Ekimov was born in Vyborg, and started training as a cyclist at age 12 with a bicycle school affiliated with the famous centre of Aleksandr Kuznetsov.

Ekimov won three Olympic gold medals:[3] in the track team pursuit in Seoul (1988) for the USSR, and in an upset, in the road time trial in Sydney (2000) for Russia.

At the 2004 Summer Olympics in Athens, Ekimov won the silver medal for Russia in the men's road individual time trial, losing to American Tyler Hamilton.

Hamilton later admitted to doping and Ekimov, who had raced for many more years than Tyler with the infamous Lance Armstrong and Johan Bruyneel partnership, was promoted to gold.

He was a key force in the winning team time trial effort in stage four and was important to Lance Armstrong's fifth Tour victory both on the flats and in the mountains.