Does Ramadan Fasting Affect the Blood Coagulation System through A Session Soccer Match?

Document Type : Research Paper


1 Department of Exercise Physiology, Alborz Campus, University of Tehran, Alborz, Iran.

2 Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.

3 Department of Community Medicine and Rehabilitation, Section of Sports Medicine, Umeå University, Umeå, Sweden.

4 Department of Education, Faculty of Social Science, Umeå University, Umeå, Sweden.


Introduction: Fasting during Ramadan is associated with modifications in athletes' metabolic, physiological, and psychological responses that may affect physical performance. The current study aimed to assess the changes in some risk factors of thrombosis in trained men following one soccer session in non-fasting and fasting conditions. Method: The 11 amateur soccer players (age: 42 ± 16 years) and (body mass index:26.49 ± 2.86) played soccer matched (~100 min: 10 min warm-up, 90 min soccer match) on two occasions: 1 week before and on the fourth day of Ramadan. The blood samples were taken before and after the soccer game. Fibrinogen and D-dimer were analyzed by the Clauss clotting method and the turbid metric assay, respectively; plasminogen and alpha 2 anti-plasmin were analyzed by spectrophotometry, and Homocysteine was analyzed by the ELISA method. The Shapiro-Wilk, independent t-test, and dependent t-test were used to analyze the findings. (P ≤0.05). Result: The results demonstrated that one session soccer match increased homocysteine in both fasting (p = 0.006) and non-fasting (p = 0.042), Alpha 2-antiplasmin decreased in fasting (p = 0.031 and non-fasting (p = 0.001) and plasminogen decreased in non-fasting (p = 0.012). one session soccer match had not a Significant Impact on Fibrinogen and D-dimer in both condition and plasminogen in fasting(p≥0.05). Also, there was no significant difference between fasting and non-fasting conditions in Homocysteine, Alpha 2-antiplasmin, FibrinogenPlasminogen, and D-dimer in response to one session soccer match (p≥0.05).  Conclusions: Amazingly, one session soccer match throughout the fasting condition is parallel with the non-fasting state, and fasting did not produce adverse consequences in the coagulation system.


1. Bouzid MA, Abaïdia A-E, Bouchiba M, Ghattassi K, Daab W, Engel FA, et al. Effects of Ramadan Fasting on Recovery Following a Simulated Soccer Match in Professional Soccer Players: A Pilot Study. Frontiers in Physiology. 2019;10(1480).
2. Waterhouse J, Alkib L, Reilly T. Effects of Ramadan upon fluid and food intake, fatigue, and physical, mental, and social activities: a comparison between the UK and Libya. Chronobiology international. 2008;25(5):697-724.
3. Roky R, Herrera CP, Ahmed Q. Sleep in athletes and the effects of Ramadan. Journal of sports sciences. 2012;30(sup1):S75-S84.
4. Sarraf-Zadegan N, Atashi M, Naderi GA, Baghai AM, Asgary S, Fatehifar MR, et al. The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors. Annals of Saudi medicine. 2000;20(5-6):377-81.
5. Aksungar FB, Eren A, Ure S, Teskin O, Ates G. Effects of intermittent fasting on serum lipid levels, coagulation status and plasma homocysteine levels. Annals of nutrition and metabolism. 2005;49(2):77-82.
6. Patelis N, Karaolanis G, Kouvelos GN, Hart C, Metheiken S. The effect of exercise on coagulation and fibrinolysis factors in patients with peripheral arterial disease. Experimental Biology and Medicine. 2016;241(15):1699-707.
7. Van Stralen KJ, Doggen CJ, Lumley T, Cushman M, Folsom AR, Psaty BM, et al. The relationship between exercise and risk of venous thrombosis in elderly people. Journal of the American Geriatrics Society. 2008;56(3):517-22.
8. Kupchak BR, Creighton BC, Aristizabal JC, Dunn-Lewis C, Volk BM, Ballard KD, et al. Beneficial effects of habitual resistance exercise training on coagulation and fibrinolytic responses. Thrombosis research. 2013;131(6):e227-e34.
9. Dobson GP, Morris JL, Davenport LM, Letson HL, editors. Traumatic-induced coagulopathy as a systems failure: a new window into hemostasis. Seminars in Thrombosis and Hemostasis; 2020: Thieme Medical Publishers.
10. Zouhal H, Saeidi A, Salhi A, Li H, Essop MF, Laher I, et al. Exercise training and fasting: current insights. Open Access Journal of Sports Medicine. 2020;11:1.
11. Darzabi  T, Hejazi K. The Effects of Ramadan Fasting on Electrolytes Index, Serum Osmolarity and Body Composition in Fasting and Non-Fasting Students: A Quasi-Experimental Study. Jundishapur J Chronic Dis Care. 2020;9(2):e100079.
12. Javanmardi H, Safari A, Borhani-Haghighi A. Effect of Ramadan fasting in incidence of cerebral venous sinus thrombosis. International journal of stroke : official journal of the International Stroke Society. 2018;13(2):Np2.
13. Arnaoutis G, Kavouras SA, Stratakis N, Likka M, Mitrakou A, Papamichael C, et al. The effect of hypohydration on endothelial function in young healthy adults. European journal of nutrition. 2017;56(3):1211-7.
14. Chaouachi A, Leiper JB, Chtourou H, Aziz AR, Chamari K. The effects of Ramadan intermittent fasting on athletic performance: recommendations for the maintenance of physical fitness. Journal of sports sciences. 2012;30(sup1):S53-S73.
15. Quchan AHSK, Kordi MR. Strategies and Solutions to Return to Training for Teams and Elite Athletes After Lifting COVID-19 Restrictions. Asian J Sports Med. 2020;11(3):e106285.
16. Costill D, Fink W. Plasma volume changes following exercise and thermal dehydration. Journal of applied physiology. 1974;37(4):521-5.
17. Jakubowski H. Homocysteine modification in protein structure/function and human disease. Physiological reviews. 2019;99(1):555-604.
18. Herrmann M, Schorr H, Obeid R, Scharhag J, Urhausen A, Kindermann W, et al. Homocysteine increases during endurance exercise. Clinical chemistry and laboratory medicine. 2003;41(11):1518-24.
19. König D, Bissé E, Deibert P, Müller HM, Wieland H, Berg A. Influence of training volume and acute physical exercise on the homocysteine levels in endurance-trained men: interactions with plasma folate and vitamin B12. Annals of nutrition & metabolism. 2003;47(3-4):114-8.
20. Real JT, Merchante A, Gómez JL, Chaves FJ, Ascaso JF, Carmena R. Effects of marathon running on plasma total homocysteine concentrations. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2005;15(2):134-9.
21. Gelecek N, Teoman N, Ozdirenc M, Pınar L, Akan P, Bediz C, et al. Influences of acute and chronic aerobic exercise on the plasma homocysteine level. Annals of Nutrition and Metabolism. 2007;51(1):53-8.
22. Venta R, Cruz E, Valcárcel G, Terrados N. Plasma vitamins, amino acids, and renal function in postexercise hyperhomocysteinemia. Medicine and science in sports and exercise. 2009;41(8):1645-51.
23. Bizheh N, Jaafari M. The Effect of a Single Bout Circuit Resistance Exercise on Homocysteine, hs-CRP and Fibrinogen in Sedentary Middle Aged Men. Iran J Basic Med Sci. 2011;14(6):568-73.
24. Deminice R, Vannucchi H, Simões-Ambrosio LM, Jordao AA. Creatine supplementation reduces increased homocysteine concentration induced by acute exercise in rats. European journal of applied physiology. 2011;111(11):2663-70.
25. Deminice R, Rosa FT, Franco GS, Jordao AA, de Freitas EC. Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition (Burbank, Los Angeles County, Calif). 2013;29(9):1127-32.
26. Iglesias-Gutiérrez E, Egan B, Díaz-Martínez ÁE, Peñalvo JL, González-Medina A, Martínez-Camblor P, et al. Transient Increase in Homocysteine but Not Hyperhomocysteinemia during Acute Exercise at Different Intensities in Sedentary Individuals. PLoS One. 2012;7(12):e51185.
27. Brosnan JT, Da Silva RP, Brosnan ME. The metabolic burden of creatine synthesis. Amino acids. 2011;40(5):1325-31.
28. Maroto-Sánchez B, Lopez-Torres O, Valtueña J, Benito PJ, Palacios G, Díaz-Martínez Á E, et al. Rehydration during exercise prevents the increase of homocysteine concentrations. Amino acids. 2019;51(2):193-204.
29. Joubert LM, Manore MM. Exercise, nutrition, and homocysteine. International journal of sport nutrition and exercise metabolism. 2006;16(4):341-61.
30. Zakrzewski M, Zakrzewska E, Kiciński P, Przybylska-Kuć S, Dybała A, Myśliński W, et al. Evaluation of fibrinolytic inhibitors: alpha-2-antiplasmin and plasminogen activator inhibitor 1 in patients with obstructive sleep apnoea. PloS one. 2016;11(11).
31. Ibrahim O, Kamaruddin N, Wahab N, Rahman M. Ramadan Fasting And Cardiac Biomarkers In Patients With Multiple Cardiovascular Disease Risk Factors. Internet Journal of Cardiovascular Research. 2011;7(2).
32. MOSESSON MW. Fibrinogen and fibrin structure and functions. Journal of thrombosis and haemostasis. 2005;3(8):1894-904.
33. Mahmoodinezhad S, Shakerian S, Ghalavand A, Motamedi P, Delaramnasab M. The Effect of Acute Training and Circadian Rhythm on Blood Hemostasis in Female Athletes. Int J Basic Sci Med.1(1):8-12.
34. Kahraman S, Bediz CS, Pişkin O, Aksu I, Topçu A, Yüksel F, et al. The effect of the acute submaximal exercise on thrombin activatable fibrinolysis inhibitor levels in young sedentary males. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2011;17(4):414-20.
35. khademi a, tofighi a, tolouei azar j, Saify Nabiabad H, Nouri Habashi A. Modulation of blood hemostasis by concurrent training in obese women with low-mobility. Studies in Medical Sciences. 2019;29(11):781-92.

Articles in Press, Accepted Manuscript
Available Online from 08 August 2021
  • Receive Date: 24 February 2021
  • Revise Date: 08 July 2021
  • Accept Date: 08 August 2021