The behavioural modifications that accompany Ramadan intermittent fasting (RIF) are usually associated with some alterations in the metabolic, physiological, and psychological responses of athletes that may affect sport performance. Muslim athletes who are required to train and/or compete during the month-long, diurnal fast must adopt coping strategies that allow them to maintain physical fitness and motivation if they are to perform at the highest level. This updated review aims to present the current state of knowledge of the effects of RIF on training and performance, focusing on key-factors that contribute to the effects of Ramadan on exercise performance: energy restriction, sleep deprivation, circadian rhythm perturbation, dehydration, and alterations in the training load. The available literature contain few studies that have examined the effects of RIF on physical performance in athletes and, to date, the results are inconclusive, so the effects of RIF on competition outcomes are not at present wholly understood. The diverse findings probably indicate individual differences in the adaptability and self-generated coping strategies of athletes during fasting and training. However, the results of the small number of well-controlled studies that have examined the effects of Ramadan on athletic performance suggest that few aspects of physical fitness are negatively affected, and where decrements are observed these are usually modest. Subjective feelings of fatigue and other mood indicators are often cited as implying additional stress on the athlete throughout Ramadan, but most studies show that these factors may not result in decreases in performance and that perceived exercise intensity is unlikely to increase to any significant degree.Current evidence from good, well-controlled research supports the conclusion that athletes who maintain their total energy and macronutrient intake, training load, body composition, and sleep length and quality are unlikely to suffer any substantial decrements in performance during Ramadan. Further research is required to determine the effect of RIF on the most challenging events or exercise protocols and on elite athletes competing in extreme environments.