Introduction: A growing number of Muslim athletes now engage in international competition. This raises the question of the advice they should be given if a major event occurs during the month of Ramadan. Methods: A narrative review has been based upon books and extensive reviews completed by the author and other investigators. Results: Practical considerations hamper assessment of the effects of Ramadan upon physical performance, but there seem small decreases in muscular strength and both anaerobic and aerobic capacity. Nevertheless, athletes who wish to observe Ramadan can reduce such effects by prior adjustment of diet and training plans, minimizing sleep loss, and careful management of fluid and food intake during the period of intermittent fasting. Conclusion: Competitors in most events can observe Ramadan with a small loss of athletic performance. However, intermittent fasting can endanger health for individuals with type I diabetes mellitus, and for participants in ultra-endurance events (particularly under hot conditions).
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