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The COVID-19 lockdown challenged the training options of athletes worldwide, including players from the most popular sport globally, football/soccer. PURPOSE: The authors explored the training practices of football players worldwide during the COVID-19 lockdown. METHODS: Football players (N = 2482, 30% professional, 22% semipro, and 48% amateur) completed an online survey (May-July 2020) on their training practices before versus during lockdown (March-June 2020). Questions were related to training frequency and session duration, as well as training knowledge and attitudes. RESULTS: Before lockdown, more professional (87%) than semipro (67%) and amateur (65%) players trained ≥5 sessions/wk, but this proportion decreased during the lockdown to 55%, 35%, and 42%, respectively. Players (80%-87%) trained ≥60 minutes before lockdown, but this proportion decreased to 45% in professionals, 43% in amateurs, and 36% in semipros during lockdown. At home, more than two-thirds of players had training space (73%) and equipment (66%) for cardiorespiratory training, while availability of equipment for technical and strength training was <50% during lockdown. Interactions between coach/trainer and player were more frequent (ie, daily) among professional (27%) than amateur (11%) and semipro (17%) players. Training load monitoring, albeit limited, was mostly performed by fitness coaches, more so with professionals (35%) than amateurs (13%) and semipros (17%). The players' training knowledge and attitudes/beliefs toward training were relatively modest (50%-59%). CONCLUSION: COVID-19 lockdown negatively affected training practices of football players worldwide, especially amateurs and semipros, for example, in training frequency, duration, intensity, technical, recovery, and other fitness training and coaching-related aspects. During lockdown-like situations, players should be monitored closely and provided appropriate support to facilitate their training.

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Ramadan intermittent fasting during the COVID-19 lockdown (RIFL) may present unique demands. We investigated training practices (i.e., training load and training times) of athletes, using pre-defined survey criteria/questions, during the 'first' COVID-19 lockdown, comparing RIFL to lockdown-alone (LD) in Muslim athletes. Specifically, a within-subject, survey-based study saw athletes (n = 5,529; from 110 countries/territories) training practices (comparing RIFL to LD) explored by comparative variables of: sex; age; continent; athlete classification (e.g., world-class); sport classification (e.g., endurance); athlete status (e.g., professional); and level of training knowledge and beliefs/attitudes (ranked as: good/moderate/poor). During RIFL (compared to LD), athlete perceptions (ranges presented given variety of comparative variables) of their training load decreased (46-62%), were maintained (31-48%) or increased (2-13%). Decreases (≥ 5%, p < 0.05) affected more athletes aged 30-39 years than those 18-29 years (60 vs 55%); more national than international athletes (59 vs 51%); more team sports than precision sports (59 vs 46%); more North American than European athletes (62 vs 53%); more semi-professional than professional athletes (60 vs 54%); more athletes who rated their beliefs/attitudes 'good' compared to 'poor' and 'moderate' (61 vs 54 and 53%, respectively); and more athletes with 'moderate' than 'poor' knowledge (58 vs 53%). During RIFL, athletes had different strategies for training times, with 13-29% training twice a day (i.e., afternoon and night), 12-26% at night only, and 18-36% in the afternoon only, with ranges depending on the comparative variables. Training loads and activities were altered negatively during RIFL compared to LD. It would be prudent for decision-makers responsible for RIFL athletes to develop programs to support athletes during such challenges.

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OBJECTIVES: Muslims observe fasting during the month of Ramadan by abstaining from eating and drinking from dawn to sunset. Available literature shows that although several studies have been conducted on athletes to determine the effects of Ramadan fasting in terms of physical fitness and performance, little data are available regarding the knowledge, beliefs and attitudes of athletes (particularly footballers) towards Ramadan fasting during high-level competitions. This study explored the knowledge, beliefs and attitudes towards Ramadan fasting among football players participating in the London 2012 Olympics football tournament. DESIGN: Cross-sectional study. SETTINGS: Team training facility. PARTICIPANTS: 54 Muslim footballers participating in the London Olympics, 2012 OUTCOME MEASURES: Each participant was asked to complete a pre-validated structured questionnaire to assess knowledge, beliefs and attitudes regarding Ramadan fasting and their intention to fast during London 2012. RESULTS: Of the 54 participating athletes, 21(39%) reported that they intended to fast during Ramadan, but not on a match day. This attitude differed across three teams interviewed -83%, 15% and 0%-showing cross-cultural variation. Overall, there was a lack of knowledge among footballers regarding the effects of Ramadan fasting on sleep and performance; around 30% of athletes gave incorrect responses. This knowledge was independent of their decision to fast on non-competition days (p>0.05). CONCLUSIONS: This is the first study to describe the knowledge, beliefs and attitudes towards Ramadan fasting among athletes from Muslim-majority countries participating in a high-level competition. Appropriate knowledge can ensure optimum performance for athletes during Ramadan fasting. Coaches, family members and friends also in possession of this knowledge can provide moral support to the players.

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Muslim athletes should fast from sunrise to sunset each day throughout the 30 days of Ramadan. Most athletes will continue to train throughout Ramadan, and they may also be required to compete at this time, but they will also engage in the religious, cultural, and social activities that Ramadan represents. The available evidence indicates that high-level athletes can maintain performance during Ramadan if physical training, food and fluid intake, and sleep are appropriate and well controlled. Individualized monitoring of athletes may help to prevent fatigue and overtraining and to reduce the risk of consequent illness and injury. The timing and intensity of training may require adjustment to optimize the training response, and training close to or after sunset may have advantages, but this will vary between individual and team sports and between environments that are predominantly Muslim and those that are predominantly non-Muslim. Training late in the day allows nutrition interventions after training to promote adaptations to the training stimulus, to promote recovery, and might help to reduce muscle damage. Sleep deficits have a number of adverse effects on well-being and performance, and athletes should ensure adequate sleep throughout Ramadan. In non-Muslim majority environments, especially in team sports, coaches and athletes should be sensitive to the needs of their team-mates who may be fasting. Event organizers should take account of the needs of Muslim athletes when scheduling the dates and timings of sports competitions.

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Islam is a monotheistic Abrahamic faith characterised by devotional orthopraxy. The actions expected of followers of Islam are closely prescribed in the Qur'an. Muslims understand Ramadan as a mandatory requirement, excused only in the event of illness, infirmity or extremes of age. Due to the increasing popularity of football among Muslims, more and more Muslim football players of all levels make the decision to follow the Ramadan fast while they need to practise and compete. Sports medicine clinicians and scientists have the responsibility to provide them with the knowledge and evidence on how exactly Ramadan fasting impacts on their performance and how to optimise their eating, drinking and sleeping in order to minimise negative effects of their religious practice, should any have been demonstrated. The first International Federation of Football Associations (FIFA) Medical Assessment and Research Centre (F-MARC) study concluded that biochemical, nutritional, subjective well-being and performance variables were not adversely affected in young male national level players who followed Ramadan fasting in a controlled environment. Match performance was however not measured and the study did not include elite level players, leading to the Ramadan consensus meeting in order to answer the remaining questions. The conclusions and recommendations published in this supplement suggest that the best coping strategies will remain individual - as is the choice to fast.

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OBJECTIVES: The goal of this study was to define electrocardiographic (ECG) and echocardiographic characteristics of adolescent African athletes. BACKGROUND: Recent observations in African athletes reported large prevalence of left ventricular (LV) hypertrophy and ECG abnormalities. No data, so far, exist for adolescent Africans, which comprise a growing proportion of competitive/professional athletes. METHODS: The study included 154 soccer players participating at the 8th African Under-17 Championship of 2009, representing Algeria, Burkina Faso, Cameroon, Gambia, Guinea, Malawi, Nigeria, and Zimbabwe. For comparison, 62 Italian players with similar ages, sport achievements, and training schedules were included. RESULTS: African athletes showed higher R5/S1-wave voltages than Caucasian athletes (48.6 ± 12.1 mm vs. 34.1 ± 8.9 mm; p < 0.01), larger prevalence of ECG LV hypertrophy (89% vs. 42%; p < 0.001), ST-segment elevation (91% vs. 56%; p < 0.001), and deeply inverted, or diffusely flat/biphasic, T waves (14% vs. 3% [p < 0.05] and 25% vs. 8% [p < 0.008], respectively). LV wall thicknesses were increased in Africans by 5% compared with Caucasians, and exceeded normal limits (≥13 mm) in 4 Africans but in no Caucasians. No athlete showed evidence of cardiomyopathies (i.e., hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy). On individual analysis, Algerians showed lower R/S-wave voltages compared with other African athletes. Increased wall thickness (≥13 mm) was observed only in sub-Saharian athletes (from Burkina Faso, Cameroon, and Niger). CONCLUSIONS: African athletes displayed large proportion of ECG abnormalities, including a striking increase in R/S-wave voltage, ST-segment elevation, and deeply inverted or diffusely flat T waves by adolescence. LV remodeling in African athletes was characterized by a disproportionate wall thickening than in Caucasians but similar cavity size. Finally, distinctive peculiarities existed in African athletes according to the country (and ethnic) origin.

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Ramadan is a month of penance during which Muslims take food or drink only after sunset and before the sun rises. This fast can present a considerable challenge to the Muslim athlete. Sports performance in those who observe Ramadan and those who do not has not been formally compared. Four Tunisian junior football squads participated in the study, and it was the individual's choice whether they observed the Ramadan fast. In this study, 64 players fasted while 36 players did not. Players completed daily questionnaires on perception of training difficulty before and during Ramadan. Anthropometric data were recorded 3 weeks before Ramadan, during the second and fourth weeks of Ramadan, and into the third week after Ramadan. Performance tests (sprint, leg power, agility, aerobic endurance, football-specific skills) were also measured on these test days. Nutritional intake was recorded by recall three times during each phase of the study. Haematological and biochemical analyses were performed on a 7-ml blood sample taken from each participant on each of the test days. Sweat samples were collected during a training session in the third week of Ramadan, when heart rate was also measured. The data analyses are presented and discussed elsewhere in this issue.

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The timing of food and liquid intake depends on the times of sunset and sunrise during the month of Ramadan. The current body of knowledge presents contradicting results as to the effect of Ramadan fasting on body mass, body composition and metabolic changes. The main objective of the present investigation was to gain additional information and scientific data in conformity with the philosophical background of Islam to allow optimisation of the daily training and dietary regimen in relation to the mental and physical performance of football players. The four teams, along with their coaches and trainers, attended a residential training camp at training centre 3 weeks before the start of Ramadan and throughout the study. Energy intake was relatively stable in the fasting group, but there was a small, albeit significant, decrease of approximately 0.7 kg in body mass. Water intake increased on average by 1.3 l/day in line with the greater energy intake in the non-fasting group in Ramadan. Daily sodium intake fell during Ramadan in the fasting players but increased slightly in the non-fasting group. Fasting players trained on average 11 h after their last food and drink, and reported that they felt slightly less ready to train during the Ramadan fast. None of the assessed performance variables was negatively affected by fasting while nearly all variables showed significant improvement at the third test session, indicating a training effect. Heart rate measurements in one training session during the third week of Ramadan appeared to suggest that the training load during training was marginally greater for the fasting than for the non-fasting players. However, the overall exercise load measures indicated that there was no biologically significant difference between the fasting and non-fasting groups. In the present study, biochemical, nutritional, subjective well-being and performance variables were not adversely affected in young male football players who followed Ramadan fasting in a controlled training camp environment. Physical performance generally improved, but match performance was not measured. We recommend that players should ensure adequate sleep and good nutrition during Ramadan to preserve football performance and general health.

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Ramadan alters the normal patterns of food intake and sleep. The aim of this study was to describe the impact of Ramadan on physical performance in youth Muslim athletes. The members of four Tunisian teams (age 18 years, N = 85) resided at the Tunisian Football Federation training ground. Each player chose either to fast or not fast during the 4-week period of Ramadan. Two teams were randomly chosen for morning testing; the remaining teams were tested in the afternoon. Testing took place 3 weeks before and in the second and fourth weeks of Ramadan. A subgroup of 45 players was tested again 3 weeks after Ramadan. Each player was assessed for speed, power, agility, endurance, and for passing and dribbling skills. No variables were negatively affected by fasting. Almost all variables had improved significantly by the third test session (training effect). A limited number of variables were also significant for time of day or in an interaction with week of testing. Changes in performance were most likely due to the effects of training and familiarity with the test methods. Based on these data, Ramadan had little effect on objective tests of physical performance in this sample of youth players observing Ramadan.

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Healthy young male football players who were either fasting (n = 59) or not fasting (n = 36) during the month of Ramadan were studied. Body mass, body composition, and dietary intake were assessed at each time point. Energy intake was relatively stable in the fasting participants, but there was a small decrease of approximately 0.7 kg in body mass during Ramadan. Mean daily energy intake increased from 14.8 MJ (s = 2.9) to 18.1 MJ (s = 3.2) during Ramadan in non-fasting participants, with concomitant increases in body mass and body fat content of about 1.4 kg and 1% respectively over the month. The fractional intake of protein increased and the fractional contribution of carbohydrate decreased for both groups in Ramadan. Estimated mean daily water intake was high (about 3.8 litres) throughout the study period. Water intake increased on average by 1.3 litres . day(-1) in line with the greater energy intake in the non-fasting group in Ramadan. Daily sodium intake fell during Ramadan in the fasting participants from 5.4 g (s = 1.1) before Ramadan to 4.3 g (s = 1.0) during Ramadan, but increased slightly by about 0.7 g . day(-1) in the non-fasting group. Dietary iron decreased in the fasting group and increased in the non-fasting group, reflecting the difference in energy intake in both groups during Ramadan. These data suggest that Ramadan fasting had some effects on diet composition, but the effects were generally small even though the pattern of eating was very different. After Ramadan, the dietary variables reverted to the pre-Ramadan values.

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Competitive Muslim athletes often have to train and compete during the holy month of Ramadan when they abstain from food and drink from sunrise to sunset. In this study, we investigated the effect of Ramadan fasting on some biochemical and haematological parameters in 78 Tunisian junior male soccer players aged 16-19 years who continued their usual schedule of daily training and weekly competition. The study population was divided into four groups based on the time of day of sampling (am or pm) and on whether they were fasting (48 players: 28 am and 20 pm) or non-fasting (30 players: 14 am and 16 pm). Resting venous blood samples were collected approximately 3 weeks before Ramadan, after 2 and 4 weeks of Ramadan, and 3 weeks after the end of Ramadan. Some small, but statistically significant, modifications were observed in circulating concentrations of haemoglobin, ferritin, transferrin, creatinine and cortisol, but the mean values for all variables were always within the reference ranges. The minor changes observed during Ramadan may be explained by changes in patterns of food consumption, activity patterns and by hypohydration. The results suggest that the combination of the changes in eating time and frequency during Ramadan fasting, together with the continuation of normal training load, has no marked effect on the blood profiles of these adolescent athletes.

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Eighty-seven players (54 fasting players, 33 non-fasting players) who carried out their club's scheduled training and competitive matches completed the daily questionnaire before and during Ramadan. Fasting players trained on average 11 h after their last food and drink. While fasting players reported that they were slightly less ready to train during the Ramadan fast than in the period before Ramadan, there was no increase in their perceived effort during training or in training difficulty compared with their ratings before Ramadan, or with those of the non-fasting group during Ramadan. The fasting players were marginally more thirsty, hungry and tired, and slightly less able to concentrate before training during Ramadan than in the pre-Ramadan period. Before Ramadan, both groups averaged more than 9 h sleep each night. The non-fasting players recorded that they had about 105 min less sleep per night during the first week of Ramadan, before reverting back to their pre-Ramadan amount of sleep. The fasting group consistently reported having about 1 h less sleep per night throughout Ramadan, but neither group appeared to find sleep quality to have altered. In the first 2 weeks after Ramadan, the modest changes reported by the fasting players reverted back to their pre-Ramadan values.

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OBJECTIVE: Ramadan is a period of daylight abstention from liquid or solid nutrients. As sports continue to be scheduled, an understanding of the effects of Ramadan on Muslim athletes is warranted. DESIGN: Two Algerian professional soccer teams (55 men) were studied. Field tests of physical and soccer performance were collected before, at the end and 2 weeks after Ramadan in 2004. Players were queried on sleeping habits and personal perception of training and match performance. SETTING: Field setting at club training ground. MAIN OUTCOME MEASURES: Performance on fitness and skill tests. RESULTS: Performance declined significantly (p<0.05) for speed, agility, dribbling speed and endurance, and most stayed low after the conclusion of Ramadan. Nearly 70% of the players thought that their training and performance were adversely affected during the fast. CONCLUSIONS: The phase shift of food intake and disruption of sleep patterns affect actual and perceived physical performance. Islamic athletes need to explore strategies that will maximise performance during Ramadan.

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