How To Optimize Your Post Race Recovery With Mario Fraioli

By Stevie Lyn Smith, MS, RDN, CSSD, CDN, September 20, 2021


You spend countless hours over many months working on your fitness for your "A" race. Then, after all of the hard work is done, you cross the finish line feeling accomplished. For many, that's where the training journey comes to an end, but it shouldn't be. There's one more critical component to consider – recovery.

We sat down with an elite runner and coach, Mario Fraioli a week after this years wet, windy, and wild Boston Marathon. We spoke about the race and how he utilizes InsideTracker for all aspects of his training, including his recovery.

The Coach

With 21 years of racing and training under his belt, Mario knows what it takes to train, race and recover. When he isn’t busy coaching and training, he enjoys giving back to the endurance community through "The Morning Shakeout", a weekly newsletter and podcast discussing all things running.

So what did racing the marathon actually do to his biomarkers?

At InsideTracker, we encourage both athletes and non-athletes alike to test multiple times a year. This creates an excellent way to look at the entire picture of your health. When it comes to athletes, strategically placing tests before and after key races opens the door for a world of information. Mario tested soon after the Boston Marathon for this exact reason.

Looking at his test results post race in comparison to his baseline test, we found a few major insights. Reacting to his results, Mario explained, ‘‘the biggest changes [I noticed] were jumps in my Creatine Kinase (CK) and liver enzymes, specifically ALT and AST. I expected a jump in CK but not in my liver enzymes.”  

What brought on the drastic change?

Creatine Kinase (CK): this is an enzyme present in our tissues, particularly muscle. After a hard workout resulting in muscle damage, CK is released into the bloodstream (a normal and healthy reaction to resistance training). CK levels are commonly elevated after skeletal muscle injury and strenuous exercise, among other conditions.1 It’s been shown that the highest levels of CK are found after prolonged distance races such as a marathon. It is markedly elevated for 24 hours after exercise and with proper rest, it's shown to return to normal levels. Prolonged and elevated levels of CK can be indicative of muscle weakness.2

Marathon runners in particular are at risk to do serious damage through a condition called rhabdomyolysis.3 Rhabdomyolysis is an extreme case of muscle tissue breakdown that results in the release of muscle fiber, specifically myoglobin, into the blood. These contents are harmful to the kidneys and often cause kidney damage with potential long term effects.4



Liver Enzymes AST and ALT: Elevated levels of liver enzymes are indicative of liver damage. They are also noted to be elevated after muscular trauma caused by strenuous exercise, particularly marathon running, and can remain elevated for up to one-week post-event. If an athlete undergoes another set of vigorous exercise in that week they could become elevated further. Without adequate rest between strenuous workouts, levels of Creatine Kinase and liver enzymes can continue to increase.  


What was surprising from his results?

Often in post-race tests we expect to see drastic changes to other biomarkers, specifically Cortisol and hsCRP.



Cortisol: catabolic hormone secreted in response to physical and psychological stress.

It plays a vital role in metabolism by helping to maintain blood glucose levels during exercise.5 Cortisol has also been found to be elevated when in a sleep-deprived state. Acute sleep deprivation has been shown to decrease cognitive function, have a negative effect on mood, and rate of perceived exertion. Cortisol should be highest in the morning and but then drop off slowly throughout the day.

Surprisingly, Mario's cortisol decreased post-Boston likely due to his focus on "...mitigating stress, improving [his] diet and intake, and putting a lot of importance on consistent and quality sleep." These are all major players in helping our bodies recover from racing and training, and all key factors are logged and tracked through his InsideTracker portal.



hsCRP: A protein found in your blood that is most indicative of inflammation levels in the body.7 

It has been shown that excessive physical activity can lead to increased levels in ultra-runners, marathoners, and triathlon racers.8  Inflammation in athletes can be combated with appropriate training and recovery strategies by avoiding significant increases in training, specifically run training. It is shown that three days of intense run training can result in substantial muscle damage in comparison to cyclists.9 Beyond adjusting your training approach, testing with InsideTracker provides personalized diet and supplementation strategies to help lower and manage inflammation levels between tests while monitoring potential future trends.

We all know you can't out train a bad diet, but the same is true for meeting the different nutritional needs as endurance athletes. Utilizing his InsideTracker results, Mario adjusted his nutrition plan to match his training plan. 


What are some diet changes he made?

  • Increased intake of fish, specifically salmon, which is high in omega-3 fatty acids, which can help reduce inflammation.
  • Added a Magnesium supplement before bed, aiding in the reduction of Cortisol levels.10
  • Increased intake of vegetables, especially green ones! They are nature's multivitamins and packed with a variety of nutrients, including antioxidants.


Mario, what is the biggest thing you’ve learned from InsideTracker?

“I wanted to take a more proactive approach than a reactive approach. I focused on shutting down work at a certain time, mitigating stress, and made being an athlete a priority. I started eating better and eating specifically to support my training by timing my meals and snacks appropriately for what workouts were planned for the day. With my InsideTracker testing, it has been a big confirmation that I was doing a lot of things right. There actually aren’t any drastic changes I need to make but it is helping me look at patterns and where the big fluctuations are.”


Tips to optimize your recovery:

  • Rest - Take a few days off of exercise and avoid vigorous activities for a week after your event.
  • Sleep - Consistent and quality sleep is crucial for recovery and one of the biggest recovery strategies Mario uses for both himself and the athletes he coaches.
  • Eat Smart - Be sure to get in a variety of nutrient and antioxidant rich fruits and vegetables, protein for muscle recovery, and omega-3 fatty acid-rich foods like salmon, avocados, or walnuts.
  • Get your blood tested - Having your blood tested with InsideTracker to establish a baseline at the start of the season can give you the tools to enter your training and racing season on the right foot. From there, testing at multiple points throughout the season, after big training blocks or high-impact races, tells us how your body handled the physical stress and when more recovery might be needed!

Maximize my recovery 

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  1. 1“Creatine Kinase (Blood).” Creatine Kinase (Blood) - Health Encyclopedia - University of Rochester Medical Center,
  2. 2 Paola Brancaccio, Nicola Maffulli, Francesco Mario Limongelli; Creatine kinase monitoring in sport medicine, British Medical Bulletin, Volume 81-82, Issue 1, 1 January 2007, Pages 209–230,
  3. 3. Sjogren, Maria H., ed. “Transaminase Levels and Vigorous Exercise.” Gastroenterology & Hepatology 3.12 (2007): 913–914. Print
  4. 4.  “Rhabdomyolysis: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine,
  5. 5. Brownlee, Kaye K., Alex W. Moore, and Anthony C. Hackney. “Relationship Between Circulating Cortisol and Testosterone: Influence of Physical Exercise.” Journal of Sports Science & Medicine 4.1 (2005): 76–83. Print.

  6. 6. DONALD, CIARAN MC et al. “Acute Effects of 24-H Sleep Deprivation on Salivary Cortisol and Testosterone Concentrations and Testosterone to Cortisol Ratio Following Supplementation with Caffeine or Placebo.” International Journal of Exercise Science 10.1 (2017): 108–120. Print.
  7. 7.  Kamath, Deepak Y. et al. “High Sensitivity C-Reactive Protein (hsCRP) & Cardiovascular Disease: An Indian Perspective.” The Indian Journal of Medical Research 142.3 (2015): 261–268. PMC. Web. 26 Apr. 2018.
  8. 8.  Ertek, Sibel, and Arrigo Cicero. “Impact of Physical Activity on Inflammation: Effects on Cardiovascular Disease Risk and Other Inflammatory Conditions.” Archives of Medical Science : AMS 8.5 (2012): 794–804. PMC. Web. 26 Apr. 2018.
  9. 9.  Nieman, David C., et al. “Immune and Inflammation Responses to a 3-Day Period of Intensified Running versus Cycling.” Brain, Behavior, and Immunity, vol. 39, 2014, pp. 180–185., doi:10.1016/j.bbi.2013.09.004.
  10. 10.  Dmitrašinović, Gordana et al. “ACTH, Cortisol and IL-6 Levels in Athletes Following Magnesium Supplementation.” Journal of Medical Biochemistry 35.4 (2016): 375–384. PMC. Web. 26 Apr. 2018.

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