Boosting Stamina for Runners

Nicholas Anastasio, M.D., a board-certified physician specializing in physical medicine and rehabilitation at Orthopedics and Joint Replacement at Mercy, recently responded to questions to a Runner’s World magazine query about how competitive runners and marathoners can increase their stamina and avoid exhaustion longer.

You hit the sauna post-run. Why does heat exposure in the sauna help increase time to exhaustion? What is happening physiologically?

The idea here is that acclimatization to heat exposure, and heat generation during exercise, can improve VO2 max, a main marker of aerobic exercise efficiency and capacity. As far as I know, most studies have been small and any meta-analyses that have looked at multiple studies have not found a clear effect (positive or negative) in terms of post-run sauna and increase in time to exhaustion.

According to 2023 research published in Scientific Reports, practicing just five minutes of hopping each day can help improve running economy—or the amount of energy your body uses at a given pace—in amateur athletes. How does improved running economy translate to increased time to exhaustion?

Running economy can be thought of as the amount of energy required to perform a running movement. There are stereotypical running techniques that reduce wasted motion and improve running efficiency, thereby increasing time to exhaustion. For example, if an amateur runner lands on their heel with their leg extended out in front of their center of mass, this effectively creates a “braking” (like the brakes of your car) effect that slows you down and is inefficient when running. Amateur runners have been shown to significantly increase their time to exhaustion by running more economically. This includes where their foot strikes the ground, where their foot lands in relation to their center of mass, the length of their stride, which muscles are being used for propulsion, and vertical or horizontal excursion. Interestingly, in some professional/elite runners, trying to improve their running economy can sometimes be a hindrance. This is likely due to the fact that these athletes are outliers in general, being blessed with ideal genetics and body shape and metabolism for running. For the average runner, however, a large effect can be obtained by optimizing running economy.

After 10 weeks of incorporating 45-minute strength training sessions every 2 to 4 days, runners demonstrated improved running economy durability and increased high-intensity time to exhaustion at the end of a 90-minute run, says a 2025 study from the American College of Sports Medicine. What does consistent strength training do to the body that increases time to exhaustion?

Consistent strength training has been shown to not only increase strength but also reduce time to muscle fatigue and improve oxidative and non-oxidative metabolism in muscle cells. The act of running also requires your muscles to support your body while you essentially hop from one foot to the next. Stronger muscles can tolerate more cycles and higher intensities of the running gait cycle. Additionally, upper body motion, including arm drive, can facilitate momentum formation in the forward direction and reduce the excess load placed on the muscles of the legs during running.

As a runner himself, Dr. Anastasio has a particular interest in running-related conditions and injuries. He brings extensive training from The Runner’s Clinic within the department of physical medicine and rehabilitation at the University of Virginia. Dr. Anastasio aims to help runners overcome acute and chronic conditions, maximize their health, and reach their running goals through orthotic and shoe evaluations, tailored physical therapy prescriptions, and comprehensive running gait analysis. Dr. Anastasio has been recognized as a “Top Doctor” by Baltimore magazine. He provides non-surgical diagnosis and treatment for patients with a wide range of orthopedic and musculoskeletal conditions affecting the muscles, bones and joints, as well as nerve-related conditions.