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Comrades Marathon out of reach? Get moving for better mental health.

As thousands of professional and amateur runners gear up for the world’s largest ultramarathon, the Comrades (9 June), psychiatrist Dr James Burger of the South African Society of Psychiatrists (SASOP) says instead of watching others at their peak physical condition, use physical activity as a powerful tool in managing your 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. 


One in four South Africans experience depression[i], [ii], and mental health conditions are the leading cause of disability both locally,[iii] and worldwide[iv],  however, only a quarter of those affected seek and receive treatment. These conditions affect a person’s quality of life, cause distress, and can impact their ability to function at home, in relationships, and in their occupations.


Mental health-related absenteeism in the workplace is estimated to cost the South African economy R19 billion annually in lost productivity,[v] and facilitating opportunities for employees to get physically fit, would likely benefit their mental fitness too, Dr Burger said.


“With the high prevalence of depression and other mental health conditions in South Africa, while only 25% receive appropriate treatment – due to stigma as well as lack of access to mental health care – 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,” he said.


Dr Burger said that studies have shown that the effect of exercise and physical activity on mental health outcomes could be, in fact, even larger than for physical conditions like heart disease and cancer.[vi]


“In mild cases of depression, exercise is an effective first-line treatment and in more severe cases, boosts the effect of medication. Evidence[vii] 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.”


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,[viii] while SASOP’s guidelines for the management of ADHD recommend exercise as a powerful non-medication treatment.[ix]

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, distracting from negative thoughts and stimulating positive thoughts and feelings of well-being and positive body image, and reducing 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.


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


Dr Burger says if you are experiencing depression start small since 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 said.


  • 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, which are more immediate, rather than expecting quick results in physical fitness.

  • Focus on your own self-discovery and social relationships gained through exercise, rather than prioritising performance and competition.

  • Try to get outdoors and have a social aspect to a physical activity, and an activity that is repeatable, as this is especially beneficial for positive mood, enjoyment and a sense of achievement.

  • Look for opportunities to get moving and be less sedentary at home, at work, in leisure time and in daily transport – such as active workstations or walking meetings at work, and 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] Mapanga W, Mtintsilana A, Dlamini SN, Ware LJ, Du Toit J, Draper CE, Richter L and Norris SA (2022). The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: A national survey in South Africa. Front. Public Health 10:986531. doi: 10.3389/fpubh.2022.986531


[ii] University of the Witwatersrand. 2022. “Mental health in SA is at shocking levels but people are not seeking help”.


[iii] Achoki T, Sartorius B, Watkins D, et al. Health trends, inequalities and opportunities in South Africa’s provinces, 1990-2019: findings from the global burden of disease 2019 study. J Epidemiol Community Health 2022; 76:471–81.


[iv] WHO. 2017. "Depression: let’s talk" says WHO, as depression tops list of causes of ill health.



[vi] 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).


[vii] 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


[viii] 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.


[ix] 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.



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