A Review of Ramadan Fasting and Regular Physical Activity on Metabolic Syndrome Indices

Document Type : Review Article


1 Professor in Sport Physiology, Faculty of Physical Education and Sports Sciences, Ferdowsi University of Mashhad, Mashhad, Iran

2 PhD student of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran


Introduction: Metabolic syndrome constitutes a cluster of risk factors such as obesity, hyperglycemia,  hypertension, and dyslipidemia, which increase the risk of cardiovascular diseases and type II diabetes mellitus. In this review article, we aimed to discuss the possible effects of fasting and regular physical activity on risk factors for cardiovascular diseases. 
Methods: Online databases including Google Scholar, SID, PubMed, and MagIran were searched, using the following keywords:  “training”, “exercise”, “physical activity”, “fasting”, “Ramadan”, “metabolic syndrome”, “fat percentage”, “blood pressure”, “blood sugar”, “cholesterol”, “triglyceride”, and “lowdensity lipoprotein-cholesterol”. All articles including research studies, review articles, descriptive and analytical studies, and ross-sectional research, published during 2006-2015, were reviewed. In case of any errors in the methodologyof articles, they were removed from our analysis. Results:Based on our literature review, inconsistent findings have been reported on risk factors for
metabolic syndrome. However, the majority of conducted studies have suggested the positive effects of
fasting on reducing the risk factors for metabolic syndrome. Conclusion: Although fasting in different seasons of the year has no significant impacts on mental health or physical fitness, it can reduce the risk of various diseases such as cardiovascular diseases. Also, based on the conducted studies, if individuals adhere to a proper diet, avoid excessive eating, drink sufficient amounts of fluids, and keep a healthy level of physical activity, fasting can improve their physical health.


  1. Shiasi-Arani K, Ghasemi S, Moravveji S, Shahpouri-Arani A. Frequency of metabolic syndrome and type 2 diabetes among the obese children and adolescents in Kashan during 2009-11. Feyz, Journal of Kashan University of Medical Sciences. 2012;16(3):240-7.
  2. Ley S, Harris S, Mamakeesick M, Noon T, Fiddler E, Gittelsohn J. Metabolic syndrome and its components as predictors of incident type 2 diabetes mellitus in an Aboriginal community. Canadian Medical Association Journal. 2009;180(6):617.
  3. Meigs J, Wilson P, Nathan D, D’Agostino R, Williams K, Haffner S. Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring. Diabetes 2003;52:2160-7.
  4. Li C, Ford E, Mokdad A, Cook S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics. 2006 118(5):e1390-8.
  5. Arnlöv J, Ingelsson E, Sundström J, Lind L. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men. Circulation. 2010 121(2):230-6.
  6. Li S, Chen W, Srinivasan S, Bond M, Tang R, Urbina E. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA 2003;290(17):2271-6.
  7. Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J. 2006;47(5):409.
  8. soltani A. The effect of the Islamic fasting month of Ramadan on the blood pressure of patients with essential hypertension treated drug. Tehran: Azad; 1999.
  9. Khaled B, Belbraouet S. Effects of Ramadan fasting on anthropometric parameters and food consuming in 276 type 2 diabetic obese women. Int J Diab Dev Cries. 2009;2(29):62-8.
  10. Attarzadeh Hosseini SR, Hejazi K. The effects of ramadan fasting and physical activity on blood hematological-biochemical parameters. Iran J Basic Med Sci. 2013 Jul;16(7):845-9.
  11. Sadiya A, Ahmed S, Siddieg H, Babas I, Carlsson M. Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome. Diabetes Metab Syndr Obes. 2011;4:409-16.
  12. Zerguini Y, Dvorak J, Maughan RJ, Leiper JB, Bartagi Z, Kirkendall DT, et al. Influence of Ramadan fasting on physiological and performance variables in football players: summary of the F-MARC 2006 Ramadan fasting study. J Sports Sci. 2008;26(3):3-6.
  13. Azizi F, Amir Rasouli H. Evaluation of certain hormones and blood constituents during Islamic fasting month. J Med Assoc Thai. 1986;69:57.
  14. Larijani B, Zahedi F, Sanjari M, Amini MR, Jalili RB, Adibi H, et al. The effect of Ramadan fasting on fasting serum glucose in healthy adults. Med J Malaysia. 2003;58(5):678-80.
  15. Bouguerra R, Jabrane J, Maatki C, Ben Salem L, Hamzaoui J, El Kadhi A, et al. [Ramadan fasting in type 2 diabetes mellitus]. Ann Endocrinol (Paris). 2006 Mar;67(1):54-9.
  16. Chaouachi A, Chamari K, Roky R, Wong P, Mbazaa A, Bartagi Z, et al. Lipid profiles of judo athletes during Ramadan. Int J Sports Med. 2008;29(4):282–8.
  17. Farshidfar G, Yousfi H, Vakili M, Asadi Noughabi F. The Effect of Ramadan Fasting on Hemoglobin, Hematocrit and Blood Biochemical Parameters. J Res Health Sci. 2006;6(2):21-7.
  18. Saada A, Selselet attou G, Belkacemi L, Ait chabane O, Italhi M, Bekada AM, et al. Effect of Ramadan fasting on glucose, glycosylated haemoglobin, insulin, lipids and proteinous concentrations in women with non-insulin dependent diabetes mellitus. African Journal of Biotechnology. 2010;9(1):87-94.
  19. Gami A, Witt B, Howard D, Erwin P, Gami L, Somers V, et al. Metabolic syndrome and risk of incident cardiovascular events and death: A systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49:403-14.
  20. Hunt K, Resendez R, Williams K, Haffner S, Stern M. National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Circulation. 2004;110:1251-7.
  21. Moghaddam M, Mehdizadeh S. Association of Metabolic Syndrome Factors and Percent Body Fat and It's With Maximal Oxygen Consumption Among Patients With Coronary Artery Disease. Iranian Journal of Endocrinology and Metabolism. 2012;13(5):479-85.
  22. Damirchi A, Babaei P, Azali Alamdari K. Effects of aerobic training on metabolic risk factors and BDNF in midlife males. Journal of Sport in Biomotor Sciences. 2012;6(2):51-61.
  23. Zorofi F, Hojjati Z, Elmiyeh A. Effect of Yoga Exercises on the Body Composition of Fasting Females. J Fasting Health. 2013;1(2):70-8.
  24. Toda M, Morimoto K. Ramadan fasting effect on healthy muslims. Social Behavior and Personality: an international journal. 2004;32(1):13-8.
  25. Nematy M, Mazidi M, Rezaie P, Kazemi M, Norouzy A, Mohajeri SAR, et al. Ramadan fasting: Do we need more evidence? Journal of Fasting and Health. 2015;3(1):4-10.
  26. Nematy M, Alinezhad-Namaghi M, Rashed MM, Mozhdehifard M, Sajjadi SS, Akhlaghi S, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutr J. 2012;11:69.
  27. Navaei L, Mehrabi Y. Changes in body weight, blood pressure, consumption pattern and biochemical parameters in diabetic patients during fasting in Ramadan. Iranian Journal of Endocrinology and Metabolism. 2001;3(2):125-32.
  28. Sweileh N, Schnitzler A, Hunter G, Davis B. Body composition and energy metabolism in resting and exercising muslims during Ramadan fast. Journal of Sports Medicine and Physical Fitness. 1992;32(2):156-63.
  29. Khoshdel A, Kheiri S, Nasiri J, Saedi E, Mobasheri M. The effect of Ramadan fasting on lipid profile in pregnant women. Journal of Fasting and Health. 2015;3(2):81-5.
  30. Unalacak M, Kara IH, Baltaci D, Erdem O, Bucaktepe PG. Effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals. Metab Syndr Relat Disord. 2011 Apr;9(2):157-61.
  31. Maughan R, Leiper J, Bartagi Z. Effect of Ramadan fasting on some biochemical and haematological parameters in Tunisian youth soccer players undertaking their usual training and competition schedule. J Sports Sci. 2008;26:39-46.
  32. Ward J, al e. Translational Mini-Review Series on Immunology of Vascular Disease: Inflammation, infections and Toll-like receptors in cardiovascular disease. Clinical and Experimental Immunology. 2009;156:386-94.
  33. Mougios V. Exercise biochemistry. 1 ed: Human Kinetics; 2006.
  34. Stote K, Baer D, Spears K, Paul D, Harris G, Rumpler W. A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. Am J Clin Nutr. 2007;85(4):981-8.
  35. Azzout B, Bois-Joyeux B, Chanez M, Peret J. Development of gluconeogenesis from various precursors in isolated rat hepatocytes during starvation or after feeding a high protein, carbohydrate-free diet. J Nutr. 1987;117(1):164-9.
  36. Hallak MH, Nomani MZ. Body weight loss and changes in blood lipid levels in normal men on hypocaloric diets during Ramadan fasting. The American Journal of Clinical Nutrition,. 1988;48(5):1197-210.
  37. Latifi N. Effects of fasting on arterial hypertension and biochemical parameters of blood. Iran Med J. 1994;12:24-8.
  38. Hall JE. Pocket Companion to Guyton & Hall Textbook of Medical Physiology: Elsevier Health Sciences; 2011.
  39. Attarzadeh Hoseini S, Rahimiyan Mashhad Z. Comparison the effect of aerobic training and diet on Body Composition and Metabolic Syndrome Indexes in overweight and obese women. Applied research of sport managment. 2012;3(1):27-36.
  40. Adlouni A, Ghalim N, Benslimane A, Lecerf J, Saile R. Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol. Ann Nutr Metab. 1997;41:242-9.
  41. Temizhan A, Tandogan I, Donderici O, Demirbas B. The effects of Ramadan fasting on blood lipid levels. Am J Med. 2000;109:341-2.
  42. Gumaa K, Mustafa K, Mahmoud N, Gader A. The effects of fasting in Ramadan. l. Serum uric acid and lipid concentrations. Br J Nutr. 1978;40:573-81.
  43. Haghdoost A, PoorRanjbar M. The interaction between physical activity and fasting on the serum lipid profile during Ramadan. Singapore Med J. 2009;50(9):897.
  44. Salehi M, Neghab M. Effects of fasting and a medium calorie balanced diet during the holy month Ramadan on weight, BMI and some blood parameters of overweight males. Pak J Biol Sci. 2007;10(6):968-71.
  45. El Harchaoui K, Van der steeg W, Stroes E, Kastelein J. The role of CETP inhibition in dyslipidemia. Curr Atheroscler Rep. 2007;9(2):125-33.
  46. Saleh S, Elsharouni S, Cherian B, Mourou M. Effects of Ramadan Fasting on Waist Circumference, Blood Pressure, Lipid Profile, and Blood Sugar on a Sample of Healthy Kuwaiti Men And Women. Mal J Nutr. 2005;11(2):143-50.
  47. Trabelsi K, Rebai H, El-Abed K, Stannard SR, Khannous H, Masmoudi L, et al. Effect of ramadan fasting on body water status markers after a rugby sevens match. Asian J Sports Med. 2011 Sep;2(3):186-94.
  48. Kassab S, Abdul-Ghaffar T, Nagalla D, Sachdeva U, Nayar U. Interactions between leptin, neuropeptide-Y and insulin with chronic diurnal fasting during Ramadan. Ann Saudi Med. 2004;24(5):345-9.
  49. Pirsaheb S, Pasdar Y, Navabi S, Rezaei M, Darbandi M, Niazi P. Fasting Consequences during Ramadan on Lipid Profile and Dietary Patterns. Asia Oceania J Nucl Med Biol. 2013;1(2):6-12.
  50. Bassami M, Ahmadizad S, Tahmasebi W, Khedmatgozar E, Rokhsati S. Effects of Ramadan Fasting and Regular Exercise Training on Fat and CHO Metabolism. Iranian Journal of Endocrinology and Metabolism. 2013; 15(4):360-69.
  51. LeMura L, Von Duvillard S, Andreacci J, Klebez J, Chelland S, Russo J. Lipid and lipoprotein prfile, cordiovascular Fitness, boody composition and deit during and after resistance , aerobic and combination training in young women. Eur J Appl physiol. 2000;82(5-6):451-8.
  52. Makuyana D, Gomo Z, Munyombwe T, Matenga JA, Hakim JG. Metabolic syndrome disorders in urban black Zimbabweans with type 2 Diabetes mellitus. Cent Afr J Med. 2004 Mar-Apr;50(3-4):24-9.
  53. Mancia G, Bertinieri G, Grassi G, Parati G, Pomidossi G, Ferrari A, et al. Effects of blood-pressure measurement by the doctor on patient's blood pressure and heart rate. Lancet. 1983 Sep 24;2(8352):695-8.
  54. Ziaei S, Ziagham S, Sayahi M. The relationship between menopausal age and metabolic syndrome in nonobese postmenopausal women. Arak Medical University Journal (AMUJ). 2013;16(74):41-8.
  55. Bjorntorp P, Holm G, Rosmond R, Folkow B. Hypertension and the metabolic syndrome: closely related central origin? Blood Press. 2000;9(2-3):71-82.
  56. Chen CH, Tsai ST, Chuang JH, Chang MS, Wang SP, Chou P. Population-based study of insulin, C-peptide, and blood pressure in Chinese with normal glucose tolerance. Am J Cardiol. 1995 Sep 15;76(8):585-8.
  57. Landsberg L. Insulin and the sympathetic nervous system in the pathophysiology of hypertension. Blood Press Suppl. 1996;1:25-9.
  58. Saeidi M. Metabolic Syndrome and Hypertension in Diabetic Patients. Iranian Journal of Endocrinology & Metabolism. 2009;11(1):11-6.
  59. Ernsberger P, Nelson D. Effects of fasting and refeeding on blood pressure are determined by nutritional state, not by body weight change. Am J Hypertens 1988;1(3):153-7.
  60. Bursztyn M, Mekler J, Wachtel N, Ben-Ishay D. Siesta and ambulatory blood pressure monitoring. Comparability of the afternoon nap and night sleep. Am J Hypertens. 1994 Mar;7(3):217-21.
  61. Beltaifa L, Bouguerra R, Ben Slama C, Jabrane H, Khadhi A, Ben Rayana M. Food intake, and anthropometrical and biological parameters in adult Tunisians during fasting at Ramadan. East Mediterr Health J. 2002;8:603-11.
  62. Perk G, Ghanem J, Aamar S, Ben-Ishay D, Bursztyn M. The effect of the fast of Ramadan on ambulatory blood pressure in treated hypertensives. J Hum Hypertens. 2001 Oct;15(10):723-5.
  63. Dewanti L, Watanabe C, Sulistiawati E, Ohtsuka R. Unexpected changes in blood pressure and haematological parameters among fasting and nonfasting workers during Ramadan in Indoensia. Eur J Clin Nutr. 2006;60:877-81.
  64. Ramadan J, Telahoun G, Al-Zaid N. Responses to exercise, fluid, and energy balances during Ramadan in sedentary and active males. Nutrition Rep Internat. 1999;15:735-9.
  65. Alinezhad Namaghi M, Hasanzadeh Dalooe M, Khoshnasab A, Khoshnasab A, Farrokhi J, Norouzy A. Effects of Ramadan Fasting on Ambulatory Blood Pressure in Hypertensive Patients. J Fasting Health. 2014;2(1):1-6.
  66. Amirkalali sijavandi ms, Shahsavan f, Asgarizadeh F, Namaty M, Heravian J, Mahmodi Z, et al. Effect of Ramadan Fasting on Blood Pressure and Lipid Profiles. Journal of Fasting and Health. 2015;3(3):126-30.
  67. Kamal K, Ahmad Q, Sayedda K, Haque M. Effect of islamic fasting on lipid profile, total protein and albumin on healthy muslim male subjects of shri ram murti smarak institute of medical sciences, bareilly, uttar pradesh. National Journal Of Medical Research. 2012;2(4):407-710.
  68. Attarzadeh Hosseini S, Shamsian A, Abbasian S, Gahremani Moghadam M. The effect of Ramadan fasting and physical activity on anthropometrics, lipid profile and blood pressure of normal male students. Daneshvar Medicine. 2012(97):1-13.
  69. Lotfi S, Madani M, Abassi A, Tazi A, Boumahmaza M, Talbi M. CNS Activation, Reaction Time, Blood Pressure and Heart Rate Variation During Ramadan Intermittent Fasting and Exercise. World Journal of Sport Sciences. 2010;3(1):37-43.
  70. Khaw K, Barrett-Connor E. The association between blood pressure, age, and dietary sodium and potassium: a population study. Circulation. 1988;77:53-61.
  71. Sadeghi Pour H, Zahedi Asl S, Riahi Asl B, Mirmiran P, Azizi F. Changes in blood pressure and its association with anthropometric indices and puberty during Ramadan in adolescent girl. Journal of Research in Medical Sciences 2006;3(1):45-51.
  72. Husain R, Cheah SH, Duncan MT. Cardiovascular reactivity in Malay Moslems during Ramadan. Singapore Med J. 1996 Aug;37(4):398-401.
  73. Boukili A, Had A, Chaari J, Hadri L, Ghafir D, Ohayon V, et al. Blood Pressure Parameters during Ramadan: 24 Hours Arterial Pressure Monitoring in 20 Normal Volunteers. First International Congress on Health and Ramadan Jan. 1994;1:19-22.
  74. Jonas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med. 1997 Jan-Feb;6(1):43-9.
  75. Henderson RJ, Hart MG, Lal SK, Hunyor SN. The effect of home training with direct blood pressure biofeedback of hypertensives: a placebo-controlled study. J Hypertens. 1998 Jun;16(6):771-8.
  76. Defronzo R, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14(3):173-94.
  77. Patel P, Mirakhur A, El-Magd KM, El-Matty AN, Al-Ghafri D. Type 2 Diabetes and its Characteristics during Ramadan in Dhahira Region, Oman. Oman Med J. 2007 Oct;22(3):16-23.
  78. Dennis K, Goldberg A. Differential effects of body fatness and body fat distribution on risk factor for cardiovascular disease in women. Impact of weight loss. Arterioscler Thromb Vasc Biol. 1993;13(10):1487-94.
  79. Joshaghan M, Kamyad V, Razavi A, Norouzy A. Evaluation of the Nutritional Effects of Fasting on Cardiovascular Diseases, Using Fuzzy Data Mining. Asia Oceania J Nucl Med Biol. 2014;2(1):16-20.
  80. Afghari N, Rabiei S, Rashidi pour Fard N, Pour Naghshband P, Rast Manesh R. Short-Term and Mid-Term Effects of Fasting and Downset Meal Pattern on Dietary Intakes, Anthropometric Parameters, and Glycemic and Lipid Profile in Fasting Women. Journal of Fasa University of Medical Sciences. 2012;2(3):199-209.
  81. Kalantary S. Effect of Fasting on Blood Sugar in NIDDM Patients in Ramazan Holy Month. Journal of Guilan University of Medical Sciences. 2007;16(63):21-5.
  82. Elnasri H, Ahmed A. Effects of Ramadan Fasting on Blood Levels of Glucose, Triglyceride and Cholesterol among Type II Diabetic Patients. Sudanese Journal of Public Health. 2006;1(3):203-6.
  83. Christ-Roberts C, Pratipanawatr T, Pratipanawatr W. Exercise training increases glycogen synthase activity and GLUT-4 expression but not insulin signaling in overweight non-diabetic and type 2 diabetic subjects. Metabolism. 2004;53:1233-42.
  84. Galbo H, Tobin L, Van Loon L. Responses to acute exercise in type 2 diabetes, with an emphasis on metabolism and interaction with oral hypoglycemic agents. Appl Physiol Nutr Metab. 2007;32(3):567-75.
  85. Tayebi S, Hanachi P, Niaki A. Ramadan fasting and weight-lifting training on vascular volumes and hematological profiles in young male weight-lifters. Global J health Sci 2010;2:160-6.
  86. Hamdy E, Attia S, Ghonna R. Effects of the Fast of Ramadan on Endothelial function and High-Sensitivity C-Reactive Protein in newly diagnosed type 2 Diabetic Patient. Kuwait Med J. 2008;40(1):53-8.
  87. Profant J, Dimsdale J. Race and diurnal blood pressure patterns. A review and meta-analysis. Hypertension. 1999;33(5):1099-104.
  88. Caviezel F, Margonato A, Slaviero G, Bonetti F, Vicedomini G, Cattaneo A. Early improvement of left ventricular function during caloric restriction in obesity. Int J Obes. 1986;10(6):421-6.
  89. Attarzadeh Hosseini S, Sardar M, Hejazi K, Farahati S. The Effect of Ramadan Fasting and Physical Activity on Body Composition, Serum Osmolarity Levels and Some Parameters of Electrolytes in Females. Int J Endocrinol Metab. 2013;11(2):88-94.
  90. Asemi Z, Samimi M, Taghizadeh M, Esmaillzadeh A. Effects of Ramadan Fasting on Glucose Homeostasis, Lipid Profiles, Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome in Kashan, Iran. Archives of Iranian Medicine (AIM). 2015;18(12):1-10
  91. Attarzadeh Hosseini SR, Motahari Rad M, Hejazi K. The effects of Ramadan fasting and physical activity on body composition and hematological biochemical parameters. Journal of Fasting and Health. 2014;2(3):96-103.
  92. Samad F, Qazi F, Pervaiz MB, Kella DK, Mansoor M, Osmani BZ, et al. Effects of ramadan fasting on blood pressure in normotensive males. Journal of Ayub Medical College Abbottabad. 2015;27(2):338-42.
  93. Paul AK, Khan MA, Fariduddin M. Effect of Ramadan Fasting on Anthropometric Measures and Metabolic Profiles among Type 2 Diabetic Subjects. Journal of Enam Medical College. 2015;5(2):93-8.
  94. Ural E, Kozdag G, Kilic T, Ural D, Sahin T, Celebi O, et al. The effect of Ramadan fasting on ambulatory blood pressure in hypertensive patients using combination drug therapy. Journal of human hypertension. 2008;22(3):208-10.
  95. Moazami M, Bijeh N, Abbasian S. A Comparison of the Effects of Ramadan Fasting and Regular Aerobic Exercise on 70-Kda Heat Shock Protein (Hsp70), Lipid Profiles and Resistance Insulin in Non-Active Obese Men. Iranian Journal of Endocrinology and Metabolism. 2013;15(1):67-77.