in FED decreased by 14%
(p = 0.019) from Bef-R to End-R, and it remained
unchanged in FAST. Total water intake decreased by
15% (p = 0.039) in FAST and by 13% (p = 0.004) in FED
during Ramadan.
Body composition
Body mass and body composition before and at the end
of Ramadan are shown in Table 4. The two-way ANOVA
(Ramadan × group) for body mass, BF% and LBM
showed no significant effects for Ramadan, no significant
effect for group and no significant effect for Ramadan ×
group interaction. Paired samples t-test revealed that
body mass, BF% and LBM did not change during the
duration of the study in FA ST nor FED. Independent
samples t-test showed no significant differences in these
parameters between the two groups at any time period.
Urine specific gravity
There wa s a significant effect for Ramadan (F
(1,14)
=
20.1; p < 0.001; η
p
2
=0.6), no significant effe ct for
Table 3 Dietary intake before and during Ramadan, M ± SD
Before Ramadan During Ramadan
FAST FED FAST FED
Energy intake (kcal · d
-1
) 3492 ± 253 3409 ± 209 3434 ± 266 3613 ± 245
Protein (g · d
-1
) 125 ± 10 133 ± 8 127 ± 9 129 ± 6
Protein (%) 14 ± 1 16 ± 1 15 ± 1 14 ± 1
Protein (g.Kg.d
-1
) 1.6 ± 0.1 1.7 ± 0.1 1.6 ± 0.1 1.6 ± 0.1
Fat (g · d
-1
) 105 ± 8 101 ± 7 104 ± 7 106 ± 6*
Fat (g.Kg.d
-1
) 1.3 ± 0.2 1.3 ± 0.1 1.3 ± 0.1 1.3 ± 0.1
Fats (%) 27 ± 4 27 ± 2 27 ± 3 26 ± 2
Carbohydrate (g · d
-1
) 511 ± 72 492 ± 44 497 ± 64 536 ± 55**
Carbohydrate (g.kg.d
-1
) 6.4 ± 0.8 6.2 ± 0.5 6.3 ± 0.6 6.8 ± 0.6**
Carbohydrate (%) 58 ± 5 58 ± 3 58 ± 4 59 ± 2
Potassium (g . d
-1
) 2.5 ± 0.4 2.8 ± 0.4 2.4 ± 0.4 2.4 ± 0.3*
Sodium (g . d
-1
) 6.9 ± 1.1 6.8 ± 1.1 7 ± 1 6.9 ± 1
Total water intake (L · d
-1
) 4.5 ± 0.4 4.5 ± 0.5 3.8 ± 0.7* 3.9 ± 0.4**
Significantly different from before Ramadan: * (P < 0.05); ** (P < 0.01). Note: FAST = subjects training in a fasted state; FED = subjects training in a fed state.
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group (F
(1,14)
=1; p=0.33; η
p
2
=0.06) and no signi-
ficant Ramadan × group interaction (F
(1,14)
=0; p=0.77;
η
p
2
=0.006 ) on urine specific gravity. Paired samples t-test
showed urine specific gravity in FAST increased signifi-
cantly (p = 0.028) from 1.019 ± 0.007 at Bef-R to 1.029 ±
0.005 at End-R. Similarly, urine specific gra vity in FED
increased significantly (p = 0.004) from 1.018 ± 0.004 at
Bef-R to 1.027 ± 0.004 at End-R. Independent samples
t-test re vealed that there wa s no difference in u rine
specific gravity values between FAST and FED at each
time period.
Renal-function markers
Renal function m arkers before and at the end of
Ramadan are presented in Table 5. Though the two-
way ANOVA (Ramadan × group) for urea , creatinine,
creatinine clearance and uric acid revealed a significant
effect for Ramadan, there was no significant group
effect or R amadan × group interaction. Paired samples
t-test showed a significant increase of urea in FAST by
4% (p = 0.006) and by 7% (p = 0.031) in FED from
Bef-R to End-R. Similarly, creatinine values at End-
R increased by 5% in FAST (p = 0.015) and by 6% in
FED (p = 0.04). However, creatinine clearance did not
change throughout the study in either group. For uric
acid concentrations, paired samples t-tes t showed
a significant increase by 17% in FA ST and FED
(p < 0.001, p = 0.04 respectively) from Bef-R to End-R.
Independent samples t-test revealed no significant differ -
ences on these parameters between the two groups at any
time period.
Serum electrolytes
Serum electrolytes concentrations before and at the end
of Ramadan are shown in Table 5. For serum sodium
and chloride concentrations, there was a significant
effect for Ramadan, no significant effect for group and
no significant Ramadan × group interaction. Paired sam-
ples t-test showed a significant increase by 1% in FA ST
and FED f or serum sodium concentrations (p = 0.029,
p = 0.019 respectively) and by 4% in FAST and FED for
serum chloride concentrations (p = 0.039, p = 0.0 04 re-
spectively) from Bef-R to End-R. Independent samples
t-test showed no significant differences in these parame-
ters between the two groups at any time period.
There was a significant effect for Ramadan, no signifi-
cant effect for group and a significant Ramadan × group
interaction for serum potassium concentrations. The
post hoc test showed a significant increase by 6% from
Bef-R to End-R (p = 0.019). However, serum potassium
concentrations of FED remained unchanged over the
whole period of the investigation. No differences were
found in potassium values between FAST and FED at
any time period of the investigati on.
Serum lipid and glucose
Serum lipid and glucose concentrations before and at
the end of Ramadan are summarize d in Table 6. The
two-way ANOVA (Ramadan × group) for TG and TC
and LDL-C concentrations showed no significant effects
for Ramadan, no significant effect for group or the inter-
action between the two. Paired samp les t-test revealed
that TG and TC concentrations did not change during
the duration of the study in either group. Independent
samples t-test showed no significant differences in these
parameters between the two groups at any time period.
There was a significant effect for Ramadan, no signifi-
cant effect for groups and a significant Ramadan × group
interaction on HDL-C concentrations. Paired samples
t-test showed a significant increase in FAST and FED by
11% (p=0.04, p=0.04 respectively) from Bef-R to End-R.
Independent samples t-test revealed that there was no
difference in HDL-C values between F AST and FED at each
time period.
For TC: HDL-C and LDL-C: HDL-C ratios, there was
a significant effect for Ramadan, no significant effect for
group an d no significant Ramadan × group interaction.
Paired samples t-test showed that TC: HDL-C and LDL-
C: HDL-C did not change throughout the study in FAST
nor FED. No differences were found in TC: HDL-C and
LDL-C: HDL-C ratios between FAST and FED at any
time period of the investigation.
Table 4 Body mass and body composition before and at the end of Ramadan, M ± SD
Group Ramadan effect Group effect Ramadan × group effect
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
Body mass (kg) FAST 79.9 ± 5.5 79.2 ± 4.6 1.06 0.32 0.07 0.043 0.83 0.003 0.72 0.41 0.05
FED 79.1 ± 3.2 79 ± 3.7
BF% FAST 14.6 ± 2.1 13.9 ± 1.9 10.92 0.005 0.043 1.21 0.29 0.08 0.85 0.37 0.05
FED 13.6 ± 1.3 13.2 ± 1
LBM (kg) FAST 68.2 ± 3.5 68 ± 3.1 0.023 0.88 0.01 0.062 0.81 0.004 0.31 0.59 0.02
FED 68.3 ± 2.6 68.6 ± 2.9
Note: FAST = subjects training in a fasted state; FED = subjects training in a fed state. BF% = Body fat percentage; LBM = lean body mass; η
p
2
= effect sizes. Before
Ramadan (Bef-R) = 2 days before beginning the fast; end of Ramadan (End-R) = 29 days after beginning the fast.
Trabelsi et al. Journal of the International Society of Sports Nutrition 2013, 10:23 Page 6 of 11
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There was no significant effect for Ramadan, no sig-
nificant effect for group or interaction between the two
on serum glucose concentrations. Paired samples t-test
showed that gluc ose concentrations did not change
throughout the study in FAST nor FED. Independent
samples t-test revealed that there was no difference in
glucose concentrations between FAST and FED at each
time period.
Cellular damage biomarkers
Cellular damage biomarkers before and at the end of
Ramadan are presented in Table 7. The two-way
ANOVA (Ramadan × group) for CK, LDH, AST, ALT, γ-
GT and PA concentrations revealed no significant effects
for Ramadan, no sign ificant effect for group or inter-
action between the two. Paired samp les t-test revealed
that CK, LDH, AST, ALT, γ-GT and PA concentrations
Table 5 Renal function markers and serum electrolyte concentrations before and at the end of Ramadan, M ± SD
Group Ramadan effect Group effect Ramadan × group effect
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
Urea (mmoll
-1
) FAST 4.55 ± 0.33 4.72 ± 0.39** 15.05 0.002 0.52 0.06 0.81 0.004 1.35 0.26 0.08
[CV = 5.7%]
a
FED 4.43 ± 0.18 4.76 ± 0.19*
Creatinine (μmoll
-1
) FAST 89.87 ± 3.18 94.12 ± 4.26* 15 0.002 0.51 1.17 0.3 0.07 0.1 0.76 0.01
[CV = 3%] FED 87.32 ± 5.32 92.62 ± 3.78*
Uric acid (μmoll
-1
) FAST 309.75 ± 68.96 356.75 ± 63.86*** 22.4 <0.001 0.61 1.21 0.28 0.08 0 0.99 0
[CV = 2.8%] FED 279 ± 56.07 326.12 ± 44.73*
Creatinine clearance FAST 129.27 ± 9.02 125.09 ± 11.97 5.36 0.04 0.27 0.008 0.93 0.0005 0.19 0.67 0.01
(mlmin-1) FED 130.61 ± 6.86 124.46 ± 7.96
Sodium (mmoll
-1
) FAST 142.25 ± 2.71 144.25 ± 1.16* 17.9 <0.001 0.56 0.2 0.64 0.01 0 1 0
[CV = 2.7%] FED 142.62 ± 1.41 144.62 ± 1.68*
Potassium (mmoll
-1
) FAST 4.49 ± 0.42 4.74 ± 0.55* 3.09 0.1 0.18 0.02 0.9 0.001 10.66 0.006 0.43
[CV = 2.8%] FED 4.67 ± 0.37 4.6 ± 0.23
Chloride (mmoll
-1
) FAST 102.37 ± 1.68 104.25 ± 1.83* 20.55 <0.001 0.6 0.89 0.36 0.05 0.17 0.68 0.01
[CV = 2.9%] FED 101.5 ± 1.19 103.75 ± 2.05**
Significantly different from before Ramadan: * (P <0.05);**(P < 0.01); *** (P < 0.001). Note: FAST = subjects training in a fasted state; FED = subjects training in a fed state;
a
= inter-assay coefficient of variance. Before Ramadan (Bef-R) = 2 days before beginning the fast; end of Ramadan (End-R) = 29 days after beginning the fast.
Table 6 Serum lipid and glucose concentrations before and at the end of Ramadan, M ± SD
Group Ramadan effect Group effect Ramadan × group effect
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
TG (mmoll
-1
) FAST 0.73 ± 0.16 0.75 ± 0.15 1.37 0.26 0.08 0.02 0.89 0.001 0.29 0.59 0.02
[CV = 2.7%]
a
FED 0.74 ± 0.11 0.75 ± 0.11
TC (mmoll
-1
) FAST 3.82 ± 0.34 3.87 ± 0.35 0.006 0.94 0 0.45 0.51 0.03 0.023 0.2 0.11
[CV = 3%] FED 3.98 ± 0.34 3.93 ± 0.35
HDL-C (mmoll
-1
) FAST 1.11 ± 0.26 1.24 ± 0.20* 23.87 <0.001 0.62 0.1 0.75 0.01 0.02 0.9 0.01
[CV = 3.1%] FED 1.15 ± 0.16 1.26 ± 0.18*
LDL-C (mmoll
-1
) FAST 2.37 ± 0.3 2.29 ± 0.26 0.05 0.82 0.003 1.92 0.19 0.12 0.07 0.08 0.19
FED 2.49 ± 0.37 2.6 ± 0.38
TC: HDL-C FAST 3.58 ± 0.82 3.18 ± 0.44 17.52 <0.001 0.55 0.02 0.89 0 0.02 0.9 0.001
FED 3.53 ± 0.59 3.15 ± 0.43
LDL-C: HDL-C FAST 2.44 ± 0.79 2.05 ± 0.43 9.06 0.009 0.39 0.08 0.78 0.01 1.9 0.19 0.11
FED 2.39 ± 0.57 2.34 ± 0.41
Glucose (mmoll
-1
) FAST 4.97 ± 0.53 4.88 ± 0.58 1.71 0.21 0.1 0.78 0.39 0.05 0.044 0.83 0.03
[CV = 2.1%] FED 4.77 ± 0.37 4.66 ± 0.47
Significantly different from before Ramadan: * (P < 0.05). Note: FAST = subjects training in a fasted state; FED = subjects training in a fed state;
a
= inter-assay
coefficient of variance. TG = triglycerides; TC = total cholesterol; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol. Before
Ramadan (Bef-R) = 2 days before beginning the fast; end of Ramadan (End-R) = 29 days after beginning the fast.
Trabelsi et al. Journal of the International Society of Sports Nutrition 2013, 10:23 Page 7 of 11
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did not change during the duration of the study in either
group. Independent samples t-test show ed no significant
differences in these parameters between the two groups
at any time period.
Immune and inflammatory markers
Immune and inflamm atory markers before and at the
end of Ramadan are shown in Table 7. There was no
significant effect for Ramadan, no significant effect
for group and no significant interaction on leukocyte
counts, neutrophils, lymphocytes, monocytes and C-
reactive protein. Paired samples t-test revealed that those
parameters did not change during the duration of
the study in either group. Independent samples t-test
showed no significant differences in these parameters
between the two groups at any time period.
Discussion
The primary purpose of this study was to evaluate the
effect of participation in Ramadan on body composition
and circulating markers of renal function, immunity and
inflammation in men, who continue to perform resist-
ance trainin g. A second aim was to determine whether
training at night (in the acutely fed state) altered the
impact of Ramadan compared to when training was
undertaken during the day (in a fasted state). Our results
showed, contrary to our hypothesis, that whether resist-
ance training was conducted in a fed or fa sted state, no
significant effect on body mass or body composition of
bodybuilders was revealed after four weeks. In addition,
even though Ramadan fasting induced changes in urin-
ary and some biochemical parameters, these changes
were not different according to the state (fed vs fasted)
in which training occurred.
Body mass and body composition did not change in
either FAST or FED during Ramadan. Our results do
not concur with the other published studies [4,27]. For
example, Trabelsi et al. [2] demonstrated that fasted-
state aerobic training resulted in a decrease in body
mass as well as fat percent in physically active men.
However, those changes were absen t if an equivalent
amount of aerobic exercise was performed in a fed state
Table 7 Cellular damage biomarkers, immunological and inflammatory parameters before and at the end of Ramadan,
M±SD
Group Ramadan effect Group effect Ramadan × group effect
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
F(1,14) P-value η
p
2
CK (IUl
-1
) FAST 310 ± 83 300 ± 94 0.26 0.62 0.01 0.17 0.69 0.01 1.05 0.32 0.06
[CV = 4.7%]
a
FED 305.5 ± 81.71 336 ± 91
LDH (IUl
-1
) FAST 283 ± 50 290.5 ± 60.2 0.01 0.91 0 0.2 0.66 0.01 1.05 0.32 0.06
[CV = 4.5%] FED 277 ± 64 271 ± 68
AST (IUl
-1
) FAST 26 ± 4. 28 ± 3 0.18 0.69 0.01 0.28 0.6 0.002 0.1 0.75 0.002
[CV = 4.8%] FED 24 ± 5 27 ± 3
ALT (IUl
-1
) FAST 20 ± 3 23 ± 5 0.42 0.53 0.002 0.18 0.69 0.001 1.58 0.56 0.003
[CV = 4.3%] FED 22.5 ± 4.31 23 ± 4
PA (IUl
-1
) FAST 128 ± 41 135 ± 34 1.69 0.21 0.1 0.13 0.91 0 0.06 0.81 0.003
[CV = 4%] FED 124 ± 39 134 ± 27
γ-GT (IUl
-1
) FAST 17 ± 3 19 ± 3 2.05 0.17 0.12 2.75 0.12 0.16 0.38 0.55 0.03
[CV = 3.8%] FED 20 ± 4 21 ± 3
Total leucocytes (10
9
l
-1
) FAST 6.41 ± 1.03 6.59 ± 1.18 1.37 0.26 0.02 0.12 0.73 0.04 0.04 0.84 0.004
[CV < 2%] FED 6.8 ± 0.53 6.86 ± 0.87
Neutrophils (10
9
l
-1
) FAST 3.42 ± 0.61 3.58 ± 0.78 0.01 0.89 0.001 1.97 0.11 0.01 1.18 0.29 0.003
[CV < 2%] FED 3.53 ± 0.46 3.4 ± 0.51
Lymphocytes (10
9
l
-1
) FAST 2.59 ± 0.58 2.67 ± 0.52 1.8 13 0.02 0.17 0.69 0..04 1.97 0.11 0.07
[CV < 2%] FED 2.93 ± 0.2 3.14 ± 0.28
Monocytes (10
9
l
-1
) FAST 0.31 ± 0.16 0.28 ± 0.16 0.78 0.39 0.06 0.88 0.36 0.04 0.14 0.71 0.008
[CV < 2%] FED 0.29 ± 0.11 0.22 ± 0.13
C-reactive protein (mgl
-1
) FAST 6.2 ± 0.9 6.1 ± 0.7 0.19 0.67 0.01 0.39 0.54 0.02 0.05 0.82 0.003
[CV = 4.5%] FED 6.4 ± 0.9 6.3 ± 0.8
Note: FAST = subjects training in a fasted state; FED = subjects training in a fed state;
a
= inter-assay coefficient of variance. CK = Creatine kinase, LDH = lactatedehydrogenase,
ALT = alanine aminotransferase, AST = aspartate aminotransferase, AP = alkaline phosphatase, γ-GT = γ-glutamyl transferase. Before Ramadan (Bef-R) = 2 days before
beginning the fast; end of Ramadan (End-R) = 29 days after beginning the fast.
Trabelsi et al. Journal of the International Society of Sports Nutrition 2013, 10:23 Page 8 of 11
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during Ramadan [2]. The discrepancy between that find-
ing and the present study is likely due to a difference in
the exercise regime; aerobic exercise will provide a better
stimulus to induce fat oxidation than does resistance
training. Notably, participation in Ramadan alone ap-
pears to improve the ability to utilize lipid during aer-
obic exercise [28], perhaps, providing an increased
opportunity to reduce body fat stores if exercise is
performed regularly during the fasting month. It appears
that despite participation in Ramadan, lean body mass
was maintained with no increase in body fat percentage.
This may be largely because of the lack of change of
training volume in this bodybuilder cohor t. In addition,
it is worth noting that energy and macronutrient intakes
did not change during Ramadan and were consistent
with the recommendation proposed by Slater and
Phillips [29] for bodybuilders to induce hypertrophy.
However, the use of a non-invasive method to measure
changes in body composition (e.g., DEXA) in future
studies of Ramadan is warranted to confirm this finding.
Urine specific gravity increased during Ramadan in
both groups, which is consistent with some degree of
dehydration [30], was previously observed with high in-
tensity exercise training [31]. This state of dehydration
has been previously attributed to a reduction of fluid in-
take [2,5,6]. It is likely our results can be similarly
explained. However, in our previous work we have ob-
served the urine specific gravity of subjects performing
aerobic exercise before breaking the fast increasing dur-
ing Rama dan, but absent in subjects practicing the
equivalent amoun t of aerobic exercise after breaking the
fast [2]. However, it is worth noting that our subjects
had only about 4 hours to consume food or fluid after
sunset on the day before the sample collection during
Ramadan. It may well be that this was insufficient time
to allow full hydration. Thus, our results concerning the
hydration status of our subjects may be influenced
independently of Ramadan. Markers of renal function
showed a similar trend, increasing in both groups. Those
findings were previously observed in subjects practicing
aerobic exercise during Ramadan [2]. Sodium and chlor-
ide concentrations increased in both groups during
Ramadan. A chr onic state of mild deh ydration in both
groups may explain the abovementioned increase of
serum electrolytes and renal function markers. Interest-
ingly Ramadan fasting did not affect serum potassium
concentrations in FED. Due to the dehydration and the
elevations in serum sodium that occurred in FED, one
might expect that increases in serum potassium concen-
trations would also be observed. However, a decrease in
potassium intake may have offse t any effects on serum
potassium caused by dehydration [32].
HDL-C increased during Ramadan in FAST and FED,
at variance with our previous work [2]. The rise in HDL-
C was explained previously by change in body mass
[2,33] or fat intakes [34]. However, in the present study,
body mass did not change in either group while fat in-
takes increased only in FED. Thus, the rise of proportion
of fat intakes during Ramadan can explain the increase
in HDL-C in FED; although mechanisms by which
fasting increases HDL-C in FAST remain unclear.
Further investigation is needed to resolve this issue.
Whether Ramadan fasting affects cellular damage was
also investigated in the present study. Serum CK, ALT,
AST, ALT, AP and γ-GT were measured to assess the ef-
fect of Ramadan fasting on cellular damage biomarkers
of bodybuilders. Ramadan fasting did not affect any of
these variables and is in accordance with previous re-
ports observing sedentary persons [35]. Nevertheless, to
our knowledge, our study is the first to investigate the
effect of R amadan fasting on these parameters in men
who undertake resista nce training during Ramadan.
Serum C-reactive protein concentrations reflect the
activity of cytokine-mediated inflammatory processes
and are roughly proportional to the extent of tissue in-
jury [36]. C-reactive protein did not change in either
group and this perhaps could be explained by the lack of
effect of Ramadan fasting on cellula r damage bio-
markers. Akin to previous studies in judokas [37],
Ramadan had no impact on leukocyte count. Thus, in
this contex t at least, con tinuation of resistance training
whilst participation in Ramadan can be performed safely.
It is worth noting that effect sizes of the parameters
measured in the current study were consistent but
rather low. This, and the small number of participants
my have resulted in type II error for some of the param-
eters measured. With this in mind, replication of the
study with more participants during Ramadan would be
difficult because of recruitment, but may result in
further significant findings. Nevertheless, we have previ-
ously observed metabolic changes with participation in
Ramadan with similar numbers of subjects [28].
Conclusion
In conclusion, hypertrophic resistance training, unlike
aerobic training, was not affected, at least in terms
of body composition and markers of immune and in-
flammatory systems, when performed in a fed compared
to a fasted state during Ramadan. However, resistance
training performed during Ramadan was associated with
an improved lipid profile and evidence of mild dehydra-
tion which may alters parameters indicative of renal
function.
In terms of a practical application, trainers should edu-
cate bodybuilders on the importance of hydration during
the nighttime in order to compensate for the dehydra-
tion that occurs during daytime within the month
Ramadan. In addition the trainers should stress the
Trabelsi et al. Journal of the International Society of Sports Nutrition 2013, 10:23 Page 9 of 11
http://www.jissn.com/content/10/1/23
importance of adopting a nutritional protocol similar to
that of the normal non-fasting period.
Abbreviations
FAST: Subjects training in a fasted state; FED: Subjects training in a fed state;
Bef-R: Before Ramadan; End-R: End of Ramadan; BMI: Body mass index;
BF%: Body fat percentage; LBM: Lean body mass; RM: Repetition maximum;
RPE: Rating of perceived exertion; TG: Triglycerides; TC: Total cholesterol;
HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein
cholesterol; CK: Creatine kinase; LDH: Lactatedehydrogenase; ALT: Alanine
aminotransferase; AST: Aspartate aminotransferase; AP: Alkaline phosphatase;
γ-GT: γ-glutamyltransferase;
a
: Inter-assay coefficient of variance.
Competing interest
The authors declare that they have no competing interests.
Authors contributions
All authors have made substantive intellectual contributions towards
conducting the study and preparing the manuscript for publication. TK, GZ,
JK, KS, MRJ, HA and ZKM were responsible for the study design, coordination
of the study, and oversight of data collection and analysis. SRS assisted in
manuscript preparation and the revision of final manuscript. All authors read
and approved of the final manuscript.
Acknowledgments
The authors would like to thank the subjects involved for their efforts,
commitment and enthusiasm throughout the study. We especially thank Mr
Moez Baghdedi and Mr Lotfi Latrech for their vital role in chemical assays.
Author details
1
University of Sfax, Laboratory of Pharmacology, Faculty of Medicine, Sfax
3029, Tunisia.
2
School of Sport and Exercise, Massey University, Palmerston
North, New Zealand.
3
School of Sport and Exercise Sciences, Loughborough
University, Loughborough, UK.
4
Laboratory of Hematology, CHU Habib
Bourguiba, Sfax, Tunisia.
5
Department of Biochemistry of the Hedi Chaker
University Hospital, Sfax 3029, Tunisia.
Received: 14 January 2013 Accepted: 16 April 2013
Published: 25 April 2013
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Cite this article as: Trabelsi et al.: Effect of fed- versus fasted state
resistance training during Ramadan on body composition and selected
metabolic parameters in bodybuilders. Journal of the International Society
of Sports Nutrition 2013 10:23.
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Trabelsi et al. Journal of the International Society of Sports Nutrition 2013, 10:23 Page 11 of 11
http://www.jissn.com/content/10/1/23
... Due to the restrictive regimes proposed by the aforementioned dietary plans, their implementation must be dependent on the type of physical activity performed. For example, the reduction in caloric intake associate to the Intermitted Fasting might result in a decrease in lean body mass and strength, and therefore, potentially, a decrease in the capacity to conduct resistance exercise [29,30]. ...
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Physical activity (PA) and sport play an essential role in promoting body development and maintaining optimal health status both in the short and long term. Despite the benefits, a long-lasting heavy training can promote several detrimental physiological changes, including transitory immune system malfunction, increased inflammation, and oxidative stress, which manifest as exercise-induced muscle damages (EIMDs). Meat and derived products represent a very good source of bioactive molecules such as proteins, lipids, amino acids, vitamins, and minerals. Bioactive molecules represent dietary compounds that can interact with one or more components of live tissue, resulting in a wide range of possible health consequences such as immune-modulating, antihypertensive, antimicrobial, and antioxidative activities. The health benefits of meat have been well established and have been extensively reviewed elsewhere, although a growing number of studies found a significant positive effect of meat molecules on exercise performance and recovery of muscle function. Based on the limited research, meat could be an effective post-exercise food that results in favorable muscle protein synthesis and metabolic performance.
... Therefore, exercise prevents excessive increase in serum urea and creatinine levels after AKI, and when combined with TR diet, its effect is greater. A study showed that TR diet in athletes did not change the renal function indexes including serum urea and creatinine levels [48]. The difference in the results could be due to differences in the studied species, and intensity and duration of exercise. ...
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Background: Acute kidney injury (AKI) is a syndrome characterized by rapid loss of excretory function of kidney. Both exercise and some diets have been shown to increase silent information regulator (SIRT1) expression leading to reduction of kidney injury. In this study, the effect of two different diets during exercise on kidney function, oxidative stress, inflammation and also SIRT1 in AKI was investigated. Materials and methods: A number of rats were randomly divided into four groups; control without exercise, control with exercise, exercise + calorie restriction (CR), and exercise + time restriction (TR). Each group was divided into two subgroups of without AKI and with AKI (six rats in each group). Endurance exercise and diets were implemented before AKI. Serum urea and creatinine, urinary albumin, kidney malondialdehyde (MDA), total antioxidant capacity (TAC), transforming growth factor (TGF-β1), and SIRT1 levels, glomerular filtration rate (GFR) and relative kidney weight were measured before and 24 h after AKI induction. Results: After induction of kidney injury, serum urea and creatinine, urinary albumin, kidney MDA and TGF-β1 levels increased in rats with both previous exercise and no previous exercise, while GFR, and kidney TAC and SIRT1 levels significantly decreased. These changes after AKI were less in the group with previous exercise than in the group that had no exercise (p <0.001). The TR diet during exercise caused a less increase in serum urea (p <0.01) and creatinine (p <0.01), and urinary albumin (p <0.001) levels after the injury compared to the just exercise group. Also, both CR and TR diets during exercise caused less change in MDA (p <0.001) and TAC (p <0.05, p <0.001, respectively) levels compared to just exercise group. Conclusions: The results showed that exercise alone had no effect on preventing function impairment of kidney, oxidative stress, inflammation and also SIRT1 alteration following AKI, although these indexes were less among those with exercise than those without exercise. However, when the CR and TR diets were implemented during exercise, strong renoprotective effects appeared, and the protective effect of TR diet was greater.
... With respect to the studies' abstracts, 51 of the reviewed studies were chosen to be potentially relevant for data analysis. The full texts of these articles were then screened; 36 of these studies (Greene et al. 2018;Helms et al. 2015b;Mero et al. 2010;Newton et al. 1993;Sawyer et al. 2013;Tinsley et al. 2017;Trabelsi et al. 2013Trabelsi et al. , 2012Vargas et al. 2018;Walberg-Rankin et al. 1993;Waldman et al. 2018;Kleiner et al. 1990;Bamman et al. 1993;Hickson et al. 1990;Withers et al. 1997;Wilson et al. 2017;Chatterton et al. 2017;Durguerian et al. 2016;Murphy and Koehler 2020;Gentil et al. 2017;Steen 1991;Manore et al. 1993;Too et al. 1998;Moro et al. 2016;Areta et al. 2014;Kysel et al. 2020;Philpott et al. 2019;Huovinen et al. 2015;Antonio et al. 2019;Bazyler et al. 2018;Mäestu et al. 2008Mäestu et al. , 2010Dudgeon et al. 2016;Mettler et al. 2010;Rossow et al. 2013;Syed-Abdul et al. 2019) were excluded from analysis for various reasons. Thus, 15 studies were used for qualitative analysis. ...
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Many sports employ caloric restriction (CR) to reduce athletes' body mass. During these phases, resistance training (RT) volume is often reduced to accommodate recovery demands. Since RT volume is a well-known anabolic stimulus, this review investigates whether a higher training volume helps to spare lean mass during CR. A total of 15 studies met inclusion criteria. The extracted data allowed calculation of total tonnage lifted (repetitions × sets × intensity load) or weekly sets per muscle group for only 4 of the 15 studies, with RT volume being highly dependent on the examined muscle group as well as weekly training frequency per muscle group. Studies involving high RT volume programs (≥ 10 weekly sets per muscle group) revealed low-to-no (mostly female) lean mass loss. Additionally, studies increasing RT volume during CR over time appeared to demonstrate no-to-low lean mass loss when compared to studies reducing RT volume. Since data regarding RT variables applied were incomplete in most of the included studies, evidence is insufficient to conclude that a higher RT volume is better suited to spare lean mass during CR, although data seem to favor higher volumes in female athletes during CR. Moreover, the data appear to suggest that increasing RT volume during CR over time might be more effective in ameliorating CR-induced atrophy in both male and female resistance-trained athletes when compared to studies reducing RT volume. The effects of CR on lean mass sparing seem to be mediated by training experience, pre-diet volume, and energy deficit, with, on average, women tending to spare more lean mass than men. Potential explanatory mechanisms for enhanced lean mass sparing include a preserved endocrine milieu as well as heightened anabolic signaling.
... Therefore, exercise prevents excessive increase in serum urea and creatinine levels after AKI, and when combined with TR diet, its effect is greater. A study showed that TR diet in athletes did not change the renal function indexes including serum urea and creatinine levels (43). The difference in the results could be due to differences in the studied species, and intensity and duration of exercise. ...
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Introduction: Acute kidney injury (AKI) is a syndrome characterized by rapid loss of excretory function of kidney. One of the molecules considered in the treatment of renal failure is the silent information regulator (SIRT1). In this study, the effect of two different diets during exercise on AKI was investigated. Materials and Methods: A number of rats were randomly divided into four groups; control without exercise, control with exercise, exercise + calorie restriction (CR), and exercise + time restriction (TR). Each group was divided into two subgroups of without AKI and with AKI (six rats in each group). Endurance exercise and diets were implemented before AKI. Serum urea and creatinine, urinary albumin, kidney malondialdehyde (MDA), total antioxidant capacity (TAC), transforming growth factor (TGF-β1), and SIRT1 levels, glomerular filtration rate (GFR) and relative kidney weight were measured before and 48 h after AKI induction. Results: After induction of kidney injury, serum urea and creatinine, urinary albumin, kidney MDA and TGF-β1 levels and relative kidney weight increased in rats with both previous exercise and no previous exercise (p <0.001), while GFR, and kidney TAC and SIRT1 levels decreased (p <0.001). These changes after AKI were less in the group with previous exercise than in the group that had no exercise (p <0.001). The TR diet during exercise caused a less increase in serum urea (p <0.001) and creatinine (p <0.05), and urinary albumin (p <0.01) levels after injury compared to the just exercise group. Also, both CR and TR diets during exercise caused less change in MDA (p <0.01, p <0.05, respectively) and TAC (p <0.001, p <0.05, respectively) levels compared to just exercise group. Conclusion: The results showed that exercise alone had no effect on preventing function impairment of kidney, oxidative stress, inflammation and also SIRT1 alteration following AKI in athletes, although these indexes were less among those with exercise than those without exercise. However, when the CR and TR diets were implemented during exercise, strong renoprotective effects appeared, and the protective effect of TR diet was greater.
... Ettrawih), could affect the sleep-wake patterns of Muslims (Chamari et al., 2012). To avoid beginning training sessions in a completely fasted state during Ramadan, training sessions for competitive soccer players (Wilson et al., 2009), amateur bodybuilders (Trabelsi et al., 2013), and recreational runners (Trabelsi et al., 2012) are often programmed at night. This has the potential to exacerbate sleep-wake disturbance, possibly engendering a decrease in sleep duration, in individuals engaged in physical activity (PA) while observing Ramadan. ...
Article
The purpose of this systematic review and meta‐analysis is to provide an accurate description of the effect of Ramadan observance on sleep duration, sleep quality, daily nap duration, and daytime sleepiness in athletes and physically active individuals. Five electronic databases (PubMed, Web of Science, Scopus, Wiley, and Taylor and Francis) were used to search for relevant studies conducted with athletes or physically active individuals during Ramadan, published in any language, and available before May 23, 2021. Studies that included assessments of sleep quantity and/or quality, and/or daytime sleepiness, and/or daily naps in athletes and physically active individuals were included. The methodological quality of the studies was assessed using “QualSyst”. Of the 18 papers included in this study (298 participants in total), 14 were of strong quality, two were moderate, and the remaining two were rated as weak. Individuals who continued to train during Ramadan experienced a decrease in sleep duration (number of studies, K = 17, number of participants, N = 289, g = −0.766, 95% confidence interval [CI] −1.199 to −0.333, p = 0.001). Additionally, the global score of the Pittsburgh Sleep Quality Index increased from 4.053 (K = 5, N = 65, 95% CI 3.071–5.034) pre‐Ramadan, to 5.346 (95% CI 4.362–6.333) during Ramadan, indicating a decrease in sleep quality. The duration of daytime naps increased during compared to pre‐Ramadan (K = 2, N = 31, g = 1.020, 95% CI 0.595–1.445, p = 0.000), whereas Epworth Sleepiness Scale scores remained unchanged during versus pre‐Ramadan (K = 3, N = 31, g = 0.190, 95% CI −0.139–0.519, p = 0.257). In conclusion, individuals who continued to train during Ramadan experienced a decrease in sleep duration, impairment of sleep quality, and increase in daytime nap duration, with no change in daytime sleepiness levels.
... Moreover, we further excluded 465 studies since they were irrelevant to the present meta-analysis (according to inclusion criteria). After reading the full text of the remaining 15 studies, seven studies [42][43][44][45][46][47][48] did not meet the inclusion criteria. In total, eight eligible studies were included in our final analysis [35,36,[49][50][51][52][53][54]. ...
Article
This systematic review and meta-analysis evaluated the influence of intermittent fasting (IF) in combination with resistance training (RT) on body composition outcomes. Studies examining IF vs. non-IF diets in individuals performing RT, published up to February 2021, were identified through PubMed, the Cochrane Library, Web of Science, Embase, and SCOPUS databases. Eight studies, including 221 participants were analyzed using a random-effects model to calculate weighted mean differences (WMDs) with 95% confidence intervals (CIs). Results indicated that IF had a significant effect on body mass (WMD = -2.08 kg; 95% CI: -3.04, -1.13), fat mass (WMD = -1.36 kg; 95% CI: -1.94, -0.78), body mass index (WMD = -0.52 kg/m2; 95% CI: -0.85, -0.19), and body fat percentage (WMD = -1.49%; 95% CI: -2.24, -0.74) relative to non-IF diets, without a significant effect for fat-free mass (WMD = -0.27 kg; 95% CI: -0.82, 0.28). The present systematic review and meta-analysis demonstrates potentially beneficial effects of IF in combination with RT for reducing body mass and body fat relative to non-IF control diets, with similar preservation of fat-free mass.
... Changes in body composition may also reflect a balance between the unavoidable decrease of meal frequency (i.e., from 3-4 to 2) and sleep duration, together with a reduction of spontaneous daily physical activity and coercive dehydration (27)(28)(29). However, the effects of Ramadan IF on body composition are not conclusive, with some studies indicating significant reductions in body weight (19,20,23,24,26,28,(30)(31)(32)(33)(34) and many other failing to show any relevant changes (21,22,27,(35)(36)(37)(38)(39)(40). Such inconsistencies might be secondary to the specificities inherent to the participants included in each study. ...
Article
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Intermittent fasting (IF) has gained popularity for body-composition improvement purposes. The aim of this systematic review and meta-analysis was to summarize the effects of Ramadan vs. non-Ramadan IF on parameters of body composition. We conducted a comprehensive search of peer-reviewed articles in three electronic databases: PubMed, Scopus, and Web of Science (published until May 2020). Studies were selected if they included samples of adults (≥18 years), had an experimental or observational design, investigated any type of IF and included body composition outcomes. Meta-analytical procedures were conducted when feasible. Sixty-six articles met the eligibility criteria. We found that non-Ramadan IF is effective for decreasing body weight (−0.341 (95% CI [−0.584, −0.098], p = 0.006), body mass index (−0.699, 95% CI [−1.05, −0.347], p < 0.001), and absolute fat mass (−0.447, 95% CI [−0.673, −0.221], p < 0.001). When contrasting pre- post-intervention data on fat-free mass between treatments and controls, group-differences were non-significant (p > 0.05). Conversely, we observed a significant increase in fat-free mass when comparing pre- to post-intervention in a within design fashion (0.306, 95% CI [0.133, 0.48], p = 0.001). Finally, despite being accompanied by dehydration, Ramadan IF is effective in decreasing body weight (−0.353; 95% CI [−0.651, −0.054], p = 0.02) and relative fat mass (−0.533; 95% CI [−1.025, −0.04], p = 0.034). Ramadan IF seems to implicate some beneficial adaptations in weight management, although non-Ramadan IF appears to be more effective in improving overall body composition.
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The scientific community currently expresses a high level of interest in intermittent fasting - periods of voluntary abstinence from energy intake, ranging from several hours to days. Intermittent fasting is clinically relevant and may represent an effective non- pharmacological strategy to improve physical performance and body composition. It has been studied mainly in athletes during the religious period of Ramadan and in people predisposed to decrease body fat without loss of fat-free mass parallel. The purpose of this review is to provide an overview of the impact of intermittent fasting during Ramadan vs. non-Ramadan intermittent fasting in terms of physical performance and body composition. The literature shows some inconsistencies in terms of the interaction between intermittent fasting and physical performance. However, non-Ramadan intermittent fasting is found to be effective in improving maximal aerobic power. Nevertheless, this intervention reduces performance during the repeated sprints over the first few days of intervention. On the other hand, intermittent fasting during Ramadan being the maximum aerobic power and this is more expressive during the second half of this religious period. However, both interventions are manifestly innocuous in terms of muscle strength and anaerobic capacity. With regard to body composition, there is greater consensus. According to available data, both interventions encourage beneficial adaptations at this level. Still, fat loss is more pronounced with intermittent non-Ramadan fasting.
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Background The popularity of applying intermittent fasting (IF) has increased as more and more people are trying to avoid or alleviate obesity and metabolic disease. This study aimed to systematically explore the effects of various IF in humans. Methods The randomized controlled trials (RCTs) related to IF vs. non-intervention diet or caloric restriction (CR) were retrieved in PubMed, Web of Science, Cochrane Library database, and Embase. Extraction outcomes included, but were not limited to, weight, body mass index (BMI), waist circumference (WC), fasting glucose, and triglyceride (TG). Results This study includes 43 RCTs with 2,483 participants. The intervention time was at least 1 month, and the median intervention time was 3 months. Contrasting results between IF and non-intervention diet showed that participants had lower weight (weighted mean difference (WMD) = 1.10, 95% CI: 0.09–2.12, p = 0.03) and BMI after IF (WMD = 0.38, 95% CI: 0.08–0.68, p = 0.01). The WC of participants after IF decreased significantly compared with the non-intervention diet (WMD = 1.02, 95% CI: 0.06–1.99, p = 0.04). IF regulated fat mass (FM) more effectively than non-intervention diet (WMD = 0.74, 95% CI: 0.17–1.31, p = 0.01). The fat-free mass of people after IF was higher (WMD = −0.73, 95% CI: (−1.45)–(−0.02), p = 0.05). There was no difference in fasting blood glucose concentrations between participants in the after IF and non-intervention diet groups. The results of insulin concentrations and HOMA-IR, though, indicated that IF was significantly more beneficial than non-intervention diet (standard mean difference (SMD) = −0.21, 95% CI: 0.02–0.40, p = 0.03, and WMD = 0.35, 95% CI: 0.04–0.65, p = 0.03, respectively). Cholesterol and TG concentrations in participants after IF were also lower than that after a nonintervention diet (SMD = 0.22, 95% CI: 0.09–0.35, p = 0.001 and SMD = 0.13, 95% CI: 0.00–0.26, p = 0.05, respectively). IF outcomes did not differ from CR except for reduced WC. Conclusion Intermittent fasting was more beneficial in reducing body weight, WC, and FM without affecting lean mass compared to the non-intervention diet. IF also effectively improved insulin resistance and blood lipid conditions compared with non-intervention diets. However, IF showed less benefit over CR.
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Objective: Our study aims was to evaluate the effect of Ramadan fasting on routine biochemical parameters in elderly subjects with cardiovascular risk factors. Design : Cohort study. Setting: Subjects were prospectively recruited and screened at nine primary care clinics, three outpatients specialized clinics and an emergency departement. Participants: subjects aged ≥ 65 years (n=87) recruted in Ramadan month in 2010, 2011 and 2012. Measurements: Dietary intake using a 24 hour recall, biochemical tests including complete lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), renal function tests, serum uric acid, serum electrolytes (sodium, potassium, chloride and protein), glycaemia, and glycated hemoglobin (HbA1C). All data related to dietary intake and biochemical tests were performed one month before Ramadan, during the last week of Ramadan and one month after Ramadan. Comparison between the three time groups were made using standard statistical tests. Results: We showed a significant decrease of creatinine clearance and an increase of serum triglycerides and blood glucose during Ramadan. After Ramadan, we observed a significant increase in HDL-C was and a significant decrease in serum triglycerides and HbA1c. No correlation was found between glycaemia and total energy intake, neither between LDL-C/HDL-C ratio and total energy intake. Conclusion: In elderly subjects with cardiovascular risk factors, Ramadan seems to induce dual effects. During the fasting period, there is a potential risk of renal function decrease and an increase of glycaemia. In contrast, after Ramadan, our findings support the potential beneficial effect of fasting on lipid regulation and glycemic control.
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During the holy month of Ramadan the quality of food and eating patterns changed and drinking will be stoppedfor at least 10 to 16 hours on the basis lunar calendar. The effects of exercise and fasting solely or combined onmetabolic and hematologic responses well established. The purpose of the present study was to study the effects ofRamadan fasting with or without weight-lifting training on vascular volumes and selected hematological indices inyoung male weight-lifters. Blood samples were taken at 24h before and 24h after the last day of holy Ramadanfasting period and weight-lifting training for determination of the selected red and white blood cells compositions.The Vascular volumes (Blood, Red cells, and plasma volumes) were determined and calculated by using bothhemoglobin and hematocrit estimations before and after Ramadan fasting with or without weight-lifting training.The results indicate that red cell volume and MCHC were significantly decreased and increased in fasting group(Phigher and significant platelet count was found in training group. The present data indicate that weight-liftingtraining during the holy Ramadan in compare to fasting had no impact on red and white cells compositionexception on platelet count and Hematocrit. A decrease in Hematocrit might be due to the incomplete dehydrationperiod which amplified by stop drinking and nutritional habits during the holy Ramadan.
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A formula has been developed to predict creatinine clearance (Ccr) from serum creatinine (Scr) in adult males: (see article)(15% less in females). Derivation included the relationship found between age and 24-hour creatinine excretion/kg in 249 patients aged 18-92. Values for Ccr were predicted by this formula and four other methods and the results compared with the means of two 24-hour Ccr's measured in 236 patients. The above formula gave a correlation coefficient between predicted and mean measured Ccr's of 0.83; on average, the difference predicted and mean measured values was no greater than that between paired clearances. Factors for age and body weight must be included for reasonable prediction.
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The aim of this study was to investigate the effects of Ramadan fasting on anaerobic power and capacity and the removal rate of lactate after short time high intensity exercise in power athletes. Ten male elite power athletes (2 wrestlers, 7 sprinters and 1 thrower, aged 20-24 yr, mean age 22.30 ± 1.25 yr) participated in this study. The subjects were tested three times [3 days before the beginning of Ramadan (Pre-RF), the last 3 days of Ramadan (End-RF) and the last 3 days of the 4th week after the end of Ramadan (After-RF)]. Anaerobic power and capacity were measured by using the Wingate Anaerobic Test (WAnT) at Pre-RF, End-RF and After-RF. Capillary blood samples for lactate analyses and heart rate recordings were taken at rest, immediately after WAnT and throughout the recovery period. Repeated measures of ANOVA indicated that there were no significant changes in body weight, body mass index, fat free mass, percentage of body fat, daily sleeping time and daily caloric intake associated with Ramadan fasting. No significant changes were found in total body water either, but urinary density measured at End-RF was significantly higher than After-RF. Similarity among peak HR and peak LA values at Pre-RF, End-RF and After-RF demonstrated that cardiovascular and metabolic stress caused by WAnT was not affected by Ramadan fasting. In addition, no influence of Ramadan fasting on anaerobic power and capacity and removal rate of LA from blood following high intensity exercise was observed. The results of this study revealed that if strength-power training is performed regularly and daily food intake, body fluid balance and daily sleeping time are maintained as before Ramadan, Ramadan fasting will not have adverse effects on body composition, anaerobic power and capacity, and LA metabolism during and after high intensity exercise in power athletes.
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Objectives. - The purpose of this study was to determine if aerobic and anaerobic training-induced adaptations were compromised as a result of Ramadan fasting. Methods. - Twenty adolescent males of the Muslim and non-Muslim faith were divided into fasting (FAS, n = 10) and non-fasting or control (CON, n = 10) groups, respectively. High-intensity interval cycle exercise training was conducted three times per week for seven weeks, with Ramadan fasting falling during training weeks 3 to 6 for the FAS group. Results. - Both groups significantly improved their peak oxygen uptake (VO2peak; FAS 2.77 +/- 0.33 to 3.08 +/- 0.22 and CON 2.61 +/- 0.22 to 2.89 +/- 0.21 L/min) and maximal anaerobic performance (total work during four Wingate bouts; FAS 53.4 +/- 5.2 to 57.7 +/- 4.8 and CON 47.4 +/- 4.5 to 52.0 +/- 4.5 kJ) (all p < 0.05). There were no significant differences in the magnitude of improvements made between groups, either for aerobic (FAS 0.31 +/- 0.28 vs. CON 0.28 +/- 0.12 L/min) or anaerobic (FAS 4.3 +/- 3.3 vs. CON 4.6 +/- 3.4 kJ) performance (all p > 0.05). Indices of training intensity (mean heart rate and mean blood lactate) and mean daily energy and fluid intake were not significantly different between groups throughout the study period. Conclusions. - Aerobic and anaerobic adaptations to seven weeks of training were not compromised by four weeks of intermittent Ramadan fasting, possibly because the overall training intensity and nutrient intake were maintained throughout the Ramadan period. (c) 2011 Elsevier Masson SAS. All rights reserved.
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