Mental Health, Sleep, and Physical Activity Among Young Saudi Women During Ramadan: A Comparative Cohort Study

Purpose: This study investigated mental health outcomes of young adult women in relation to physical activity and sleep patterns before, during, and after Ramadan. Participants and Methods: A prospective repeated-measures cohort study was conducted in the Department of Physical Therapy at Jazan University, Saudi Arabia. Healthy women aged 18– 30 years were recruited through convenience sampling, with exclusions for chronic illness, pregnancy, lactation, psychological disorders, or recent hospitalization. Self-reported data were collected online at three time points: before Ramadan, during Ramadan, and after Ramadan. The study assessed physical activity using the International Physical Activity Questionnaire–Short Form, sleep quality using the Pittsburgh Sleep Quality Index, and emotional states using the Depression, Anxiety, and Stress Scale-21. Results: Thirty young adult females participated in the study. Physical activity showed a gradual increase, with significant improvements from pre-Ramadan to Ramadan (p =0.039) and from pre-Ramadan to post-Ramadan (p =0.009). Sleep was significantly disrupted during Ramadan, with shorter duration (p < 0.001) and poorer global sleep quality (p =0.002), followed by marked improvement post-Ramadan (all pairwise p ≤ .001). Stress levels peaked during Ramadan and declined significantly afterward (p =0.010), whereas depression and anxiety remained stable across all phases (p > 0.05). Regression analyses showed that poorer sleep quality significantly predicted higher depression, anxiety, and stress before and during Ramadan (all p ≤ .002), but not after Ramadan. Physical activity and BMI were not associated with mental health outcomes. Conclusion: The study found that while depression and anxiety stayed stable across the Ramadan periods, stress decreased after Ramadan. Sleep quality consistently related to mental health, whereas increased physical activity during Ramadan showed no link to emotional well-being. Overall, sleep and stress emerged as the key factors influencing well-being throughout the Ramadan cycle. Plain Language Summary: This study explored how Ramadan fasting influences physical activity, sleep, and mental health in young women. Thirty healthy women aged 18– 30 years in Saudi Arabia completed online surveys before, during, and after Ramadan to report their activity levels, sleep patterns, and emotional well-being. Physical activity increased during Ramadan and stayed higher afterward compared to before fasting. In contrast, sleep was noticeably disrupted during Ramadan, with shorter sleep duration and poorer sleep quality. After Ramadan, both sleep duration and overall sleep quality improved significantly. Mental health patterns showed mixed results. Depression and anxiety levels remained steady across all three phases. Stress levels rose during Ramadan but dropped significantly once Ramadan ended. Poor sleep quality was strongly linked to higher depression, anxiety, and stress before and during Ramadan, but this connection disappeared after Ramadan. Increased physical activity did not show a direct relationship with mental health outcomes. Overall, Ramadan fasting was associated with more physical activity, temporary sleep disturbances, and improvements in stress and sleep quality after fasting. Sleep quality emerged as an important factor for emotional well-being, suggesting that supporting healthy sleep habits may help young women maintain resilience during lifestyle changes such as Ramadan fasting.