This is the third article in a series examining the inactivity epidemic by Dr Jayantha Dassanayake, PGdiP (UK) MAppSc (Australia), PhD Australia, PDF (Canada).
Dr Dassanayake presents compelling evidence for physical inactivity as a primary modifiable risk factor in non-communicable disease development across the Middle East. Drawing upon epidemiological data and clinical research, Dr Dassanayake’s series explores evidence-based interventions to address this public health challenge. This series aims to provide healthcare professionals with practical strategies for implementing exercise prescription within clinical practice.
Ramadan is a sacred month observed by millions across the Middle East and worldwide. Beyond its spiritual significance, it represents discipline, reflection, and renewal — including renewal of health behaviours. Yet many individuals reduce or completely stop physical activity during fasting hours due to concerns about dehydration, fatigue, or medical risk. While caution is appropriate, complete inactivity is neither necessary nor advisable for most people.
Regular physical activity improves insulin sensitivity, cardiovascular function, blood pressure, lipid profiles, body composition, and psychological wellbeing [1]. As emphasised in Move to Heal, movement should be viewed not simply as recreation but as structured preventive medicine embedded within daily life [2]. With appropriate timing and intensity, exercise can be maintained safely during Ramadan.
Exercise timing during fasting
Hydration status, glycogen availability, and cardiovascular load fluctuate across the fasting day [3,4]. Understanding these changes allows safe planning.
Late afternoon (before Iftar — light activity only).
Light walking, stretching, or mobility work may be performed 30–60 minutes before breaking the fast. This timing allows prompt rehydration and nutrient intake afterwards. However, vigorous or prolonged sessions should be avoided due to increased dehydration risk, reduced plasma volume, and potential hypoglycaemia — particularly in individuals with diabetes [3,7].
After Iftar (1–2 hours post-meal).
For most individuals, this is the safest window for moderate-intensity activity. Hydration and glucose stores have been replenished, reducing cardiovascular strain and perceived exertion [3]. Exercise tolerance is generally better than during late-afternoon fasting hours [4]. Brisk walking, light resistance training, or supervised programmes are typically well tolerated.
Before Suhoor (pre-dawn).
Light activity before the pre-dawn meal may support metabolic regulation, provided adequate hydration and nutrient intake follow [3]. Consistency and moderation remain key.
Regardless of timing, exercise should stop immediately if dizziness, chest discomfort, confusion, palpitations, marked fatigue, or unusual breathlessness occur. These symptoms may signal dehydration, hypoglycaemia, hypotension, or cardiac strain and require medical review [1,6].
Myths versus Evidence
Myth 1: Exercise invalidates fasting.
Physical activity does not invalidate the fast. Islamic jurisprudence prioritises preservation of health, and breaking the fast is permitted if medical harm is anticipated. Contemporary clinical guidance supports safe activity during Ramadan [7].
Myth 2: Exercise is unsafe during fasting.
For most healthy adults, light-to-moderate activity is safe when properly timed. Even modest levels of physical activity significantly reduce mortality risk and extend life expectancy [5].
Myth 3: Muscle loss is inevitable.
Muscle preservation depends more on adequate protein intake and resistance training than on fasting itself. With appropriate nutrition and training adjustment, lean mass can be maintained [3].
Myth 4: People with chronic disease must avoid exercise.
Lifestyle interventions incorporating physical activity reduce progression to type 2 diabetes [8] and improve glycaemic control [6]. Exercise remains central to chronic disease management, including during Ramadan with appropriate supervision.
Guidance for people with diabetes
Ramadan fasting alters glucose regulation and may increase risks of hypoglycaemia or hyperglycaemia, particularly among those using insulin or insulin secretagogues. International consensus guidelines recommend pre-Ramadan risk assessment and individualised medication adjustment [7].
Practical advice for individuals with well-controlled type 2 diabetes includes:
• Prefer light-to-moderate intensity exercise
• Choose post-Iftar sessions where possible
• Monitor blood glucose before and after activity
• Maintain adequate hydration between sunset and dawn
Structured lifestyle modification reduces diabetes incidence by 58% among high-risk individuals [8], and moderate exercise improves insulin sensitivity [6]. Those with poorly controlled diabetes or recent severe hypoglycaemia should seek medical advice before exercising while fasting [7].
Guidance for people with cardiovascular disease
Individuals with stable cardiovascular disease should generally continue prescribed activity unless medically contraindicated. Moderate-intensity exercise such as walking is appropriate, especially after Iftar when hydration is restored. Peak heat exposure should be avoided.
Regular physical activity improves endothelial function, blood pressure, lipid regulation, and overall cardiovascular risk [1]. Exercise should be stopped immediately if chest pain, unusual breathlessness, or arrhythmias occur.
A balanced public health message
Ramadan is not a month of inactivity but of balance. Light-to-moderate, well-timed physical activity is safe for most individuals and remains essential for long-term prevention of diabetes, cardiovascular disease, and other non-communicable conditions [1]. As highlighted in Move to Heal, prevention-first strategies must adapt to cultural and religious contexts while maintaining scientific integrity [2]. Ramadan offers an opportunity not only for spiritual renewal but also for reinforcing lifelong, health-protective behaviours across the Middle East.
References
- Warburton DER, Bredin SSD. Health benefits of physical activity. Curr Opin Cardiol. 2017;32(5):541–556. doi:10.1097/HCO.0000000000000437. http://dx.doi.org/10.1097/HCO.0000000000000437
- Dassanayake J. Move to Heal. Melbourne: Move to Heal Publishing; 2025.
- Trabelsi K, et al. Ramadan fasting and physical performance. Br J Sports Med. 2013;47(8):491–494. doi:10.1136/bjsports-2012-091425. http://dx.doi.org/10.1136/bjsports-2012-091425
- Chaouachi A, et al. Ramadan fasting and sports performance. Int J Sports Physiol Perform. 2009;4(4):419–434. doi:10.1123/ijspp.4.4.419. http://dx.doi.org/10.1123/ijspp.4.4.419
- Wen CP, et al. Minimum physical activity and mortality. Lancet. 2011;378:1244–1253. doi:10.1016/S0140-6736(11)60749-6. http://dx.doi.org/10.1016/S0140-6736(11)60749-6
- Colberg SR, et al. Exercise and diabetes. Diabetes Care. 2016;39(11):2065–2079. doi:10.2337/dc16-1728. http://dx.doi.org/10.2337/dc16-1728
- Hassanein M, et al. Diabetes and Ramadan guidelines. Diabetes Res Clin Pract. 2017;126:303–316. doi:10.1016/j.diabres.2017.03.003. http://dx.doi.org/10.1016/j.diabres.2017.03.003
- Tuomilehto J, et al. Prevention of type 2 diabetes. N Engl J Med. 2001;344:1343–1350. doi:10.1056/NEJM200105033441801. http://dx.doi.org/10.1056/NEJM200105033441801
