The course went north for eight miles through rural agricultural area before turning east at the Zumbro River, following paved trails to Soldiers Field Golf Course and Mayo Park into Rochester.

The race route went south and connected the loop, and the runners followed the Zumbro once again, this time ending at the Mayo Civic Center.

The race weekend begins with the Med City Fitness Expo in the Mayo Civic Center.

Both new events were scheduled for the same week as Med City, which was already facing competition from the other large regional marathons: Fargo and Madison.

In previous years, Canadian Pacific managers would not halt trains during the marathon, despite the requests from race directors.

[9] 2019 saw a totally new course, when the start of the race was moved just north of Stewartville, Minnesota, near the Rochester International Airport.

[10] An official race sponsor was added in 2015: the North Dakota-based Scheels, which had opened a large store in the Apache Mall that year.

But on July 20, race director Mark Bongers put out a press release announcing the cancelation of the marathon, writing that "after conversations with the Minnesota Department of Health, members of the Minnesota Running Industry Task Force, the USATF, Mayo Clinic Emergency Medicine physicians, our sponsors and community leaders on how we could safely race, we came to the conclusion that it just isn't possible with so many ongoing uncertainties surrounding the COVID-19 pandemic.

"[14] In 2021, the race was postponed again, in the hopes that it would run September 12 with the blessing of the department of health and the city of Rochester.

[15][16] As of 2021, six people had run the marathon every year: Allen Holtz, Jeff Miller, Nels Pierson, Pete Martin, Tom Perri, and Ward Lenius.

[18] Key: Course record All cities in Minnesota unless indicated otherwise * Due to hot weather, race official called runners off the course.