Why does strenuous exercise lead to elevated bilirubin level in blood?

It doesnot: Strenuous exercise might increase liver enzymes due to leakage from muscle. This should not increase your bilirubin. In patients with gilbert syndrome- bilirubin may increase with fasting, fever and possibly strenuous exercise.

Hemolysis: Very strenuous exercise that involves pavement-pounding can destroy enough red blood cells that the bilirubin and reticulocyte counts go up. As a pathologist, i'm always reminding folks to look at the person, not the numbers. If your bilirubin's up and it's not jogger's hemolysis or gilbert's, try to find the cause with your physician's help.