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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 11–18 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 study’s 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 2–3 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 week’s 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
manufacturer’s 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 Jaffé 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 (ml•min
-1
) = 1.25 × body mass (kg) × (140 - age
(y)): creatinine (μmol•l
-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 (mmol•l
-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.
Trabelsi et al. Journal of the International Society of Sports Nutrition 2013, 10:23 Page 5 of 11
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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 (mmol•l
-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 (μmol•l
-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 (μmol•l
-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
(ml•min-1) FED 130.61 ± 6.86 124.46 ± 7.96
Sodium (mmol•l
-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 (mmol•l
-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 (mmol•l
-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 (mmol•l
-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 (mmol•l
-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 (mmol•l
-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 (mmol•l
-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 (mmol•l
-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
http://www.jissn.com/content/10/1/23
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 (IU•l
-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 (IU•l
-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 (IU•l
-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 (IU•l
-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 (IU•l
-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 (IU•l
-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 (mg•l
-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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doi:10.1186/1550-2783-10-23
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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