Ramadan Observance Exacerbated the Negative Effects of COVID-19 Lockdown on Sleep and Training Behaviors: A International Survey on 1,681 Muslim Athletes

Mohamed Romdhani; Achraf Ammar; Khaled Trabelsi; Hamdi Chtourou; Jacopo A Vitale; Liwa Masmoudi; Mathieu Nédélec; Dale E Rae; Ramzi A Al Horani; Helmi Ben Saad; Nicola Bragazzi; Gürhan Dönmez; Ismail Dergaa; Tarak Driss; Abdulaziz Farooq; Omar Hammouda; Nesrine Harroum; Bahar Hassanmirzaei; Karim Khalladi; Syrine Khemila; Leonardo Jose Mataruna-Dos-Santos; Imen Moussa-Chamari; Iñigo Mujika; Hussein Muñoz Helú; Amin Norouzi Fashkhami; Laisa Liane Paineiras-Domingos; Mehrshad Rahbari Khaneghah; Yoshitomo Saita; Maher Souabni; Nizar Souissi; Jad Adrian Washif; Johanna Weber; Piotr Zmijewski; Lee Taylor; Sergio Garbarino; Karim Chamari

doi:10.3389/fnut.2022.925092

Ramadan Observance Exacerbated the Negative Effects of COVID-19 Lockdown on Sleep and Training Behaviors: A International Survey on 1,681 Muslim Athletes

Front Nutr. 2022 Jun 30:9:925092. doi: 10.3389/fnut.2022.925092. eCollection 2022.

Authors

Mohamed Romdhani^{1

2}, Achraf Ammar^{3

4}, Khaled Trabelsi^{1

5}, Hamdi Chtourou^{1

2}, Jacopo A Vitale⁶, Liwa Masmoudi¹, Mathieu Nédélec⁷, Dale E Rae⁸, Ramzi A Al Horani⁹, Helmi Ben Saad¹⁰, Nicola Bragazzi^{11

12}, Gürhan Dönmez¹³, Ismail Dergaa¹⁴, Tarak Driss¹⁵, Abdulaziz Farooq¹⁶, Omar Hammouda^{15

17}, Nesrine Harroum¹⁸, Bahar Hassanmirzaei^{19

20}, Karim Khalladi¹⁶, Syrine Khemila^{2

21}, Leonardo Jose Mataruna-Dos-Santos^{22

23}, Imen Moussa-Chamari²⁴, Iñigo Mujika^{25

26}, Hussein Muñoz Helú²⁷, Amin Norouzi Fashkhami²⁸, Laisa Liane Paineiras-Domingos^{29

30}, Mehrshad Rahbari Khaneghah²⁸, Yoshitomo Saita³¹, Maher Souabni¹⁵, Nizar Souissi^{2

21}, Jad Adrian Washif³², Johanna Weber^{33

34}, Piotr Zmijewski³⁵, Lee Taylor^{36

37}, Sergio Garbarino^{38

39}, Karim Chamari¹⁶

Affiliations

¹ High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia.
² Physical Activity, Sport and Health, UR18JS01, National Observatory of Sports, Tunis, Tunisia.
³ Institute of Sport Science, Otto von Guericke University, Magdeburg, Germany.
⁴ Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg University Mainz, Mainz, Germany.
⁵ Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, Tunisia.
⁶ IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
⁷ The French National Institute of Sport (INSEP), Research Unit, Laboratory Sport, Expertise and Performance (EA7370), Paris, France.
⁸ Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁹ Department of Exercise Science, Yarmouk University, Irbid, Jordan.
¹⁰ Laboratoire de Recherche (LR12SP09) "Insuffisance Cardiaque" Sousse, Faculté de Médecine de Sousse, Hôpital Farhat Hached, Université de Sousse, Sousse, Tunisia.
¹¹ Department of Health Sciences, Postgraduate School of Public Health, University of Genoa, Genoa, Italy.
¹² Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada.
¹³ Department of Sports Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
¹⁴ PHCC, Primary Health Care Corporation, Doha, Qatar.
¹⁵ Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS (Faculty of Sport Sciences), UPL, Paris Nanterre University, Nanterre, France.
¹⁶ Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.
¹⁷ Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia.
¹⁸ Faculty of Medicine, School of Kinesiology and Physical Activity Science, University of Montreal, Montreal, QC, Canada.
¹⁹ Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
²⁰ Iran Football Medical Assessment and Rehabilitation Center, IFMARC, FIFA Medical Center of Excellence, Tehran, Iran.
²¹ High Institute of Sports and Physical Education, Ksar Said, Manouba University, Manouba, Tunisia.
²² Department of Sport Management, Faculty of Management, Canadian University Dubai, Dubai, United Arab Emirates.
²³ Coventry University - Centre for Trust, Peace and Social Relation, Coventry, United Kingdom.
²⁴ Physical Education Department, College of Education, Qatar University, Doha, Qatar.
²⁵ Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Spain.
²⁶ Exercise Science Laboratory, Faculty of Medicine, School of Kinesiology Universidad Finis Terrae, Santiago, Chile.
²⁷ Department of Economic-Administrative Sciences, Universidad Autónoma de Occidente, Culiacán, Mexico.
²⁸ Esteghlal Physiotherapy Clinic, EPC, Tehran, Iran.
²⁹ Programa de Pós-graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
³⁰ Departamento de Fisioterapia, Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia, Salvador, Brazil.
³¹ Department of Sports and Regenerative Medicine, Juntendo University, Tokyo, Japan.
³² Sports Performance Division, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia.
³³ Neurocognition and Action - Biomechanics, Bielefeld University, Bielefeld, Germany.
³⁴ Institute for Sports Science, Christian-Albrechts-University of Kiel, Kiel, Germany.
³⁵ Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland.
³⁶ National Center for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
³⁷ Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.
³⁸ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences, University of Genoa, Genoa, Italy.
³⁹ Post-graduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.

Abstract

Objective: Disrupted sleep and training behaviors in athletes have been reported during the COVID-19 pandemic. We aimed at investigating the combined effects of Ramadan observance and COVID-19 related lockdown in Muslim athletes.

Methods: From an international sample of athletes (n = 3,911), 1,681 Muslim athletes (from 44 countries; 25.1 ± 8.7 years, 38% females, 41% elite, 51% team sport athletes) answered a retrospective, cross-sectional questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: (i) Pittsburgh sleep quality index (PSQI); (ii) insomnia severity index (ISI); (iii) bespoke questions about training, napping, and eating behaviors, and (iv) questions related to training and sleep behaviors during-lockdown and Ramadan compared to lockdown outside of Ramadan. The survey was disseminated predominately through social media, opening 8 July and closing 30 September 2020.

Results: The lockdown reduced sleep quality and increased insomnia severity (both p < 0.001). Compared to non-Muslim (n = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both p < 0.001), but not pre-lockdown (p > 0.05). Muslim athletes reported longer (p < 0.001; d = 0.29) and later (p < 0.001; d = 0.14) daytime naps, and an increase in late-night meals (p < 0.001; d = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p < 0.001). Both sleep quality (χ² = 222.6; p < 0.001) and training volume (χ² = 342.4; p < 0.001) were lower during-lockdown and Ramadan compared to lockdown outside of Ramadan in the Muslims athletes.

Conclusion: Muslim athletes reported lower sleep quality and higher insomnia severity during- compared to pre-lockdown, and this was exacerbated by Ramadan observance. Therefore, further attention to Muslim athletes is warranted when a circadian disrupter (e.g., lockdown) occurs during Ramadan.

Keywords: confinement; pandemic; religious fasting; sleep-wake pattern; training load.

Copyright © 2022 Romdhani, Ammar, Trabelsi, Chtourou, Vitale, Masmoudi, Nédélec, Rae, Al Horani, Ben Saad, Bragazzi, Dönmez, Dergaa, Driss, Farooq, Hammouda, Harroum, Hassanmirzaei, Khalladi, Khemila, Mataruna-Dos-Santos, Moussa-Chamari, Mujika, Muñoz Helú, Norouzi Fashkhami, Paineiras-Domingos, Khaneghah, Saita, Souabni, Souissi, Washif, Weber, Zmijewski, Taylor, Garbarino and Chamari.