The Crescent Moon rising at sunset, marking the start of the month of Ramadan

The month of Ramadan begins tomorrow, July 9, and lasts until August 7.  As many of this blog’s readers will know, observant Muslims will fast from dawn until sunset:  no food, no liquids…..no sports drinks or power bars.  The questions of ‘carb loading’ or ‘gluten free’, (‘should i drink some chocolate milk after my workout?‘) can all be put on the table until the evening.  The diet is one of pure abstinence, morning until night.

Muslim athletes are not unique in observing a fast: Catholic Christians will consume much less than usual if observing the prescribed tenets of Lent on Ash Wednesday and Good Friday, and Jewish athletes will go a full 24 hours consuming nothing on Yom Kippur: friends have told me they will be loath to brush their teeth or even shower, lest anything whatsoever pass into their mouths on that, the holiest day in the Jewish calendar.

And, of course, there are athletes who experiment with fasts, juices and cleanses that have nothing to do with religious observance (I’ve tried the “Master Cleanse” myself once).

What may be unique, however, to Islam  is the duration of the practice:  a full 30 days, where an observant Muslim will forego all food and drink from dawn (Sahur) to dusk (Iftar).

I admire the discipline the act of fasting requires.  As a sports medicine clinician, I have often wondered how athletes observing such fasts might be impacted.  Of course, I am  not alone in this, as the subject of the Ramadan fast and its effect on athletes was, for instance, a subject of considerable interest in the 2012 London Olympics, which took place during Ramadan.  The effects of Ramadan on sports performance have even been discussed in this blog in a 2011 post.  And now  the most recent issue of the CJSM, which rolls out today, highlights a study looking at this very practice of fasting and its impact on footballers:  “Does Ramadan Affect the Risk of Injury in Professional Football.” Read more of this post

Le Tour et La Corse


Les montagnes de L’Île de Beauté: La Corse

…et La Centieme:  The 100th edition of Le Tour, the Tour de France, begins today, with the Grand Start in Corsica for the first time in the race’s history.


Who needs the Tricolor? The Flag of Corsica: once an independent republic, now part of France, still with its own language and distinct customs.

What a way to celebrate the centennial of the Tour!

Corsica, or La Corse, is a French island in the Mediterranean, and is comprised of two of that nation’s departments: Haute-Corse and Corse-du-Sud.  It is the only region of France which has not previously hosted a stage of Le Tour.

The island has a long history, perhaps best told in one of the finer travel books I have ever read, The Granite Island, by Dorothy Carrington.  The island has passed through many hands over its history:  the Carthaginians, Romans, Genoans and others have all claimed the island for their own.  The island even enjoyed an independent existence for some years:  the Corsican Republic was formed in 1755 under the leadership of Pasquale Paoli.  Corsica’s most famous son, Napoleon, was born there in 1769.  And it was during the time of the “Napoleonic wars” that he set loose on Europe that the island became part of France.  It has remained a part of that country ever since.

I have a special fondness for this land, known by the French as  L’Île de Beauté:  the Isle of Beauty.  I have visited Corsica twice, and was smitten with the island from the first my eyes lay sight on the port of Calvi. (Some readers may recognize Calvi as the site of the 2011 IOC Advanced Team Physician course.)

Corsica is quite simply arresting:  from its mountains and trails, to its beaches, to the very smell of the island (its vegetation, known as the ‘maquis’, has a distinctively lovely fragrance), it can put anyone under its spell.

That said, I suspect the cyclists in Le Tour this year may be smitten in a different way than I was on my visits.  Like any beauty, Corsica has its caprices.  The mountains I found lovely will almost certainly pose extraordinary challenges to the competitors.


Cirque de la solitude: in the mountains of central Corsica


The capital of Corsica: Corte, through which the 2nd stage of the Tour will pass











The second stage of the Tour this year will traverse the mountains that form a spine through the center of the Island, heading from Bastia on the east coast, through the mountainous capital of Corte, and ending on the west coast in Ajaccio, the birthplace of Napoleon.  The Tour’s website describes the ride as a rollercoaster; “Expect some real damage,” the site boasts menacingly!    Let’s hope no one meets his ‘Waterloo’!

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The Larks and the Owls – chronotypes and desynchronosis. Time for an individual approach with MEQ-SA analysis?

The practical management article in this month’s edition of the Clinical Journal of Sport Medicine by Charles H Samuels highlights a difficult problem facing athletes and their support staff that is commonly encountered during air travel, that of the issue of jet lag. Samuels makes the point about the difference between travel fatigue and jet lag (desynchronosis), defining the former as a  constellation of physical, psychological and environmental factors that impact over time on an athlete’s capacity to recover and perform, and the latter being defined as a number of symptoms occurring following travel between time zones.

The key to the understanding of these concepts lies within the study of Chronobiology – the field of biological science that examines cyclical phenomena in living organisms and their adaptation to solar and lunar rhythms. Human beings are normally diurnal creatures, usually being active in the day and sleeping at night. However, as many night and shift-pattern workers will attest, many of us are required to adapt to different patterns of activity and sleep as part of our everyday lives. Some of us are able to cope with these pattern shifts better than others, whereas extremes of sleep-activity outside the normal range may cause a person difficulty in participating in normal work, school and social activities.

Flight travel over different time zones presents a challenge for the individual as the body seeks adjusts its circadian rhythms to these different  zones. A number of different modalities may be used in order to prevent athletes developing jet-lag, including the use of melatonin, preflight adjustment to travel, timed light exposure and avoidance, and changes in training schedules. However, it is interesting to observe that some individuals seem to suffer from jet lag more than others, and that there is variability in the efficacy of preventative and treatment strategies for desynchronosis amongst athletes.

Why is it that some of us seem to cope better with time zone changes and shift pattern working? Perhaps the answer lies in an individual’s chronotype.

Sleep researchers refer to ‘Larks’ as individuals who naturally wake up in the morning, contrasting with the ‘Owls’ who wake up and go to sleep late. These groups are also described as being comprised by individuals with ‘morning-ness’ and ‘evening-ness’ tendencies. Most people lie somewhere in between. However, there are some interesting differences between the groups with some researchers going as far as to suggest that disease processes may be directly influenced by morning-ness and evening-ness. This news feature in Nature, published in 2009, discusses some of these concepts in greater detail for those readers who may be interested to know more.

Horne & Ostberg in 1976 presented a self-assessment morningness-eveningness questionnaire and this has been modified by others to produce an MEQ-SA. Those of you who may wish to objectively assess your lark-ish and owl-ish tendencies can find the modified MEQ-SA questionnaire and scoring table here. 

It is unclear which factors contribute to an individual’s chronotype, as there seems to be no clear correlation to gender, ethnicity, or socio-environmental factors. However, perhaps chronotype variation may go some way to explaining why there is such variability in the effect of different preventative strategies for jet-lag between individuals. If so, then the assessment of an individual’s chronotype may form an important part of an overall primary preventative strategy for travelling athletes and support staff, which may be best conducted as part of an individual approach rather than a team approach.

Unfortunately, there is currently a paucity of literature on chronotype analysis in elite athletes in relation to jet-lag prevention representing an opportunity for further research in this area.

Are any readers using chronotype analysis as part of a jet-lag prevention strategy? CJSM would like to know.

References –

Samuels, Charles H. 2012. Jet Lag and Travel Fatigue: A Comprehensive Management Plan for Sport Medicine Physicians and High-Performance Support Teams. Clin.J.Sport Med. 22(3): 268-273

Phillips, Melissa Lee. 2009. Of owls, larks and alarm clocks. Nature 458 

Horne JA & Ostberg O.1976. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int. J. Chronobiol. 4(2):97-110 


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