Doctor-Recommended Tests for Runners

Molly Hurford
by Molly Hurford
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Doctor-Recommended Tests for Runners

Going for an annual physical might seem unnecessary for those of us who exercise religiously and love to compete in races. Even if you’re feeling super awesome, it’s a good idea to regularly check in. First, you’ll establish your baseline (since everyone’s ’normal’ is different). Knowing your baseline can shed light on overtraining issues and help you get ahead of deficiencies that lead to lack of energy.


Michael Ross, MD, a sports medicine physician at the Rothman Institute and the medical director at The Performance Lab, is a fan of breaking testing down into three categories: daily, quarterly, annually. On a daily basis, he recommends tracking heart rate variability (HRV) for a general baseline for how recovered you are and monitoring urine color as an indicator of hydration status.

Quarterly, he likes to see runners and other endurance athletes do some kind of fitness testing, whether it’s your best 5K time, or clocking your sprint up your local hill for time. Any effort you can measure against past efforts is good: You can see if you’re improving, holding steady or regressing. With that info, plus your daily intel in hand, a doctor can be more helpful at pinpointing problems. For example, if your times are slowing down, Ross says it can indicate fatigue or training issues, but it could also be an indicator of a deeper problem, like anemia, that can be addressed.

Yearly, Ross suggests getting a complete blood count that looks at your total red and white cells: It’s one of the most broad blood tests, but gives a good overall picture of your health, and whether anything is out of balance. “A CBC has two real components that are important,” he says. “Hematocrit — percent of red blood cells — and a white blood cell count. If you’re anemic, your hematocrit goes down.”



Matt Marchal, MD, a former team doctor for pro road cycling team Team Type 1 and avid cyclist, is no stranger to endurance athletes coming in with various ailments. He agrees with Ross that a CBC is a great starting point. “As somebody goes from mild, to moderate, to significant activity, the stresses on the body become more intense and more frequent, and if there is an underlying problem in the body, the ability to continue to improve athletically can become compromised,” he says. A simple look at hematocrit and hemoglobin can go a long way toward telling if an athlete is doing well, or if there’s an issue somewhere.

Ross sees anemia fairly frequently among athletes, particularly women. Because of that, he likes to check iron levels as well. He says anemia is often tied to nutritional imbalances, and notes, “When I see people who feel sluggish but have normal exercise testing, I check ferritin levels. Anemia can do weird things.” (You might think that this means you should just add an iron supplement to your diet, but Ross cautions against that: too much can also be detrimental.)

“Vegan and vegetarians who are not careful can have low iron stores because they don’t take in that much iron, people with eating disorders simply don’t bring in much of anything, and women during their menstrual cycles are losing iron, sometimes faster than they can bring it in,” Marchal adds. But it’s not just the ’typical’ cases where doctors see athletes with anemia. “Also, with overtraining or very heavy training, you can start leading to an anemia simply through the volume of work causing breakdown of your red blood cells,” he says.


“We think we’re spending all this time outside, but often we’re out when it’s not bright, and we’re wearing sunscreen,” Ross says, so he also likes to check vitamin D levels.

A complete metabolic profile is a bit more in-depth, but Marchal says it can be useful for athletes. “It looks at your electrolyte levels — sodium, potassium chloride and calcium — liver function, kidney function and blood sugar.” He uses this test on normal patients as part of a test process for diabetes, but in athletes, he’s looking for abnormal kidney function, which is sometimes related to excessive NSAID (ibuprofen) use. He adds, “I’ve even found abnormal liver function tests because of supplements that people have been taking.”


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About the Author

Molly Hurford
Molly Hurford

Molly is an outdoor adventurer and professional nomad obsessed with all things running, nutrition, cycling and movement-related. When not outside, she’s writing and podcasting about being outside, training and health. You can follow along with her adventures on Instagram at @mollyjhurford.


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