By: dr.Vardian Mahardika, M.Biomed, SpPD, AIFO-K
Endurance and hybrid sports are becoming increasingly popular. Marathon, half marathon, trail run, and HYROX are no longer limited to professional athletes. More and more people are training seriously, setting race goals, and increasing their training load aggressively. This is a positive trend. However, one important aspect is often overlooked: not everyone who is enthusiastic about training is medically ready for it.
In daily practice, I often meet individuals who appear fit on the outside, but when evaluated more carefully, they turn out to have elevated blood pressure, less-than-ideal body composition, metabolic issues, or symptoms during exercise that had previously been ignored. For that reason, preparing for a marathon, HYROX, or trail run should not focus only on the training plan, but also on medical screening.
Why Is Medical Screening Important?
The goal of medical screening is not to scare people or discourage exercise. On the contrary, it is meant to help you train more safely, more precisely, and in a way that matches your body’s condition.
Marathon and trail running require aerobic capacity, muscular endurance, and proper energy and hydration management. HYROX adds another layer of challenge by combining running with high-intensity functional exercise. In some individuals, a rapid increase in training volume and intensity may reveal problems that were previously unnoticed, from chest discomfort, palpitations, and disproportionate shortness of breath to unexplained drops in performance.
Who Should Consider Screening First?
Medical screening is especially worth considering if you:
- are over 35 years old and just starting higher-intensity training
- have a history of hypertension, diabetes, high cholesterol, obesity, or smoking
- have a family history of sudden cardiac death or premature heart disease
- have ever experienced chest pain, dizziness, fainting, palpitations, or shortness of breath during exercise
- are preparing for an ambitious event target
- feel that you are already training seriously, but your body breaks down easily or recovery is unusually slow
For younger individuals without symptoms and without major risk factors, evaluation may be relatively simple. But in selected groups—especially masters athletes and recreational athletes in midlife—a more structured medical assessment can be very helpful.
What Can Be Evaluated?
Medical screening usually begins with a thorough history and physical examination. This already provides valuable information: sleep quality, prior injuries, exercise-related symptoms, medical conditions, blood pressure, and signs of overtraining or poor recovery.
Basic tests such as an ECG (electrocardiogram) can help detect heart rhythm abnormalities that may otherwise go unnoticed. Laboratory tests are also useful to assess metabolic health and organ function, including kidney and liver function, both of which play important roles in performance and recovery.
Further tests can then be tailored to the individual.
- BIA (Bioimpedance Analysis)
BIA evaluates body composition, not just body weight. This is important because performance in running or HYROX is influenced not only by body weight, but also by muscle mass, body fat percentage, and fat distribution. In marathon and trail runners, poor body composition may reduce movement efficiency. In HYROX participants, low muscle mass or high visceral fat may impair performance and recovery.
- Treadmill Test
A treadmill test helps assess the heart’s response to exercise, especially in individuals with cardiovascular risk factors or symptoms during training. It is not required for everyone, but it can be very useful in selected patients.
- VO₂max / CPET
This provides insight into cardiorespiratory capacity and exercise tolerance. In training, VO₂max testing can help define training intensity more precisely, identify performance limitations, and guide a more personalized program. It is particularly useful for those who want to train seriously while still progressing safely.
- CT Cardiac
This is not a routine test for every runner or HYROX participant. However, in selected individuals—such as those who are older, have multiple cardiovascular risk factors, or are suspected of having coronary artery disease—cardiac CT may be considered for further risk stratification. In other words, it is a selective tool, not a mass screening test.
Do Not Just Train Hard—Prepare Smart
Many people focus on the training plan but forget to assess the “engine” first. The goal of sport should not be simply to finish, but to finish safely, strongly, and recover well.
Medical screening also helps answer practical questions such as:
- Am I safe enough to increase mileage?
- Am I truly ready for my first HYROX?
- Why is my pace not improving despite hard training?
- Is my fatigue normal, or is there an underlying medical issue?
Nutrition matters too. Balanced intake of carbohydrates, protein, healthy fats, vitamins, and minerals has a direct impact on performance, endurance, and recovery. Poor nutrition can make training feel harder, increase injury risk, and slow down adaptation.
Conclusion
Preparing for a marathon, trail run, or HYROX should not be viewed only as a physical training challenge, but also as a matter of medical and nutritional readiness. This approach is not meant to reduce motivation, but to make training smarter, safer, and more effective.
If you would like to prepare for your event with a more comprehensive approach—including risk evaluation, body composition analysis, cardiorespiratory assessment, heart and laboratory testing, and nutritional optimization—you may consult with me through the integrated services at RS Abdi Waluyo.
