Fasting during Ramadan – what are the fitness for work implications?

Ramadan – balancing religious and professional obligations

Ramadan is the ninth month in the Islamic lunar calendar year where healthy adult Muslims observe fasting during daylight hours. As one of the five pillars of the faith, fasting is considered obligatory to all Muslims (The Holy Quran, Chapter 2, verse 183).

Ramadan also serves as a time for charity, self-reflection and discipline, with the hope that the behavioural habits of physical and emotional self-restraint can be carried forward to other aspects of life, including work.

During Ramadan in Muslim-majority countries, work schedules are adjusted and work hours can be truncated.

In countries where Muslims are a minority, fasting individuals must accommodate their fasting and religious practices within their standard work practices, posing unique challenges. Muslim employees have previously highlighted how an organization’s predominantly non-Muslim core structure can lead to constraints, but at other times also enabled them to practice their religion. It is important for employers to recognize that for many Muslim employees, the practices prescribed by their faith cannot be decoupled from the workplace, and employers should engage proactively to align their workers’ professional and Muslim identities.

Legislation in most countries, such as the Equality Act 2010 in the UK, protects workers against discrimination based on religion. Most of the 2 billion Muslims across the world observe Ramadan, thus it is important for employers to understand what Ramadan is and what it means for Muslims.

What is the potential impact of fasting on health and fitness for work?

We aim to increase the understanding of Ramadan and highlight what the potential challenges and opportunities are for a Muslim worker fasting during the month of Ramadan. We have suggested advice and guidance for employers on supportive measures for colleagues who are fasting.

The impact of fasting during Ramadan on work, including the risk of dehydration and potential impact on the cardiovascular system in the context of the COVID-19 pandemic, has been previously reported.

Studies have demonstrated no major impact on body composition, biochemical and haematological parameters in fasting individuals who undertook aerobic activity at submaximal level (70% of VO₂ max). Any mild cardiovascular changes were likely to be due to dehydration. Other studies have not demonstrated any significant impact on respiratory function as a result of fasting.

Therefore, it is recommended that in specific job roles where fasting workers are exposed to physical hazards such as heat stress and heavy manual work, a suitable and sufficient risk assessment is undertaken to minimize the risk of dehydration and any resultant cardiovascular effects.

There is no convincing evidence to demonstrate that the process of fasting during Ramadan adversely impacts on neuro-performance or alertness. Some studies have shown that intermittent fasting does not increase daytime sleepiness or alter cognitive function, whereas other studies suggested an adverse effect on daytime alertness and mood.

Fasting/feeding schedules and altered mealtimes during Ramadan may cause misalignment of the circadian system; in non-constrained environments that do not control for lifestyle changes, sudden and significant delays in bedtime and wake time can occur. Multiple studies have also shown that the main change in sleep architecture during fasting is reduction in the proportion of Rapid Eye Movement sleep. However, when sleep hygiene is adequately controlled for, then overall, no significant impairment of daytime alertness or cognitive function is noted.

Limited research exists regarding the effects of fasting on safety critical tasks with a requirement for high levels of exercise. In high-effort roles, such as in elite sportspersons, research has shown that individuals are unlikely to suffer any substantial decrements in performance during Ramadan, provided they are able to maintain and monitor their total energy and macronutrient intake, maintain good sleep length and quality and are able to carefully manage their training load.

Therefore, multiple factors, including changes to the sleep–wake cycle and altered mealtimes followed during Ramadan, may need to be considered when risk assessing fasting Muslim workers undertaking shift work and safety critical work. It is recommended that those undertaking shift work and safety critical work while fasting ensure good quality sleep hygiene.

What can employers do to support employees who are fasting?

Fasting remains a personal choice of employees based on a variety of factors, including motivation, ability to tolerate the fast and prior experience of fasting. However, if terminating the fast prematurely when at work becomes common, workers should consider abstaining from subsequent fasts if the pattern of work remains unchanged, following advice from a trusted religious authority beforehand if necessary.

It is recommended that workers with pre-existing long-term conditions consider the potential impact of fasting on the control of their underlying health condition and any subsequent impact on their fitness for work. It would be advisable for such workers to speak to their line manager well in advance and look at appropriate task rotation or consider alternative duties, such as healthcare workers who are required to wear full personal protective equipment. However, it remains a managerial decision as to whether alternative duties can be accommodated.

In the temperate regions of the Northern hemisphere, fasting during summer lasts longer as compared to fasting during winter (the opposite being true in the South). Such long hours, sometimes 17 hours or more, combined with disturbances in normal sleep patterns, have the potential to leave workers physically and cognitively tired especially towards the end of the day if not appropriately adjusted for. Adjustments that could be considered include an earlier start and/or a shorter lunch break with an earlier finish time, so that workers can get home in time to rest and end the fast. Workers can also undertake trial fasts prior to Ramadan to help with acclimatization in their tasks.

Other adjustments that could be considered include avoiding holding events, such as staff meals, business meal meetings, away days and get-togethers during Ramadan. If this is unavoidable, employers should not be offended if the worker is reluctant to participate in such events. It is not necessary for non-Muslim colleagues to abstain from eating or drinking in the presence of workers who are fasting, though repeated offering of sustenance to the fasting worker is insensitive.

Exemptions from fasting

However, certain groups are exempt from fasting. These include but are not limited to: those who are advised that they will come to harm from fasting owing to an acute illness or from complications related to an existing chronic condition; travellers; women menstruating, experiencing postpartum bleeding, pregnant and breast-feeding particularly if there are concerns for the well-being of the child; and individuals who lack mental capacity. Therefore, some Muslim colleagues may not be fasting during Ramadan, as they may be exempt, and managers should not assume that all Muslim staff will be fasting. Workers and managers are advised to discuss Ramadan to ensure both parties are aware of any issues that may arise.

During winter in the Northern hemisphere, when the fast can be shorter (as little as eight hours), workers may break their fasts [iftar] at work after sunset and may suggest sharing their food with non-Muslim colleagues. This is a good way of enhancing understanding of Ramadan in the workplace and improving relationships within a working team.

Employers may wish to seek advice from their occupational health department in relation to suitable adjustments to help the fasting worker and occupational health physicians could refer to appropriate clinical guidance to help with their risk assessments.

The last 10 days and nights of Ramadan are important to Muslims who tend to increase their worship and charity during this period. At the end of Ramadan, Muslims celebrate the festival of Eid-al-Fitr. Workers may wish to take annual leave or reduce their hours, either during the month of Ramadan or specifically during the last 10 days or on Eid day itself. The actual day of Eid depends on the new moon and may vary between countries and within communities of a city. Workers may therefore not be very specific about which day they wish to take for annual leave, so flexibility, where practicable, is welcome. It is also helpful to consider requests for unpaid leave or allow the worker the opportunity to make up any time taken during Ramadan.