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Thousands of professional and amateur runners gear up for the world’s largest ultramarathon, the Comrades (9 June). Now, psychiatrist Dr. James Burger suggests using physical activity to manage mental health instead of watching others run the race.

Marathons for Mental Health?

“This is not to say that everyone needs to run marathons, but we like to aim for physical activity in some form every day, all year round, which has proven to be beneficial for people struggling with depression, anxiety, dementia, ADHD, and other mental health conditions. Even gentle activity such as walking can have lasting impacts,” says Dr. Burger.

With 2020 seeing a worldwide increase in depression and anxiety by 27.6% and 25.6%, it’s now more important than ever to take charge of our mental health. However, only a quarter of those affected seek and receive treatment. These conditions impact quality of life, cause distress, and hinder functioning at home, in relationships, and at work.

Poor mental health is projected to cost the global economy approximately $6 trillion per year by 2030.

“Exercise can be an affordable and accessible ‘protective factor’ that can make a substantial difference to improving the nation’s mental health, wellbeing, and functioning,” said Dr. Burger.

Studies suggest exercise’s impact on mental health may surpass its effects on physical conditions like heart disease and cancer.

“In mild cases of depression, exercise is an effective first-line treatment and in more severe cases, boosts the effect of medication. Evidence[ii] continues to show that adding exercise is better than no treatment, and has positive effects combined with anti-depressants in reducing depressive symptoms and thoughts of suicide.”

Exercise and Mental Health

Beyond improving mood and anxiety, exercise also offers significant improvements for thinking and memory. Exercise can slow down the effects of dementia and protects intellectual, decision-making, and attention functions in cases of mild dementia, [iii] while SASOP’s guidelines for the management of ADHD recommend exercise as a powerful non-medication treatment.[iv]

Dr. Burger said exercise had positive mental health effects on brain networks, helping to regulate the neurotransmitters serotonin and noradrenaline that play a role in mood and cognitive functions, releasing the “happy hormone” endorphins, and reducing brain inflammation and stress.

Exercise also has positive psycho-social effects. It distracts from negative thoughts and stimulates positive thoughts and feelings of well-being and positive body image. It also reduces feelings of worthlessness and hopelessness.

“Physical activity creates positive feelings through the experience of being challenged, exercising autonomy, self-control and personal mastery, and through the sense of achievement that comes with mastering a new skill and self-improvement. It can also contribute to social connectedness and support, and a feeling of belonging,” he said.

Get moving for a better mood

Struggling to get moving? Dr. Burger’s tips for getting started and staying the course:

He says if you are experiencing depression, start small. Depression can affect energy levels and cause withdrawal, limiting one’s ability to do tasks and activities.

“Depression turns our view of ourselves negative, and it can be useful to have objective measures of progress, such as journals or professionals helping to supervise the process. Continue to lean towards more physical activity and build on progress.”

“Most important is to find what you enjoy, an activity that is sustainable because the pleasure you get out of it means you are more likely to keep at it. And remember that anything is better than nothing, and don’t let perfect be the enemy of good,” he says.

  • Set a start date and a clear, manageable goal.
  • Give yourself permission to set aside time for exercise. Even walking for 10 minutes a day and building from there is a good start.
  • Focus on the positive impacts on your mental state. This is more immediate, rather than expecting quick results in physical fitness.
  • Focus on your own self-discovery and social relationships gained through exercise, rather than prioritizing performance and competition.
  • Try to get outdoors. Try having a social aspect to a physical activity, and an activity that is repeatable. This is especially beneficial for positive mood, enjoyment, and a sense of achievement.
  • Look for opportunities to get moving. Try to be less sedentary at home, at work, in leisure time and in daily transport. This can include active workstations, walking meetings at work, or using the stairs instead of the lift.
  • Group activities and supervision, such as a team sport or exercise/movement group class, can help to keep you motivated, involved and connected to other people.


[i] Posadzki, P., Pieper, D., Bajpai, R. et al. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health 20, 1724 (2020).

[ii] Lam RW, Kennedy SH, Adams C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l’humeur et de l’anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. The Canadian Journal of Psychiatry. 2024;0(0).  doi:10.1177/07067437241245384

[iii] Huang X, Zhao X, Li B, Cai Y, Zhang S, Wan Q, Yu F. Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis. J Sport Health Sci. 2022 Mar;11(2):212-223. doi: 10.1016/j.jshs.2021.05.003. Epub 2021 May 16. PMID: 34004389; PMCID: PMC9068743.

[iv] Schoeman R, Liebenberg R. The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder. S Afr J Psychiat. 2017;23(0), a1060.

Em Sloane

Em Sloane

I am an introverted nature lover, and long time contributor to My role is to publish the information in a consumer friendly format, which we receive on the latest medical news, press releases and general information on the latest longevity related research findings.


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