International  Journal  of
Environmental Research
and Public Health
Review
A Scoping Review of the Relationship between
Running and Mental Health
Freya Oswald 1,*
, Jennifer Campbell 1
, Chloë Williamson 2, Justin Richards 3 and Paul Kelly 2
1
Edinburgh Medical School, The University of Edinburgh, Edinburgh EH16 4TJ, UK; s1604637@sms.ed.ac.uk
2
Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh EH8 8AQ, UK;
chloe.williamson@ed.ac.uk (C.W.); p.kelly@ed.ac.uk (P.K.)
3
Faculty of Health, Victoria University Wellington, Wellington 6140, New Zealand; justin.richards@vuw.ac.nz
*
Correspondence: s1504283@sms.ed.ac.uk
Received: 10 October 2020; Accepted: 29 October 2020; Published: 1 November 2020


Abstract: Poor mental health contributes signiﬁcantly to global morbidity. The evidence regarding
physical beneﬁts of running are well-established. However, the mental health impacts of running
remain unclear. An overview of the relationship between running and mental health has not
been published in the last 30 years. The purpose of this study was to review the literature on the
relationship between running and mental health. Our scoping review used combinations of running
terms (e.g., Run* and Jog*) and mental health terms (general and condition speciﬁc). Databases used
were Ovid(Medline), Ovid(Embase), ProQuest and SportDiscus. Quantitative study types reporting
on the relationships between running and mental health were included. Database searches identiﬁed
16,401 studies; 273 full-texts were analysed with 116 studies included. Overall, studies suggest that
running bouts of variable lengths and intensities, and running interventions can improve mood and
mental health and that the type of running can lead to diﬀerential eﬀects. However, lack of controls
and diversity in participant demographics are limitations that need to be addressed. Cross-sectional
evidence shows not only a range of associations with mental health but also some associations with
adverse mental health (such as exercise addiction). This review identiﬁed extensive literature on the
relationship between running and mental health.
Keywords: exercise; mental health; psychology; physical activity; running; jogging
1. Introduction
Poor mental health contributes signiﬁcantly to the global health burden [1]. The strain of mental
health and behavioural disorders is estimated to account for more years of lived disability than any
other chronic health ailment [1,2]. The global proportion of disability-adjusted life years caused by
mental ill-health has increased from 12.7% to 14% (males) and 13.6% to 14.4% (females) from 2007 to
2017 [3]. Due to the burden and increasing prevalence of mental ill-health, eﬀective management of
mental health disorders is vital [4].
There is substantial evidence to support the relationship between physical activity (PA) and various
mental health outcomes across the lifespan [5–7]. There has been investigation of low-intensity PA on
mental health; for example, Kelly et al. (2018) reported the positive relationships between walking and
mental health in an earlier scoping review [8]. However, a similar synthesis for higher-intensity PA
such as running has not been reported.
While the evidence base for the beneﬁts of running on physical health is well-established,
the mental health changes from running remain unclear. Addressing the gap within this knowledge is
valuable as running is a form of PA popular among many population groups [9]. Inclusive organisations
such as “Couch to 5k” [10], “Girls on the run” [11] and “Parkrun” can support running while promoting
Int. J. Environ. Res. Public Health 2020, 17, 8059; doi:10.3390/ijerph17218059
www.mdpi.com/journal/ijerph
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well-being and satisfaction with physical health, facilitating socialisation and community connectedness,
and reducing loneliness [12–14]. In primary care settings, national initiatives such as “Parkrun-Practice”
promote well-being through running [15].
In recent years, there has been a transition within healthcare to focus on disease morbidity rather
than disease mortality, in particular with a drive to improve global mental health [16]. There is
increasing prevalence of mental ill-health; therefore, eﬀective management of mental health disorders
is vital [4]. In order to investigate any diﬀerences in mental health eﬀects between high and low
intensities of running, all genres of running must be considered including jogging, sprinting, marathon
running and orienteering.
To the best of the authors’ knowledge, no recent reviews of the relationship between running and
mental health are available. The synthesis provided by this review will enable healthcare practitioners,
psychologists and policy makers to better advise on running for mental health. It will also identify key
gaps in the literature for future research. The aims of this scoping review are the following:
(1)
to provide an overview of what is known regarding the relationship between running and mental
health outcomes in all age groups and populations
(2)
to highlight current knowledge gaps and research priorities
2. Materials and Methods
A scoping review was concluded to be the most appropriate to address the research aims as it
provides an overview of the volume and distribution of the evidence base as well as highlights where
more research is warranted. The review followed the ﬁve-stage scoping review framework proposed
by Arksey and O’Malley and was guided by the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) scoping review extension checklist (Appendix A) [17,18].
2.1. Identify Research Question
Research questions were developed to address the research aims: “What is known about the
eﬀects of running on mental health outcomes?” and “What are the current knowledge gaps?”.
Research question formulation was guided by item 4 in the PRISMA scoping review extension checklist
(Appendix A). The deﬁnition of running included jogging, sprinting, marathon running, orienteering
and treadmill running. A wide range of intensities were included as the aim of the scoping review
was to provide an overall picture of the relationship between running (of various intensities) and
mental health.
2.2. Identify Relevant Outcomes
Mental health outcomes were informed by Kelly et al. (2018) [8], who reviewed the relationships
between walking and mental health (Table 1). Measures or disorders of cognitive dysfunction were
considered neurological and thus outside the scope of this review. Eating disorders were included as
they signiﬁcantly impair physical health or psychosocial functioning. Health-related quality-of-life
was excluded as it was considered to incorporate physical, social, emotional and mental factors.
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Table 1. Deﬁnitions of the mental health outcomes included within the review: the outcomes were
informed by Kelly et al. (2018) [8].
Outcome
Description
Depression
Depression is a mood disorder with prolonged periods of low mood and a lack of interest and/or pleasure
in normal activities most of the time. This includes major depressive disorder [19].
Anxiety
Anxiety is characterised by uncomfortable or upsetting thoughts and is usually accompanied by agitation,
feelings of tension and activation of the autonomic nervous system. It is important to note the distinction
between transient anxiety symptoms (state anxiety), persistent symptoms (trait anxiety) and anxiety
disorders: a collection of disabling conditions characterised by excessive, chronic anxiety. Examples of
anxiety disorders are speciﬁc phobias, social phobia, generalised anxiety disorder, panic disorder,
obsessive–compulsive disorder and post-traumatic stress disorder [20].
Self-eﬃcacy
Self-eﬃcacy is a situation-speciﬁc form of self-conﬁdence. Self-eﬃcacy beliefs inﬂuence how people think,
feel, motivate themselves and act [21].
Psychological stress
Psychological stress or distress can be deﬁned as the unique discomforting, emotional state experienced
by an individual in response to a speciﬁc stressor or demand that results in harm, either temporary or
permanent, to that person [22].
Eating pathology
Eating pathology or disorder can be described as persistent disturbance of eating behaviours or
behaviours intended to control weight, which signiﬁcantly impairs physical health or psychosocial
functioning. This disturbance should not be secondary to any recognised general medical disorder,
e.g., hypothalamic tumour. This deﬁnition includes anorexia nervosa and bulimia nervosa [23].
Self-esteem
Self-esteem is the feelings of value and worth that a person has for oneself. It contributes to overall
self-concept as a construct of mental health [24].
Addiction
Addiction designates a process whereby a behaviour that can function both to produce pleasure and to
provide escape from internal discomfort is employed in a pattern characterized by (1) recurrent failure to
control the behaviour (powerlessness) and (2) continuation of the behaviour despite signiﬁcant negative
consequences (unmanageability) [25].
Psychological well-being
Psychological well-being links with autonomy, environmental mastery, personal growth, positive relations
with others, purpose in life and self-acceptance. This is often referred to as eudemonic well-being [26].
Self-concept
Self-concept is the organisation of qualities that the individual attributes to themself, which in turn guides
or inﬂuences the behaviour of that individual [27].
Mood
Mood is a transient state of a set of feelings, usually involving more than one emotion. Seen as a conscious
summative recognition of feelings that can vary in intensity and duration [28].
2.3. Identify Relevant Studies
Studies were included based on the following criteria:
•
Any geographical location
•
All years between 1970 and 2019
•
Quantitative eﬀects of running on predetermined mental health outcomes
#
Preventive eﬀects (negative)
#
Health promotion eﬀects (positive)
#
Intervention eﬀects
•
Any age group or sex
•
Human studies
•
Designs including primary research (cross-sectional, longitudinal, interventions and natural
experiments with pre-post measures with or without non-running comparisons)
•
Studies that mentioned walking as well as running were included because it is not possible to
diﬀerentiate walkers from runners in events such as Parkrun.
Studies were excluded based on the following criteria:
•
Specialist groups including elite, professional or competitive athletes.
•
General physical or aerobic activity, rather than exclusively running
•
Qualitative and ethnographic designs
•
Systematic and scoping reviews (individual studies from identiﬁed reviews were included
if relevant)
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•
Editorials, opinion pieces, magazine/newspaper articles, case reports and papers without
primary data
•
Focus on secondary mental health within clinical groups with speciﬁc physical or mental
conditions that is not the condition being treated with running (e.g., eﬀects on depression in
patients with cancer)
•
Evidence types including guidelines, unpublished and ongoing trials, annual reports, dissertations
and conference proceedings
•
Animal studies
•
Unavailable in English
•
Running intervention was part of a wider study where diﬀerentiating the individual eﬀect of
running was not possible (e.g., combined with weight management).
•
Conference abstracts that were not published as full articles
Search Strategy and Databases
Databases searched were Ovid (Medline), Ovid (Embase), ProQuest and SportDiscus. Databases
were searched for titles and abstracts that included at least one running term with one mental health
outcome term. Appropriate truncation symbols were used to account for search term variations.
Common running terms were combined. Search terms and the full search syntax can be found in
Appendix B. Searches were conducted for papers published up to August 2019.
2.4. Study Selection
All identiﬁed records were uploaded to Covidence (https://www.covidence.org), and duplicates
were automatically removed. Titles and abstracts were screened, with 20% cross-checked early in the
process to assess agreement between authors. Full texts were reviewed by 2 authors.
2.5. Charting the Data
Data extraction was completed by the lead author (F.O.) with 5% double screened by a second
author (J.R.). The data extraction form was pilot tested with the ﬁrst 20 studies and informed the
following standardised extraction agreed upon by all authors:
(1)
Author(s), year of publication and geographical location of study
(2)
Mental health conditions examined
(3)
Sample size and population details
(4)
Study design
(5)
Measures used to quantify any change in mental health outcome(s)
(6)
Running dose (if applicable) and compliance (if applicable)
(7)
Whether running was beneﬁcial and the main ﬁndings
In studies that used “Proﬁle of Mood States” (POMS) as a measurement of mood state, total mood
disturbance was used in this review if reported by the authors. If the authors only reported one/some
of the POMS subdimensions, these data were extracted instead.
2.6. Collating, Summarising and Reporting Results
Included studies were organized into 3 categories: cross-sectional studies, acute (single, double or
triple) bouts of running, and long-term running interventions. For each of these 3 categories, the results
were presented in two ways: (a) a descriptive numerical analysis to highlight the prevailing domains
of research regarding geographical location, mental health outcomes and research methods and (b) a
narrative summary of the key ﬁndings.
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3. Results
3.1. Included Studies
From initial searches, 29,851 papers were identiﬁed. Following removal of duplicates, 16,401 were
screened at the title and abstract levels and 273 papers were retained for full-text assessments. Ultimately,
116 papers met the inclusion criteria for this review. Figure 1 displays the PRISMA study ﬂowchart.
The results are presented in the following 3 categories: cross-sectional studies, acute bouts of running
and longer-term interventions.
Int. J. Environ. Res. Public Health 2020, 17, x  
5 of 66 
 
From initial searches, 29,851 papers were identified. Following removal of duplicates, 16,401 
were screened at the title and abstract levels and 273 papers were retained for full-text assessments. 
Ultimately, 116 papers met the inclusion criteria for this review. Figure 1 displays the PRISMA study 
flowchart. The results are presented in the following 3 categories: cross-sectional studies, acute bouts 
of running and longer-term interventions. 
 
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) depicting 
the identification, screening, eligibility and inclusions of texts within the scoping review. 
3.2. Category 1: Cross-Sectional Studies 
Forty-seven studies utilised cross-sectional designs (with and without non-running comparison 
groups) (Table 2) [29–75]. These studies assessed exposure to regular running by questionnaire. 
Narrative description of findings of the 47 cross-sectional studies are included within Table S1 within 
the supplementary material. 
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) depicting
the identiﬁcation, screening, eligibility and inclusions of texts within the scoping review.
3.2. Category 1: Cross-Sectional Studies
Forty-seven studies utilised cross-sectional designs (with and without non-running comparison
groups) (Table 2) [29–75]. These studies assessed exposure to regular running by questionnaire.
Narrative description of ﬁndings of the 47 cross-sectional studies are included within Table S1 within
the supplementary material.
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Table 2. Summary of data extraction from the 47 cross-sectional studies.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Wilson et al. [29]
(1980)
Canada
Cross-sectional
n = 30, all male; age range 20–45;
10 marathoners, 10 regular
joggers and 10 non-exercisers
Mood (Proﬁle of Mood States)
Comparing mood states of
marathon runners, regular
joggers and non-exercisers
Marathoners and joggers reported less depression (F(2,28) = 7.51, p < 0.003), anger (F = 10.11,
p < 0.001) and confusion (F = 12.41, p < 0.001) and more vigour (F = 103.21, p < 0.001) than
non-exercisers. Marathoners reported less fatigue (F = 10.26, p < 0.001) and tension (F = 7.51,
p < 0.003) than non-exercisers. Marathoners and joggers did not signiﬁcantly diﬀer on
reported fatigue and tension; however, marathoners had signiﬁcantly less depression, anger
and confusion but more vigour than joggers.
Joesting [30]
(1981)
USA
Controlled
cross-sectional
n = 100 runners; 79 males,
mean age 18.36; 21 females,
mean age 16.53
Depression (Depression Adjective
Checklist)
Investigating the relationship
between running and depression
Signiﬁcantly (p < 0.01) decreased depression in males and female runners compared to
Lubin’s data for nonpsychiatric patients: male and female runners mean depression scores
were 4.59 and 4.33, respectively, while the normative nonpsychiatric sample means were 8.02
and 7.32, respectively.
Jorgenson et al.
[31]
(1981)
USA
Cross-sectional
n = 454 regular runners;
390 males and 64 females;
majority aged 30–39
Emotional well-being (structured
questionnaire consisting of 55 items
designed by the author)
Investigating the relationship
between emotional well-being
and running
Of the runners, 92.3% (n = 419) indicated an increase in emotional well-being (p < 0.01) but
no report on the scale of improvement. Age and emotional well-being were signiﬁcantly
correlated (gamma value = 0.42, p < 0.001), with the older runner having the greater
perception of emotional well-being resulting from running. There was a signiﬁcant inverse
relationship between average hours per week running and emotional well-being (gamma
value = −0.43, p < 0.001).
Valliant et al. [32]
(1981)
Canada
Cross-sectional
n = 68 male runners; 30 marathon
runners, mean age 34.4;
38 recreational runners,
mean age 20.6
Self-suﬃciency and personality proﬁles
(a 1-h “Sixteen Personality Factor
Questionnaire”)
Comparing self-suﬃciency and
personality proﬁles in marathon
runners vs. recreational joggers
Marathon runners had a more self-suﬃcient personality compared to joggers who were less
assertive and more conscientious and had controlled personality types: On average,
marathoners more reserved (F = 17.07, df = 1,66, p < 0.001), intelligent (F = 12.69, df = 1,66,
p < 0.001), tender-minded (F = 11.79, df = 1,66, p < 0.001), imaginative (F = 11.09, df = 1,66,
p < 0.005) and self-suﬃcient (F = 19.84, df = 1,66, p < 0.001) than joggers. Conversely, joggers
were more happy-go-lucky (F = 10.05, df = 1,66, p < 0.005), apprehensive (F = 10.51, df = 1,66,
p < 0.005) and controlled (F = 7.09, df = 1,66, p < 0.01).
Francis et al. [33]
(1982)
USA
Cross-sectional
n = 44 male participants; mean
age 32; non-running controls who
ran 0 miles weekly (n = 16),
20 miles (n = 10), 30–40 miles
(n = 8) and 50–60 miles (n = 10)
Anxiety, depression and hostility
(State-Trait Anxiety Inventory and the
Multiple Aﬀect Adjective Check List)
Comparing anxiety, depression
and hostility in various groups of
runners vs. sedentary controls
Compared to sedentary controls, runners had lower anxiety (4.2 vs. 7.2, p < 0.01),
depression (8.6 vs. 12.3, p < 0.01) and hostility (4.8 vs. 6.8, p < 0.01).
Hailey et al. [34]
(1982)
USA
Cross-sectional
n = 60 male runners; aged 13–60;
Those who ran for less than 1
year (n = 12), those who ran for
1–4 years (n = 32) and those who
ran for over 4 years (n = 16)
Negative addiction (Negative
addiction scale)
Investigating the relationship
between running and negative
addiction
The more years that a male had been running, the greater the risk of developing negative
addiction (F(2,58) = 3.48, p < 0.05). Runners with a running history of <1 year scored a mean
of 3.84 (scale of 1–14), those running for 1–4 years scored 5.63 and those running for 4+ years
scored 6.38. Addiction scores for runners of 4+ years was greater than the addiction score for
runners of <1 year (t(59) = 2.72, p < 0.005). Likewise, the addiction score for runners of
between 1–4 years was greater than the score for runners <1 year (t(59) = 2.52, p < 0.01).
No statistically signiﬁcant diﬀerence in addiction scores were found between the 1–4-year
group and the 4+ year group.
Callen [35]
(1983)
USA
Cross-sectional
n = 424 non-professional runners
who ran on average more than
28.8 miles per week; 303 males
and 121 females; mean age 34
Mental and emotional aspects (a
questionnaire designed by the author)
Investigating mental and
emotional aspects associated with
long-distance running in
non-professional runners,
including depression, tension,
mood, happiness, self-conﬁdence
and self-image
Ninety-six percent of subjects noticed mental/emotional beneﬁts from running, but none
reported the size of beneﬁts. Beneﬁts included relief of tension (86% of all respondents, n.s.),
improved self-image (77%, n.s.), better mood (66%, p < 0.05), improved self-conﬁdence (64%,
n.s.), relieved depression (56%, p < 0.05) and improved happiness (58%, n.s.). However, 25%
stated they had experienced emotional problems associated with running, with almost every
instance being a problem of depression, anger or frustration associated with not being able to
run due to injury, but no details of size or signiﬁcance were reported. Sixty-nine percent of
runners experienced an emotional “high” while running.
Galle et al. [36]
(1983)
USA
Controlled
cross-sectional
n = 391 female subjects; aged 15
to 50; runners (n = 102), infertility
patients (n = 103), fertile subjects
(n = 139) and Clomid study
patients whose only infertility
abnormality was ovulation
dysfunction (n = 47)
Anxiety and depression (Hopkins
Symptom Checklist-90)
Comparing psychologic proﬁles
including anxiety and depression
in runners, infertility patients,
fertile subjects and Clomid study
patients whose only infertility
abnormality was ovulation
dysfunction
Emotional distress scores of runners were not signiﬁcantly diﬀerent from the fertile control
subjects (F = 1.19, ns), but both groups of infertility patients showed greater distress on items
in the depression subscale than the runners and fertile control subjects (F = 3.42, p < 0.025).
The only signiﬁcant diﬀerence between runners and fertile control subjects was that control
subjects had higher hostility (p < 0.05). Regarding just runners, there was signiﬁcant
diﬀerences in depression between amenorrhoeic (n = 15) and regular cycling runners (n = 87),
with amenorrhoeic runners scoring higher in the depression factor than regular ovulation
cycle runners (F = 3.0, p < 0.10).
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Table 2. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Lobstein et al. [37]
(1983)
USA
Pre-post controlled
between subject
design
n = 22 medically healthy men;
11 physically active men and 11
sedentary men; aged 40–60
Depression (Minnesota Multiphasic
Personality Inventory)
Assessing the impact of a
treadmill run with increasing
gradient on depression
Sedentary men were signiﬁcantly more depressed than men who ran (mean = 61.36 vs. 50.73,
respectively, p < 0.01), but both groups were within clinical limits for normal, mentally
healthy, middle aged men.
Rudy et al. [38]
(1983)
USA
Cross-sectional
n = 319 female regular runners;
aged between 16 and 60
Anxiety and self-esteem (Rosenberg
Self-esteem Scale and Zuckerman’s
Anxiety Adjective Checklist)
Investigating how levels of
anxiety and self-esteem related to
intensity of jogging
Female runners jogging with great intensity had signiﬁcantly less anxiety than lower
intensities (x2 = 22.83; p < 0.001). Results indicate that intensity of jogging inﬂuences
self-esteem but was not signiﬁcant: 89% of women scored in the range of high self-esteem,
and in the open-ended answers, 29% of responses stated that they feel better about
themselves, 12% had increased self-conﬁdence and 6% stated a sense of accomplishment.
Goldfarb et al. [39]
(1984)
USA
Cross-sectional
n = 200 distance runners;
136 males and 64 females
Anorexia nervosa traits (Goldfarb Fear
of Fat scale and Activity Vector
Analysis)
Investigating anorexia nervosa
traits within distance runners
Runners had a mean score of 2.91 (on a 10-point scale), indicating a low–normal fear of fat,
and only 29 (14.5%) participants reported a high fear-of-fat score (score between 6 and 10).
Fear-of-fat scores did not correlate signiﬁcantly with measures of running zealousness:
miles run per week (r = −0.04), number of workouts per week (r = 0.09), number of road
races (r = 0.05), marathons completed (r = −0.05) or degree of importance placed on running
(r = −0.03). Runners who demonstrated the greatest zealousness demonstrated Activity
Vector Analysis proﬁles that clustered around one particular proﬁle (r = 0.64, p < 0.05)
indicating assertive, obsessive, perfectionistic and anxious individuals. Results do not
support a correlation between running and fear of fat; however, runners most closely
resembling “obligatory runners” exhibited traits characteristic of anorexia nervosa patients.
-Guyot et al. [40]
(1984)
USA
Controlled
cross-sectional
n = 126 participants; 64 runners
(44 males and 20 females) vs. 62
non-runners (37 males and
25 females)
Death anxiety (Death Concern Scale)
Comparing death anxiety in
runners vs. non-runners
Runners experienced more death thoughts (F(1,122) = 4.49, p < 0.05) but less death anxiety
(F(1,122) = 6.35, p < 0.05) than non-runners.
Rape [41]
(1987)
USA
Controlled
cross-sectional
n = 42 male participants; aged
18–25; 21 runners vs. 21
non-exercisers
Depression (Beck Depression
Inventory)
Comparing depression scores in
runners vs. non-exercisers
Runners were signiﬁcantly less depressed (M = 4.38, SD = 3.88) than the non-exercisers
(M = 9.55, SD = 5.40) (t40 = 3.55, p < 0.001). Overall results suggest that running
reduces depression.
Weight et al. [42]
(1987)
South Africa
Controlled
cross-sectional
n = 135 female participants
consisting of marathon runners
(n = 85) vs. cross country runners
(n = 25) vs. non-running controls
(n = 25); aged 18–56
Eating attitudes and disorders (Eating
Attitudes Test and the Eating Disorder
Inventory)
Comparing eating attitudes and
disorders in marathon runners vs.
cross country runners vs.
non-running controls.
No signiﬁcant diﬀerences were found between groups on any of the Eating Attitudes Test
scores (mean scores = 8.4, 14.3 and 11.8). Eating Disorder Inventory scores also did not follow
a deﬁnite pattern (mean scores for marathoners, cross country runners and non-running
controls were 24.8, 27.1 and 32.0, respectively), indicating that abnormal eating attitudes and
the incidence of anorexia was no more common among competitive female runners than
among the general population, with a low incidence of anorexia in the total group (2 out of
135 participants).
Chan et al. [43]
(1988)
USA
Cross-sectional
n = 60 runners who ran at least
3× per week for a minimum of a
year; 28 males and 32 females;
prevented runners n = 30 vs.
continuing runners n = 30;
aged 15–50.
Depression, self-esteem and mood
(Zung depression Scale, Rosenberg
Self-esteem Scale and Proﬁle of Mood
States)
Comparing depression,
self-esteem and mood in
prevented runners vs. continuing
runners
Prevented runners reported signiﬁcantly greater overall psychological distress (Wilks’s = 0.63,
p < 0.01: X92 = 24.38, p < 0.01), depression (F(1,58) = 11.57, p < 0.01) and overall mood
disturbance (F(1,58) = 11.03, p < 0.01) than continuing runners. Prevented runners reported
signiﬁcantly lower self-esteem (F(1,58) = 3.17, p < 0.05), less satisfaction with the way their
bodies’ present looks (F(1,58) = 4.17, p < 0.05) and had greater desire to change something
about the way their bodies look (F(1,58) = 4.54, p < 0.05) compared to continuing runners.
Frazier [44]
(1988)
USA
Post only,
nonrandomised
long-term
observational
study
n = 86 regular, distance runners
who had all completed a
marathon; 68 males with mean
age of 33.7 and 18 females with a
mean age of 32.2
Mood (Proﬁle of Mood States)
Investigating the relationship
between running and mood in
regular distance runners
Results suggest that regular, distance running improves mood in both males and females.
Running subjects had lower mean scores on tension, anger, depression, fatigue and confusion
and a higher mean of vigour compared to scores for test norms; however, statistical
signiﬁcance was not reported here. The only signiﬁcant diﬀerence between males and females
was on the confusion subscale: female mean = 7.8 vs. male = 5.5 (F(1,84) = 5.33, p < 0.05).
Lobstein, Ismail et
al. [45]
(1989)
USA
Controlled
cross-sectional
n = 36 male participants; aged
40–60; runners (n = 21) vs.
sedentary controls (n = 15)
Anxiety and depression (Minnesota
Multiphasic Personality Inventory and
Eysenck Personality Inventory)
Comparing anxiety and
depression levels in runners vs.
sedentary controls
Overall, running reduced anxiety (mean = 48.95 vs. 61.48 respectively, p < 0.05, standardised
canonical coeﬃcient = −1.07) and depression (mean = 50.76 vs. 57.93, respectively, p < 0.05,
standardised canonical coeﬃcient = 0.00) compared to being sedentary.
Lobstein,
Rasmussen et al.
[46]
(1989)
USA
Controlled
cross-sectional
n = 20 psychologically normal,
medically healthy men; aged
40–60; physically active joggers
(n = 10) vs. sedentary (n = 10)
Depression and stress (Eysenck
Personality Inventory and Minnesota
Multiphasic Personality Inventory)
Comparing depression and stress
in sedentary men to physically
active joggers
The ﬁndings suggest that regular jogging increases emotional stability (t = −2.84, p < 0.01) and
decreases subjective depression with MMPI subscales of depression and Wiggins depression
both being signiﬁcantly lower in the joggers (t = 3.70, p < 0.01; t = 2.40, p < 0.05; respectively).
Int. J. Environ. Res. Public Health 2020, 17, 8059
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Table 2. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Nouri et al. [47]
(1989)
USA
Cross-sectional
n = 100 male participants; aged
18–62; non-exercisers (n = 28),
drop-out joggers (n = 21),
beginning joggers (n = 15),
intermediate joggers (n = 16) and
20 advanced joggers (n = 20)
Anxiety and addiction/commitment
(State-Trait Anxiety Inventory,
Commitment to Running Scale,
and The Buss–Dutkee Inventory
measuring hostility and aggression)
Investigating the relationship
between various levels of jogging
vs. non-exercising on anxiety and
addiction/commitment
Running reduced anxiety levels compared to physical inactivity (F(4,89) = 4.43, p < 0.01),
with advanced joggers scoring signiﬁcantly lower on trait anxiety than beginner and
intermediate joggers (1.42 vs. 1.77 vs. 1.69, respectively, p < 0.01) and commitment to running
signiﬁcantly higher for the joggers than the non-exercisers (F(4,89) = 14.30, p < 0.01).
Chan et al. [48]
(1990)
Hong Kong
Cross-sectional
n = 44 male runners of track clubs
who ran a mean of 57.2 km per
week; mean age 27.8
Depression, stress, tension and
personality proﬁles (Chinese version of
the Personality Research Form)
Investigating the relationship
between running and depression,
stress, tension and personality
proﬁles
Running increased mood, happiness and outlook, while relieving anger, depression and
aggression, but none reported the size of changes or signiﬁcance; 36.4% of participants
reported “improving mental health” as a reason to start running. Emotional beneﬁts from
running reported were more self-conﬁdent (59.1% of respondents), happier (56.8%), better
mood (50.0%), relieved tension (45.5%), better self-image (36.4%), relieved depression (36.4%),
more aggression (36.4%), improved outlook (34.1%), more content (31.8%) and better family
relationship (15.9%). However, when participants stopped running, 38.6% experienced low
mood and 25.0% experienced anxiousness. More experienced runners, compared to less
experienced runners, were less aggressive or easily angered (t = 2.92, df = 42, p < 0.01),
less guarded or defensive (t = 2.13, df = 42, p < 0.005) and more likely to present themselves
favourably (t = 2.68, df = 35, p < 0.05).
Chapman et al.
[49]
(1990)
USA
Cross-sectional
n = 47 runners; 32 males aged
34–57 and 15 females aged 35
to 59
Running addiction, psychological
characteristics and running (Running
Addiction Scale, Commitment to
Running Scale, Symptom Checklist
(SCL-90-R) and Levenson’s Locus of
Control Scale)
Investigating the relationship
between running addiction,
psychological characteristics
and running
Results suggest a sex diﬀerence in the relationship between addiction and commitment,
in that commitment to running can occur without addiction in females. Running Addiction
Scale (RAS) scores correlated strongly for both sexes with self-rated addiction (p < 0.05) and
moderately with discomfort (p < 0.05). However, the Commitment to Running Scale (CR) did
not signiﬁcantly correlate with self-rated addiction in females (0.246, ns) while RAS did
(0.753, p < 0.05) (z = 2.00, p < 0.05). Running addiction was associated with a high frequency
of running (p < 0.05) and longer duration of running (males = p < 0.05; females = ns). The CR
score correlated signiﬁcantly with run frequency for male (0.59, p < 0.05) but not female
runners (0.14, ns), while CR and run duration did not correlate signiﬁcantly for either sex
(males = 0.16, females = 0.28, n.s.). Duration of running was associated with mood
enhancement, implying that the beneﬁts of running to mood may be obtained without
addiction. Males were above the norm for obsessive–compulsive tendencies (SCL-90 score)
and signiﬁcantly higher than for females (p < 0.05), with running addiction associated with
male-positive personality characteristics (p < 0.05) but not with mood enhancement.
There were no signiﬁcant correlations with personality traits for females.
Guyot [50]
(1991)
USA
Cross-sectional
n = 370 regular long-distance
runners; 289 males, mean age 38;
81 females, mean age 35
Addiction and death anxiety (Dickstein
Death Concern Scale and
author-created questionnaires for pain
running, running motives, risk taking
and medical symptoms)
Investigating the relationship
between addiction and death
anxiety between pain runners
and non-pain runners
Of the 370 runners, 56% pushed themselves during running until they felt pain. Compared to
non-pain runners, pain runners were more likely to be male, taller (F(1,366) = 11.45, p < 0.05),
heavier (F(1,366) = 9.19, p < 0.05) and younger (F(1,366) = 5.75, p < 0.05). Overall, results
suggest that runners classiﬁed as pain runners experienced signiﬁcantly more death thoughts
(F(1,364) = 5.04, p < 0.05) and death anxiety (F(1,364) = 8.86, p < 0.05) than non-pain runners.
Maresh et al. [51]
(1991)
USA
Cross-sectional
n = 29 male distance runners;
mean age 40.1
Psychological characteristics including
anxiety, depression and stress
(Myers–Briggs Type Indicator Form
and Multidimensional
Anger-Inventory)
Investigating psychological
characteristics including anxiety,
depression and stress in
distance runners
Results suggest that long-term involvement in running is associated with low levels of
self-reported anxiety (m = 2.5 on a 6-point scale), depression (M = 1.8) and stress (m = 2.5).
Runners’ personality proﬁles diﬀered from the normative sample, suggesting that running is
associated with more introverted personalities compared to men in the general population.
Compared to a normative sample of male control students, runners were less angry overall,
less frequently angry, and angry across fewer situations. However, 82% of runners reported
withdrawal symptoms when forced to be inactive, with a self-reported addiction average of
4.4 (“moderately” to “very”) on a 6-point scale.
Gleaves et al. [52]
(1992)
USA
Controlled
cross-sectional
n = 60 female participants;
runners (n = 20), bulimia patients
(n = 20) and a non-exercising,
non-dieting control group (n = 20)
Depression, body image and bulimia
nervosa symptomology (Beck’s
Depression Inventory, Body Image
Assessment Procedure, subscales from
the Eating Disorder Inventory,
Automatic thoughts Questionnaire and
dieting/weight loss questionnaire)
Comparing depression, body
image disturbance and bulimia
nervosa symptomology in
runners, bulimia patients and a
non-exercising, non-dieting
control group
No diﬀerences were found between runners and controls throughout the study. Bulimics had
signiﬁcantly higher depression scores than runners and controls (20.65, 3.30 and 4.80
respectively, F = 56.95, p < 0.0001), but runners and controls did not diﬀer from each other.
The same pattern of results was found for the Autonomic Thoughts Questionnaire (F = 45.87,
p < 0.0001) and Eating Disorder Inventory (F = 34.95, p < 0.0001), with bulimics scoring
higher, but no signiﬁcant diﬀerence was found between runners and controls:
ATQ means = 85.40, 41.10 and 41.50, respectively, and EDI means = 12.80, 0.80 and 1.60,
respectively. There were signiﬁcant group eﬀects for all three variables of body image
(p < 0.01); again, bulimics diﬀered from runners and controls.
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Table 2. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Coen et al. [53]
(1993)
USA
Cross-sectional
n = 142 male marathon runners;
mean age 44.07; obligatory
runners (n = 65) vs.
non-obligatory runners (n = 77)
Anxiety, anorexia and self-identity
(Obligatory Exercise Questionnaire,
State-Trait Personality Inventory and
The Ego Identity Scale)
Investigating the relationship
between obligatory running vs.
non-obligatory running on
anxiety, anorexia and self-identity
Compared to the non-obligatory runners, the obligatory group ran signiﬁcantly more miles
per week,0 spent more time running each week (t(140) = 13.19, p < 0.001) and had signiﬁcantly
higher levels of anxiety (18.85 vs. 6.45, respectively, (p < 0.01), suggesting that running
represents a successful coping mechanism to reduce anxiety. There was no statistically
signiﬁcant diﬀerence in Ego Identity Scale score (p > 0.05), indicating that neither group
showed a higher developed sense of identity.
Furst et al. [54]
(1993)
USA
Controlled
cross-sectional
n = 188 participants, with n = 98
runners: 72 males and 26 females
vs. n = 90 gym exercisers: 60
males and 30 females; majority
aged 20–29
Negative addiction (Negative
Addiction Scale)
Comparing negative addiction in
runners vs. gym exercisers
A signiﬁcant association was found between years of participation in physical activity and
addiction scores (F(5,182) = 6.39, p < 0.01) regardless of the type of activity, with no signiﬁcant
diﬀerences in addiction scores between runners and gym exercisers.
Masters et al. [55]
(1993)
USA
Cross-sectional
n = 712 participants in a
marathon; 601 males and 111
females; aged 16–79
Self-esteem and psychological coping
of runners (Motivation of Marathoners
Scales, Sport Orientation
Questionnaire, Marlowe–Crowne
Social Desirability Scale, Attentional
Focusing Questionnaire, and 3 body
satisfaction and composition questions)
Investigating self-esteem and
psychological coping of marathon
runners
Participation in marathon running and training was used as a way to problem solve with
self-distraction for psychological coping (r(66) = 0.54, p < 0.001), improving self-esteem (r(66)
= 0.31, p < 0.01) and life meaning (r(66) = 0.36, p < 0.01). Marathon runners reporting higher
anxiety levels were more likely to endorse psychological motives for marathon running,
indicating that their running helps them avoid or dampen negative emotional experiences:
psychological coping (r(62) = 0.38, p < 0.01) and self-esteem (r(62) = 0.36, p < 0.01).
Women more strongly endorsed weight concern as a reason for involvement in marathons
(t(588) = −3.52, p < 0.001). Personal goal achievement and competition were both positively
related to training miles per week (r(575) = 0.22, p < 0.001 and r(576) = 0.30, p < 0.001,
respectively).
Pierce et al. [56]
(1993)
USA
Cross-sectional
n = 89 male runners; n = 33
non-competitive runners vs.
n = 24 5-km runners vs. n = 32
marathoner runners
Exercise dependence (negative
addiction scale)
Comparing exercise dependence
in recreational (non-competitive)
runners vs. 5-km runners vs.
marathoner runners
Training mileage was signiﬁcantly correlated with exercise dependence, with marathoners
showing signiﬁcantly higher (p < 0.05) mean exercise dependence scores (3.78) compared to
5K (2.9) and recreational runners (2.16). There was no signiﬁcant diﬀerence in exercise
dependence scores found between recreational and 5K runners.
Klock et al. [57]
(1995)
USA
Controlled
cross-sectional
n = 22 females who were not
currently pregnant or taking oral
contraceptives; amenorrhoeic
runners (n = 7, mean age 28.0),
eumenorrheic runners (n = 9,
mean age 32.1) and eumenorrheic
sedentary women as controls
(n = 6, mean age = 27.5)
Depression, anorexia nervosa,
excessive exercise and eating disorder
(The modiﬁed Body Image
Questionnaire, the Beck Depression
Inventory, the Symptom Checklist-90
and the Eating Disorders Inventory)
Comparing depression, anorexia
nervosa, excessive exercise and
eating disorders in amenorrhoeic
runners, eumenorrheic runners
and eumenorrheic sedentary
women as controls
No signiﬁcant diﬀerences were found between amenorrhoeic runners, eumenorrheic runners
and eumenorrheic sedentary controls on any of the psychological measures; hence,
these results do not suggest that there are psychological similarities between obligatory
runners and anorexics. However, there was a subgroup of amenorrhoeic runners (3 out of 9)
who scored in the clinically depressed range on the BDI, indicating that they were mild to
moderately depressed, and who also had the highest scores in their group on the Eating
Disorder Inventory measures.
Thornton et al.
[58]
(1995)
UK
Cross-sectional
n = 40 long-standing, habitual
male runners who ran on average
4 times per week with a weekly
mileage of 42.5 miles;
mean age 38
Addiction (Rudy and Estok Running
Addiction Scale, the Hailey and Bailey
Running Addiction Scale, and the
Personal Incentives for Exercise
questionnaire)
Investigating a relationship
between habitual running and
addiction
A high level of commitment in runners was found, with 55% classiﬁed as moderately
committed (scores 13–20) and 22% classiﬁed as highly “addicted” (scores +20), but no
relationship between years of running and addiction scales was found. This contrasts the
signiﬁcant correlations between both the Estok RAS and frequency of running (rs = 0.38;
p < 0.05) and the Bailey RAS and number of runs per week (rs = 0.55; p < 0.01).
The correlation between the two addiction scales revealed a strong positive relationship
(rs = 0.81; p < 0.001). The primary motivation for running was mastery (mean Personal
Incentives for Exercise score of 4.2), followed by competition (3.93), weight regulation (3.9),
health beneﬁts (3.89), ﬁtness (3.87) and social recognition (3.01).
Powers et al. [59]
(1998)
USA
Controlled
cross-sectional
n = 57; habitual male runners
(n = 20), habitual female runners
(n = 20) and female anorexia
nervosa patients (n = 17)
Psychological proﬁles (Minnesota
Multiphasic Personality Inventory,
Leyton Obsessional Inventory, Obligate
Running Questionnaire, Becks
Depression Inventory and three body
image tests)
Comparing psychological proﬁles
of habitual male runners, habitual
female runners and female
anorexia nervosa patients
Signiﬁcant diﬀerences in body image between groups (F = 7.969, p < 0.001) were found,
but no signiﬁcant diﬀerences between female groups were found. Anorexics scored higher
than either group of runners (p < 0.001) for MMPI subscales of depression, hysteria and
psychopathic deviate, while none of the mean scores for either set of runners were considered
clinically signiﬁcant. Anorexics scored higher on the Becks Depression Inventory than both
male and female runners (F = 68,645, p < 0.0001, mean scores = 23, 2.4 and 3.45, respectively),
but again, there was no signiﬁcant diﬀerences between the runners. While there were
suggestive similarities between female runners and anorexics on body image, the overall
results found few psychological similarities between anorexia patients and habitual runners,
with evidence of signiﬁcant psychopathology on all psychological measures in the anorexia
group, while both groups of runners were consistently in the normal range.
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Table 2. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Slay et al. [60]
(1998)
USA
Cross-sectional
n = 324 regular runners;
240 males and 84 females;
84 classiﬁed as obligatory
runners: 63 males and 21 females;
ages 15–71
Eating pathology traits (Eat Attitudes
Test, and Obligatory Running and
Motivations for Running
Questionnaire)
Comparing eating pathology
traits between obligatory and
non-obligatory runners
Obligatory runners, particularly females, are most at risk of eating pathophysiology,
as obligatory runners scored signiﬁcantly higher on the EAT test, with female obligatory
runners having the highest mean EAT score (r = 0.40, p < 0.0002). At low levels of obligatory
running, women and men scored similarly on the EAT test (F(1,164) = 2.78, p > 0.05); however,
at higher levels of obligatory running, women demonstrated signiﬁcantly higher EAT scores
than men (F(1,164) = 29.50, p < 0.001).
Ryujin et al. [61]
(1999)
USA
Controlled
cross-sectional
n = 55 female participants;
collegiate distance runners
(n = 20) vs. non-running
undergraduate student controls
(n = 35)
Eating disorder symptomology
(Eating Disorders Inventory 2)
Comparing eating disorder
symptomology in collegiate
distance runners to non-running
undergraduate student controls
Distance runners showed no enhanced symptomatology of eating disorders; instead,
female distance runners exhibited fewer symptoms of eating disorders on all subscales of the
Eating Disorder Inventory-2 except Perfectionism: drive for thinness (t(107) = 3.34, p < 0.005),
bulimia (t(107) = 2.48, p < 0.05) and body dissatisfaction (t(107) = 4.23, p < 0.001).
Leedy [62]
(2000)
USA
Controlled
cross-sectional
n = 276 runners with an average
of 11.5 years of running
experience; 239 men, mean age
37.9; 37 women, mean age 40.5
Depression and anxiety (Diagnostic
and Statistical Manual-IV, and an
author-adapted scale based on the
Running Addiction Scale)
Comparing depression and
anxiety in runners to non-runners
Of the non-runners and runners, 16.2% and 4.6%, respectively, had been diagnosed with an
anxiety disorder or prescribed an anxiolytic medication. These participants had signiﬁcantly
higher anxiety trait scores than those without a diagnosis: F(1,274) = 18.87, p < 0.0001; 27% of
non-runners and 11.8% of runners reported a diagnosis of depression or were prescribed an
antidepressant. These participants had signiﬁcantly higher measures of depression traits:
F(1,274) = 22.46, p < 0.0001. Women’s Stress Relief scores were signiﬁcantly higher than men’s
(F(1,229) = 20.51, p < 0.001). Stress relief scores also varied across race length (F(2,229) = 6.47,
p < 0.005), indicating that runners entered in the 5–10K runs had lower scores than those
running the half/full marathon. Results indicate that highly committed runners (n = 31) had
signiﬁcantly lower anxiety (F(2,113) = 5.73, p < 0.01) and depression scores (F(2,113) = 8.00,
p < 0.001) than recreational runners (n = 46) and non-runners (n = 39).
Edwards et al. [63]
(2005)
South Africa
Cross-sectional
n = 277 participants; 94 males and
183 females; mean age 25.2;
hockey players (n = 60), runners
(n = 40) and health club gym
members (n = 69) vs. a control
group of non-exercisers (n = 108)
Psychological well-being and physical
self-perception (Ryﬀ’s Short
Standardized 18-item scale of Objective
Psychological Well-being, Fox’s
Physical Self-Perception Proﬁle (PSPP)
and the Physical
Self-Perception Proﬁle)
Comparing psychological
well-being and physical
self-perception in hockey players,
runners and health club gym
members vs. a control group of
non-exercisers.
All three forms of physical activity were associated with signiﬁcantly higher (p < 0.01) scores
on 11 out of the 15 dimensions of psychological well-being and physical self-perception
scales compared to the control group: autonomy (F = 11.3), personal growth (F = 35.4),
environmental mastery (F = 9.6), purpose in life (F = 149.2), positive relations with others
(F = 81.6), self-acceptance (F = 50.4), sport competence (F = 41.3), conditioning (F = 28.1),
sport importance (F = 11.7), conditioning importance (F = 28.1) and body importance
(F = 31.0).
Schnohr et al. [64]
(2005)
Denmark
Observational
cohort study
n = 12,028 participants;
5479 males and 6549 females;
aged 20–79
Stress (An author-created
questionnaire)
Comparing stress levels between
jogging and various levels of
physical (in)activity in
leisure time
Those who were vigorously physically active (joggers) had the lowest level of stress
compared to those with low activity levels (males, 3.1% vs. 12.8%, respectively; female,
3.3% vs. 19.3%, respectively). With increasing physical activity in leisure time, there was a
decrease in level of stress between sedentary persons and joggers (Odds Ratio (OR) = 0.30)
and a decrease in life dissatisfaction between sedentary persons and joggers (OR = 0.30).
The highest levels of stress and dissatisfaction was seen in sedentary persons who remained
inactive at follow-up, while the group that changed from sedentary to active had an adjusted
OR < 0.50.
Strachan et al. [65]
(2005)
Canada
Prospective
longitudinal study
n = 67 regular runners; 32 were
male and 35 were female; mean
age of 40.6
Self-eﬃcacy and self-identity
(author-created measures of task
self-eﬃcacy and self-regulatory eﬃcacy,
and a 10-item, validated athletic
identity measurement scale)
Investigating the relationship
between running and self-eﬃcacy
and self-identity
Signiﬁcant comparisons were made between extreme self-identity groups on social cognitive
and behavioural variables (F(5,37) = 4.72, p < 0.002), with those higher in self-identity scoring
higher on task self-eﬃcacy (p < 0.001), scheduling self-eﬃcacy (p < 0.03), running more
frequently (p < 0.001) and running for longer durations (p < 0.005) than those who scored
lowest on self-identity. Both scheduling self-eﬃcacy (R2 change = 0.16, p < 0.001) and barriers
to self-eﬃcacy (R2 change = 0.22, p < 0.001) were correlated with self-identity to prospectively
predict running frequency (F(2,64) = 9.98, p < 0.001; F(2,63) = 12.89, p < 0.001, respectively).
Both task self-eﬃcacy (R2 change = 0.06, p < 0.05) and self-identity (R2 change = 0.06,
p < 0.04) were signiﬁcant predictors of maintenance duration.
Int. J. Environ. Res. Public Health 2020, 17, 8059
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Table 2. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Galper et al. [66]
(2006)
USA
Retrospective
cross-sectional
n = 6728 participants; 5451 males
with a mean age of 49.5 and 1277
females with a mean age of 48.1;
inactive (n = 1454 men and
n = 422 women), insuﬃciently
active (n = 1892 men and n = 443
women), suﬃciently active
(n = 1396 men and n = 283
women) and highly active
(n = 709 men and n = 129 women)
Depression and emotional well-being
(Center for Epidemiological Studies
Scale for Depression and the General
Well-Being Schedule)
Assessing retrospectively if the
level of walking/running
impacted depression and
emotional well-being
Signiﬁcant inverse association between increased physical activity and reduced depression
scores for both men (F(6, 5306) = 20.93, p < 0.0001) and women (F(6, 1247) = 11.80, p < 0.0001)
and a positive association between increased physical activity and increased well-being
scores in men (F(6, 5306) = 78.65, p < 0.0001) and women (F(6, 1247) = 24.82, p < 0.0001) were
found. These eﬀects peaked at 11–19 miles per week (the suﬃciently active category).
Luszcynska et al.
[67]
(2007)
UK
Longitudinal
prospective cohort
study
n = 139 runners; 111 males and 29
females; mean age of 29.5; strong
(n = 72) and weak (n = 66)
maintenance self-eﬃcacy, strong
(n = 72) and weak (n = 61)
recovery self-eﬃcacy, and strong
(n = 87) and weak (n = 45)
intentions
Self-eﬃcacy and running behaviour
(an author-created questionnaire)
Investigating the relationship
between self-eﬃcacy and running
behaviour with data collected
twice with a time gap of 2 years
Participants decreased the frequency of running sessions after 2 years, regardless of baseline
intensions or self-eﬃcacy; however, those with stronger recovery in self-eﬃcacy jogged more
than those with weaker recovery in self eﬃcacy 2 years later. All participants reduced the
number of jogging or running sessions over 2 years (F(1,131) = 43.43, p < 0.001); however,
those with strong baseline recovery self-eﬃcacy ran/jogged more often at 2 years than those
who had weak recovery self-eﬃcacy at baseline (F(1,131) = 6.12, p < 0.05). Participants reduced
the number of running or jogging sessions over the 2 years, regardless of strong or weak
intentions at baseline (F(1,130) = 34.55, p < 0.001) or of strong or weak baseline maintenance of
self-eﬃcacy (F(1,130) = 42.12, p < 0.001). No eﬀects of maintenance self-eﬃcacy were found.
Recovery self-eﬃcacy at T1 predicted recovery self-eﬃcacy (p < 0.05), maintenance
self-eﬃcacy (p < 0.05), and jogging or running behaviour (p < 0.05) assessed 2 years later.
Overall, social-cognitive variables predicted behaviour, whereas behaviour did not predict
social-cognitive variables.
Smith et al. [68].
(2010)
UK
Cross-sectional
n = 93 non-competitive, regular
runners; 47 males and 46 females
Exercise dependence, running
addiction and social physique anxiety
(Exercise Dependence Scale, Running
Addiction Scale and Social Physique
Anxiety Scale)
Comparing exercise dependence,
running addiction and social
physique anxiety in male vs.
female runners
While a signiﬁcant proportion of runners displayed symptoms of exercise dependence,
results did not ﬁnd that exercise dependence was linked to social physique anxiety
(F(3.179) = 1.21, p > 0.05) or that there was a diﬀerence between men and women (p > 0.05 in
all cases). There was no signiﬁcant diﬀerence between males and females for running
addiction scale (22.64 and 20.91, respectively), social physique anxiety scale (22.30 and 22.61,
respectively) or total exercise dependence scale scores (72.56 and 66.86, respectively).
Gapin et al. [69]
(2011)
USA
Cross-sectional
n = 179 regular runners; 88 males
and 91 females; 91 obligatory and
88 non-obligatory runners
Disordered eating (Eating Disorder
Inventory, Athletic Identity
Measurement Scale and Obligatory
Exercise Questionnaire)
Comparing disordered eating in
obligatory and non-obligatory
runners.
Obligated running (exercising to maintain identiﬁcation with the running role) may be
associated with pathological eating and training practices, with obligatory runners scoring
signiﬁcantly higher on all of the Eating Disorder Inventory measures (F(1,166) = 9.75,
p < 0.002),and the Athletic Identity Measure Scale (F(8,161) = 8.85, p < 0.001). Results also
indicated that runners in the obligatory group demonstrated greater concern with dieting,
preoccupation with weight and pursuit of thinness.
Wadas [70]
(2014)
USA
Cross-sectional
n = 68 male, high school cross
country runners; mean age 15.9
Disordered eating behaviours
(questionnaire consisting of The
Exercise Motivation Inventory 2,
the Eating Attitudes Test 26 and the
ATHLETE questionnaire)
Investigating any relationship
between male runners with
disordered eating behaviours and
eating attitudes
Risk factors associated with eating disorders within high school male cross-country runners
were found. Factors that had a signiﬁcant relationship with disordered eating were weight
management (r = 0.31, p = 0.011), drive for thinness and performance (r = 0.36, p < 0.05),
and feelings about performance/performance perfectionism (r = 0.26, p < 0.05). No signiﬁcant
relationships were found between disordered eating behaviours and personal body feelings
(r = 0.19, p = 0.109), feelings about eating (r = 0.18, p = 0.137), and feelings about being an
athlete (r = 0.12, p = 0.345); 4.41% (n = 3) of participants scored 20 or higher on the EAT-26,
indicating being at risk for disordered eating and displaying symptoms. An additional 13.2%
(n = 9) met the cutoﬀ score of 14 for disordered eating behaviours.
Samson et al. [71]
(2015)
USA
Cross-sectional
n = 308 marathon runners;
177 males and 191 females;
mean age 41
Self-esteem and psychological coping
(Motivation for Marathons Scale,
The Perceived control questionnaire
and Sport Mental Toughness
Questionnaire)
Investigating the relationship
between self-esteem and
psychological coping with
marathon running
Self-esteem was positively associated with perceived control (r = 0.40) (x27 = 47.08, p < 0.001,
CFI = 0.85 and RMSEA = 0.14) but negatively associated with mental toughness. There was
also a positive relationship between perceived control and psychological coping (r = 0.42)
(x28 = 45.65, p < 0.001, CFI = 0.85 and RMSEA = 0.12). Results of the Motivations of
Marathoners Scales suggested than females were more likely to run to improve psychological
coping (4.8 and 4.42, respectively) and self-esteem (5.22 and 4.62, respectively) than men.
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Table 2. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Lucidi et al. [72]
(2016)
Italy
Cross-sectional
prospective ﬁeld
study
n = 669 runners training for a
marathon; 569 males and 100
females; mean age 42.07
Stress (Perceived Stress Scale,
the Passion Scale and The Italian
version of the Locomotion and
Assessment Scales)
Investigating the relationship
between running and stress in
runners training for a marathon
Results suggest that running does not directly impact stress (β = −0.01; p = 0.75); however,
running increases harmonious passion (β = 0.37; p < 0.001), which in turn reduced athletes’
experience of stress. The indirect eﬀect of running on anticipatory stress perception through
harmonious passion was statistically signiﬁcant (αβ = −0.10; 95% conﬁdence interval:
from −0.15 to −0.05). Similarly, the indirect eﬀect of assessment on stress through obsessive
passion was statistically signiﬁcant (αβ = 0.12; 95% conﬁdence interval: from 0.07 to 0.17).
Results also indicated a signiﬁcant direct eﬀect of assessment on the athletes’ experience of
stress (β = 0.22; p < 0.001).
Batmyagmar et al.
[73]
(2019)
Austria
Prospective
longitudinal study
n = 99 participants; n = 50 elderly
marathon runners, mean age of
66, with 46 men and 4 women vs.
n = 49 non-exercising controls,
mean age of 66, with 44 men and
5 women
Self-reported health and well-being
and quality of life (Short Form Health
Survey-36)
Comparing self-reported health
and well-being,
and quality of life over 4 years in
elderly marathon runners to
non-exercising controls
Findings suggested that extensive high-intensity endurance exercise is linked with improved
subjective health and well-being in elderly persons, with athletes evaluating their health as
better than non-athletes in the following categories: general health perception (F = 14.21,
p < 0.001), vitality (F = 13.37, p < 0.001), social functioning (F = 11.30, p < 0.001), emotional
role functioning (F = 1.42, p < 0.002) and mental health (F = 6.07, p < 0.0016).
Cleland et al. [74]
(2019)
Australia
Cross-sectional
372 participants of “Parkrun”
events; mean age 43.8
Enjoyment, self-eﬃcacy and factors of
participation in Parkrun event
(author-created questionnaires).
Investigating enjoyment,
self-eﬃcacy and factors of
participation in Parkrun event
participants
Overall results suggested that perceived social beneﬁts (B coeﬃcient = 0.43) and self-eﬃcacy
for Parkrun (B coeﬃcient = 0.18) were positively associated with Parkrun participation.
Perceived beneﬁts of Parkrun including enjoyment and social factors (B = 0.70) were
positively associated with participation, as was overall enjoyment (B = 0.30), self-eﬃcacy for
Parkrun (B = 0.46), social support for Parkrun from family (absolute: B = 0.05) and social
support from friends (B = 0.04) related to Parkrun.
Lukacs et al. [75]
(2019)
Hungary
Cross-sectional
n = 257 amateur runners with at
least 2 years of running
experience; 131 males and 126
females; mean age 40.49
Exercise addiction and psychological
features (Exercise Dependence Scale;
a Cantril ladder for Overall life
satisfaction; SCOFF eating disorder
questionnaire; the UCLA 3-item
Loneliness Scale; Body Image Subscale
from Body Investment scale; and the
Depression, Anxiety and Stress
Scale-21).
Investigating the prevalence of
exercise addiction and
psychological features in amateur
runners, including perceived
health, life satisfaction, loneliness,
stress, anxiety, depression, body
shape and eating disorders
Respondents (137) were characterized as nondependent symptomatic, 97 were nondependent
asymptomatic and 23 were at risk of exercise addiction. Results found that ﬁve variables
signiﬁcantly predicted the risk of exercise addiction in runners: weekly time spent running,
childhood physical activity, lower educational attainment, anxiety and loneliness (ranges of B
= 0.47 to 2.06, 95% CI for odds ratio = 1.61 to 7.86, p < 0.001 to p = 0.023).
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3.2.1. Runners Versus Non-Running Comparisons
Sixteen of the 47 studies directly compared measures of mental health in runners and non-running
comparisons [29,33,36,37,40–42,45–47,57,61–64,73]. They found that runners had lower depression and
anxiety [33,36,37,40,41,45–47,62], lower stress [64], higher psychological well-being [63,73], and better
mood [29] compared to sedentary controls. In these studies, there was no evidence of increased
prevalence of eating psychopathology in non-elite runners [42,57,61].
3.2.2. Runners Only
Nineteen studies only included runners [30,31,34,35,39,44,48,49,51,55,58,65–67,70,74–76] and
compared diﬀerent levels and types of running. Some studies found a positive association with
higher self-identity runners and low levels of depression and high self-eﬃcacy [30,65–67,74].
Studies investigating marathon training found a positive relationship of marathon training with
self-esteem and psychological coping [55,71]. Two questionnaires of long-distance runners found a
correlation between long-distance running and disordered eating behaviours, with obligatory runners
(obsessive runners who sacriﬁced commitments and relationships for running and suﬀered withdrawal
symptoms if they missed a run) exhibiting traits characteristic of anorexia nervosa patients [39] and risk
factors for eating disorders identiﬁed within male high school cross-country runners [70]. One study of
runners training for a marathon suggested that running did not directly impact stress [72]. There were
conﬂicting results from papers investigating negative addiction; one indicated that with more years
spent running came a greater risk of negative addiction [34], while another found no relationship
between years of running and addiction [58] and another found a sex diﬀerence in that commitment to
running can occur without addiction in female runners but not in males [49]. Another paper found
that ﬁve variables signiﬁcantly predicted risk of exercise addiction in runners: weekly time spent
running, childhood PA, lower educational attainment, anxiety and loneliness [75]. The remaining
four cross-sectional studies of runners only found that, since participating in running, they had better
emotional well-being, relief of tension, self-image and self-conﬁdence, mood, depression, aggression
and anger, anxiety and happiness, but not all reported signiﬁcance or eﬀect size [31,35,44,48,51].
A further eight studies compared groups of runners [32,38,50,53,56,60,68,69]. One paper found
that females jogging with greater intensity had signiﬁcantly less anxiety than those jogging at lower
intensities [38]. The results from these studies showed that obligatory runners had signiﬁcantly
higher anxiety [53] and eating disorder measures [60,69] than non-obligatory runners and that female
obligatory runners are most at risk of eating pathophysiology [60]. Non-elite marathoners showed
signiﬁcantly higher exercise dependence scores [56] but had more self-suﬃcient personalities compared
to recreational runners who did not run marathons [32].
One paper did not ﬁnd that exercise
dependence was linked to social physique anxiety [68], while another found that runners classiﬁed as
pain runners (pushed themselves until they felt pain) experienced signiﬁcantly more death thoughts
and death anxiety than non-pain runners [50].
3.2.3. Runners Compared to Individuals with Eating Disorders
Two studies compared runners to individuals with diagnosed eating disorders but neither indicated
that habitual running led to development of disordered eating or body-image problems [52,59].
3.2.4. Prevented Runners
One study found that habitual runners prevented from running by illness or injury had signiﬁcantly
greater overall psychological distress, depression and mood disturbance than continuing runners as
well as signiﬁcantly lower self-esteem and body-image [43].
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3.2.5. Runners Compared to Gym Exercisers
A study comparing negative addiction in runners versus gym exercisers found signiﬁcant
association between years of participation in running and gym exercise with negative addiction,
regardless of activity type [54].
3.2.6. Summary of Cross-Sectional Evidence
Consistent evidence was found for a positive association between positive mental health outcomes
and habitual or long-term recreational running compared to non-runners. In contrast, there was
evidence that high or extreme levels of running (high frequency and long distance including marathon
running) were associated with markers of running ill-health compared to levels of moderate running.
3.3. Category 2: Acute Bouts of Running
Narrative description of ﬁndings of the 35 studies with an acute bout of running are included
within Tables S2–S4 within the supplementary material.
3.3.1. Single Bouts
Twenty-three studies incorporated a design using a single bout of running to compare pre-post
measurements of mood and short-term measures of mental health (Table 3) [77–99]. Twenty-two of
these found positive improvement in measures of mental health (including anxiety, depression and
mood); however, one found a decrease in self-eﬃcacy of children following participation in gymnasium
PACER (progressive aerobic cardiovascular endurance run) running challenge [95].
Eleven studies used a single bout of treadmill running, and all found positive pre-post diﬀerences in
mental health outcomes [84–86,88–93,97,99]. Results found signiﬁcant reductions in state-trait anxiety;
total mood disturbance; and POMS subscales of anxiety, depression and confusion. A single bout
of treadmill running also signiﬁcantly improved self-esteem; psychological well-being; children and
adolescent self-eﬃcacy; state anxiety, depression and totally mood disturbance; adult self-eﬃcacy;
and general aﬀective response. One study found that mood improvements were not evident until
40 min of running [88], while another found that depressed individuals participating in a treadmill run
with increasing gradient improved depressed mood immediately post-run but that depressed mood
increased at 30-min postexercise [93].
Three studies used a single bout of track running and found signiﬁcant decreases in anxiety [78,87]
and total mood disturbance [81]. Two studies found that a single outdoor run signiﬁcantly improved
depression scores and that even a 10-min jog caused signiﬁcant mood enhancement [80,94]. Two studies
found that a single bout of self-paced running signiﬁcantly reduced all but one of the POMS subscales
and had signiﬁcant positive changes in all measures of states of aﬀect [82,96].
There were signiﬁcant improvements for self-esteem, stress and total mood disturbance following
a 5-km Parkrun [98], while a 3-mile “fun-run” increased positive mood and decreased negative
mood [83]. Two studies used longer runs as exposures: one found that a 1-h run signiﬁcantly reduced
anxiety and nonsigniﬁcantly reduced depression [79], while the other found that a 12.5-mile jog
signiﬁcantly improved pleasantness; decreased trait anxiety; nonsigniﬁcantly increased activation; and
reduced state-anxiety, sadness, anxiety, depression and relaxation subscales [77].
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Table 3. Summary of data extraction from the 23 single-bout studies.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Nowlis et al. [77]
(1979)
Canada
Pre-post non-controlled
study
n = 18, experienced joggers; 5 females
and 13 males; age range 17 to 55
Mood and anxiety (Mood
Adjective Checklist and State
Trait Anxiety Inventory)
Impact of a 12.5-mile jog on mood
and anxiety
Signiﬁcant improvement in measures of pleasantness (2.00 to 2.67, p < 0.01);
a signiﬁcant decrease in trait anxiety (34.81 to 33.31, p < 0.10); a nonsigniﬁcant
increase in activation; a reduction in state-anxiety; and a reduction of sadness,
anxiety, depression and relaxation subscales
Wilson et al. [78]
(1981)
Canada
Pre-post controlled study
n = 42; 20 runners, 12 aerobics class
exercisers vs. 10 people having lunch;
23 females and 19 males; age range 21
to 28
Anxiety (State-Trait Anxiety
Inventory)
Impact of a solo indoor track run
on anxiety
Signiﬁcant decrease in anxiety post-activity (F(1,39) = 15.63, p < 0.003)
Markoﬀ et al. [79]
(1982)
Hawaii
Pre-post non-controlled
n = 15, all had run at least 1 marathon;
11 males and 4 females; aged 23–45
Mood (Proﬁle of Mood States)
Impact of a 1-h run on mood
Signiﬁcant reduction in anxiety (t = 2.72, p < 0.01) and a nonsigniﬁcant
reduction in depression (t = 1.80, n.s.)
Thaxton et al. [80]
(1982)
USA
Non-randomised
controlled trial
n = 33, regular runners; 24 males and 9
females; mean age 36; 4 groups: outdoor
running test (n = 6), pre-test but no
running test (n = 9), no pre-test but
running test (n = 11), and no pre-test and
no running test (n = 7).
Mood (Proﬁle of Mood States)
Impact of 30 min outdoor
running on mood
Signiﬁcant diﬀerences in the depression scores between the 30 min outdoor
running group and abstaining groups (F(1,29) = 4.8, p < 0.05) but no signiﬁcant
diﬀerences between anxiety, vigour and fatigue scores
McGowan et al.
[81]
(1991)
USA
Non-randomised
controlled trial
n = 72, college students; 25 joggers vs. 11
karate vs. 26 weight lifters vs. 10 science
lecture class members
Mood (Proﬁle of Mood States)
Impact of 75 min of jogging on an
outdoor track on mood
Signiﬁcant decrease in total mood disturbance from pre- (35.68) to post- (24.16)
test (t24 = 2.84, p < 0.009) following 75 min of jogging on a track
Goode et al. [82]
(1993)
USA
Pre-post non-controlled
n = 150, regular runners; 104 males,
36 females; mean age 31.7
Mood (Proﬁle of Mood States)
Impact of own training for
running on mood
Signiﬁcant alterations in all but one (vigor) of the POMS scales, with a
signiﬁcant reduction post-run in tension/anxiety (mean change of −3.1, p < 0.1),
depression (mean change of −1.5, p < 0.1), confusion (mean change of −1.1,
p < 0.1) and anger (mean change of −1.8, p < 0.1) and a signiﬁcant increase in
fatigue post-run (mean change of +1.8, p < 0.1).
Morris et al. [83]
(1994)
UK
Pre-post non-controlled
n = 165, members of a road runners club;
98 males and 67 females; mean age 34
Mood (author-devised adjective
checklist based on POMS)
Impact of a 3 mile “fun-run” on
mood
Increase in positive mood (F(1,163) = 68.18, p < 0.001), decrease in negative mood
(F(1.163) = 47.62, p < 0.001) and greater improvements in mood in women than in
men that was not signiﬁcant (p > 0.1).
Rudolph et al. [84]
(1996)
USA
Randomised
non-controlled trial
n = 36, moderately active female
university students; n = 12 for 10-, 15-
and 20-min interventions; mean age 20.6
Self-eﬃcacy (Exercise-Eﬃcacy
Scale)
Impact of various timings of
treadmill running on self-eﬃcacy
(10, 15 and 20 min)
Signiﬁcant increase in mean scores of self-eﬃcacy in all 3 groups, from pre to
postexercise (F(1, 33) = 74.57, p < 0.001), and moderate eﬀect sizes in the 15-
(ES = 0.36) and 10- (ES = 0.49) minute conditions although the largest eﬀect size
(ES) occurred in the 20-min condition (ES = 0.68)
Cox et al. [85]
(2001)
USA
Randomised controlled
trial
n = 24, physically active male university
students; mean age of 28.3
Psychological aﬀect and
well-being (Subjective Exercise
Experiences Scale)
Impact of 30 min of treadmill
jogging at either 50% or 75%
predicted VO2 max on
psychological aﬀect and
well-being
Signiﬁcant improvement in psychological well-being following an acute bout of
aerobic exercise (p = 0.037, η2p = 0.07)
O’Halloran et al.
[86]
(2002)
Australia
Pre-post non-controlled
n = 50, regular runners; 25 males and 25
females; mean age 26.6
Mood (Proﬁle of Mood States and
Beliefs Concerning Mood
Improvements Associated with
Running Scale)
Impact of a 60-min treadmill run
on mood
Signiﬁcant reductions in anxiety (composed-anxious POMS scale = 25.6 to 29.12,
p < 0.05, i.e., more composed-less anxious) and depression (elated-depressed
POMS scale = 24.56 to 27.10, p < 0.01, i.e., more elated-less depressed)
Szabo et al. [87]
(2003)
UK
Pre-post non-controlled
time series
quasi-experimental
n = 39, sports science university students;
22 males and 17 females; aged 20–23
Anxiety, positive well-being and
psychological distress
(Spielberger State Anxiety
Inventory and Exercise induced
Feeling Inventory)
Impact of 20 min of track running
on anxiety and feelings
Signiﬁcant reduction in state anxiety (F(1.5, 58.3) = 5.32, p < 0.01) and a positive
eﬀect on psychological distress and positive well-being
O’Halloran et al.
[88]
(2004)
Australia
Randomised controlled
trial
n = 160 regular runners; 80 did run vs. 80
no running; 80 males and 80 females;
aged 18–40
Mood (Proﬁle of Mood States and
Beliefs Concerning Mood
Improvements Associated with
Running Scale).
Impact of a 60-min treadmill run
on mood
Improvements in composure, energy, elation and mental clarity during the run;
in the energetic-tired subscale, evident improvements at 25 min (F(1,156) = 10.09,
p = 0.002); in the rest, non-evident mood improvements until 40 min of running;
and more composure (less anxious) (F(1,156) = 9.47, p = 0.002) and more clear
headedness (less confused) (F(1,156) = 5.57, p = 0.02) in runners
Robbins et al. [89]
(2004)
USA
Pre-post non-controlled
n = 168, inactive children and
adolescents; 86 males and 82 females;
mean age 12.6
Self-esteem using the Walking
Eﬃcacy Scale
Impact of a 20-min treadmill run
on self-eﬃcacy in children and
adolescents
Signiﬁcant increase in children and adolescents’ self-eﬃcacy postexercise
(F(1, 158) = 84.31, p < 0.001) but signiﬁcantly lower pre-activity self-eﬃcacy in
African American girls reported than the other three race-gender groups (F(3,164)
= 5.55, p < 0.01)
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Table 3. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Pretty et al. [90]
(2005)
UK
Randomised controlled
trial
n = 100; 45 males and 55 females; mean
age 24.6
Mood and self-esteem (Proﬁle of
Mood States and Rosenberg
Self-Esteem Questionnaire)
Impact of a 20-min treadmill run
with rural vs. urban stimuli on
mood and self-esteem
Signiﬁcant increase in self-esteem (from 19.4 to 18.1 on the Rosenberg
Self-Esteem Questionnaire, p < 0.001), with rural and urban pleasant stimuli
producing a signiﬁcantly greater positive eﬀect on self-esteem than exercise
alone, while both rural and urban unpleasant scenes reduced the positive eﬀects
of exercise on self-esteem
Hoﬀman et al. [91]
(2008)
USA
Pre-post pre-experimental
study
n = 32; 16 regular exercisers and 16
non-exercisers; 8 males and 8 females in
each group
Mood (Proﬁle of Mood States)
Impact of a 30-min treadmill run
on mood
Decreased total mood disturbance in a 30-min treadmill run in both regular
exercisers (−16 points, 95% CI = 7–24) and non-exercisers (−9 points, 95%
CI = 1–18) but almost double the eﬀect in exercisers.
Kwan et al. [92]
(2010)
USA
Pre-post non-controlled
n = 129; 62 males and 67 females; mean
age 22
General aﬀective response
(Physical Activity Aﬀect scale)
Impact of a 30-min treadmill run
on general aﬀective response
Positive eﬀect of the run on general aﬀective response during exercise (b = 0.52,
SE = 0.09, p < 0.0001) and 15 min postexercise (b = 0.73, CI.95 = 0.56, 0.89,
t(126) = 8.63, p < 0.0001).
Weinstein et al.
[93]
(2010)
USA
Pre-post controlled study
n = 30; 15 males and 15 females; 2 with
minor depressive disorder, 12 with major
depressive disorder and 16 as controls;
mean age 39.8
Mood and depression (Becks
depression Inventory scale and
Proﬁle of Mood States)
Impact of 25 min of increasing
graded treadmill running on
mood and depression
Not only improvements in depressed mood immediately following exercise
(p = 0.02) of 25 min of increasing graded treadmill running but also increased
depressed mood at 30 min postexercise (F(1,27) = 3.98; p = 0.05; ηp2 = 0.13) and
signiﬁcant relation between the severity of depression and increases in
depressed mood (r = 0.60, p = 0.001) at 30 min postexercise
Anderson et al.
[94]
(2011)
UK
Randomised controlled
trial 2 × 2 mixed design
n = 40, from various sports clubs; aged
18–25
Mood (“Incredibly Short Proﬁle
of Mood States”)
Impact of a light 10-min outdoor
jog on mood
Signiﬁcant mood enhancement even with a light 10=min jog on a grass playing
ﬁeld (F(1,38) = 24.18, p < 0.001, n2p = 0.39) compared with a 10-min cognitive task
Kane et al. [95]
(2013)
USA
Pre-post non-controlled
n = 34 school children; 16 males and 18
females; aged 11–14
Self-eﬃcacy (Self-eﬃcacy
questionnaire adapted for
children)
Impact of the running PACER
challenge (20 m sprints with
increasing pace inside a
gymnasium) on self-eﬃcacy
in children
Decrease in self-eﬃcacy following participation in the run (from 2.7 to 2.3
following exercise, t = 4.6, p < 0.001, large eﬀect size of d = 0.79) but positive
correlation between PACER laps and pre- and post-measures of exercise
self-eﬃcacy
Szabo et al. [96]
(2013)
Hungary
Pre-post non-controlled
n = 50 recreational runners; 37 males and
13 females mean age 29.02
States of aﬀect using the Exercise
Induced Feeling Inventory
Impact of a 5 km self-paced run
along a public running path on
states of aﬀect
Signiﬁcant positive changes in all 4 measures of states of aﬀect following a 5-km
self-paced run: revitalisation (F(1,48) = 145.93, p < 0.001, partial n2 = 0.75,
ES = 2.0), positive engagement (F(1,48) = 97.11, p < 0.001, partial n2 = 0.67,
ES = 1.6), tranquillity (F(1,48) = 85.02, p < 0.001, partial n2 = 0.64, ES = 1.5) and
exhaustion (F(1,48) = 32.25, p < 0.001, partial n2 = 0.40, ES = 1.0)
McDowell et al.
[97]
(2016)
Ireland
Randomised controlled
trial
n = 53; 27 males and 26 females;
mean age of 21.2
Mood and anxiety (Proﬁle and
Mood States and State-Trait
Anxiety Inventory)
Impact of a 30-min treadmill run
on mood and anxiety
Signiﬁcantly improved state anxiety (F1,92 = 12.52, p < 0.001), feelings of
depression (F1,86 = 5.05, p < 0.027) and total mood disturbance (F = 36.91,
p < 0.001) compared to 30 min of seated quiet rest
Rogerson et al.
[98]
(2016)
UK
Pre-post non-controlled
mixed between-within
n = 331 Parkrun attendees; 180 males and
151 females; mean age 40.8
Psychological well-being
(Questionnaire containing parts
of the Proﬁle of Mood States,
Rosenberg Self-esteem scale and
Perceived Stress Scale)
Impact of a 5-km park run on
psychological well-being
Signiﬁcant (p < 0.001) improvements post-run for self-esteem (7.7%
improvement; F(1, 324) = 100.58, η2 = 0.24), stress (18.4% improvement;
F(1, 315) = 50.78, η2 p = 0.139) and total mood disturbance (14.2% improvement;
F(1, 278) = 22.15, η2p = 0.07)
Edwards et al. [99]
(2017)
USA
Randomised controlled
trial
n = 27; 8 joggers vs. 9 walkers vs. 10
stretchers; aged 18–35
Stress and anxiety
(Exercise-Induced Feeling
Inventory and Aﬀective
Circumplex Scale, and the
Strait-Trait Anxiety Inventory)
Impact of a 15-min treadmill jog
on stress and anxiety
Emotionally protective eﬀect from a 15-min bout of treadmill jogging (n = 8)
compared to an equivalent amount of time walking (n = 9) or stretching (n = 10)
after exposure to a ﬁlm clip intended to elicit a negative emotional response,
with reduced anxiousness from baseline to post-jog (28.8 to 13.1, p = 0.06) on the
State-Trait Anxiety Inventory, and increased anger score from baseline to
post-ﬁlm clip in the stretching group (1.2 to 26.0, p = 0.048) unlike the walking
(p = 0.11) and jogging (11.3 to 9.4, p = 0.19) groups
Int. J. Environ. Res. Public Health 2020, 17, 8059
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3.3.2. Double Bouts
There were nine studies that had a double-bout design [100–108] (Table 4). Eight of the nine
studies were primarily designed to compare conditions rather than to compare the impact of running
on mental health, including green/park versus urban, solo versus group, diﬀerent pacing and diﬀerent
durations of running [101–108]. Seven of the eight studies found that markers of mental health
improved signiﬁcantly after running [101–107]. Only one study was designed to primarily assess the
impact of running on mental health, and although there was no control, they found higher mood and
feelings of pleasantness post-run but these “did not reach signiﬁcance” [100].
Four studies compared park/rural versus urban running, and all found measures of mental health
including anxiety, depression, mood and self-esteem improved post-run [103–105,107]. No paper
reported a statistically signiﬁcant diﬀerence in emotional beneﬁt between park and urban conditions.
Two studies compared solo versus group running: one found that anxiety reduced following both group
and solo running [101], while the other found that children’s anxiety levels increased nonsigniﬁcantly
following individual and group running [108]. One study compared 10- and 15-min runs and found
that they produced similar psychological beneﬁts to mood [102]. Another compared a self-paced
versus prescribed-paced run and found higher self-eﬃcacy before the prescribed-paced run compared
to the self-paced run [106].
3.3.3. Triple Bouts
Three studies used three bouts of running (Table 5) [109–111]. One study found that, while two
indoor runs had a positive eﬀect on mood, the outdoor run had an even greater beneﬁt to mood
with subjects feeling less anxious, depressed, hostile and fatigued and feeling more invigorated [109].
Another study also used 3 runs of varying intensities and found signiﬁcant overall mood beneﬁts
postexercise but no signiﬁcant diﬀerences between intensities [110]. One study compared 3 intensities
of treadmill exercise to a sedentary control condition and found that state anxiety improved following
running at 5% below and at the lactate threshold but that anxiety increased after running at 5% above
the lactate threshold [111]. Overall, these studies suggest that running improves mood, that outdoor
running has a greater beneﬁt to mood and that most intensities of running improve mood, with the
exception of an intensity markedly above the lactate threshold. However, only one study included a
control condition [111].
3.3.4. Summary of Acute Bouts
Overall, these studies suggest that acute bouts of running can improve mental health and that the
type of running can lead to diﬀerential eﬀects. The evidence suggests that acute bouts of treadmill,
track, outdoor and social running (2.5–20 km and 10–60 min) all result in improved mental health
outcomes. There were few diﬀerences between high and low intensities. Studies consistently show that
any running improves acute/short-term mood markers, but the lack of inactive comparison conditions
is a limitation to the strength of the evidence. Little variation in the demographics of participants and
small sample sizes limit generalizability and precision of ﬁndings.
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Table 4. Summary of data extraction from the 9 double-bout studies.
Author
Year
Country
Design
Population
Mental health Outcome
(Measurement)
Study Aim
Main Findings
Krotee [108]
(1980)
USA
Pre-post pre-experimental
non-controlled
n = 78, children aged 7–12.
Anxiety (State-Trait Inventory for
Children)
Impact of 50-metre group vs.
solo run on anxiety
Children’s anxiety levels increased nonsigniﬁcantly following a run in
either an individual (30.54 to 32.72, n.s.) or a group setting (30.67 to 31.83,
n.s.).
Wildmann et al.
[100]
(1986)
Germany
Pre-post non-controlled
n = 21, male long-distance
runners; mean age of 29.8
Feelings of pleasantness and
changes of mood
(Eigenschaftsworterliste scale
adjective checklist)
Impact of 2 identical 10-km
runs (1 week apart) on
feelings of pleasantness and
change of mood
Higher scores of good mood and feelings of pleasantness were found
following the runs (mean increase of the two runs for all subjects was 2.79
from a total of 19 items, but the increase did not reach signiﬁcance).
O’Connor et al.
[101]
(1991)
USA
Pre-post non-controlled
n = 17, members of local
running clubs; 10 males
and 7 females;
mean age 25
Anxiety and body awareness
(State-Trait Anxiety Inventory
and Body Awareness Scale)
Impact of a 5-mile outdoor
group vs. solo run on anxiety
Anxiety levels were reduced following both a group (mean baseline = 34.0
vs. pre-exercise = 42.5 vs. postexercise = 27.5, p < 0.05) and solo run (mean
baseline = 34.0 vs. pre-exercise = 40.0 vs. postexercise = 30.0, p < 0.05).
Nabetani et al.
[102]
(2001)
Japan
Pre-post non-controlled
n = 15, healthy,
moderately active male
graduate students
Mood (Mood Checklist
Short-form 1)
Impact of a 10-min vs. a
15-min treadmill run on mood
Following the 10-min trial, anxiety signiﬁcantly decreased (ES = 0.61,
p < 0.01), whilst there was no signiﬁcant diﬀerence in pleasantness
(ES = 0.86) and relaxation (ES = 0.33). Following the 15-min trial, anxiety
(ES = 0.51) and pleasantness (ES = 0.62) signiﬁcantly decreased (p < 0.01),
but relaxation (ES = 0.07) had no signiﬁcant pre-post diﬀerence.
Bodin et al. [103]
(2003)
Sweden
Pre-post non-controlled
within-subjects
n = 12, regular runners. 6
male and 6 female. Mean
age of 39.7.
Emotional restoration ie.
depression/anxiety
(Exercise-Induced Feeling
Inventory and the Negative
Mood Scale).
Impact of 1 h park vs. urban
run on depression and
anxiety.
Runners preferred the park to the urban environment and perceived it as
more psychologically restorative; there was no statistical diﬀerence in
results for park vs. urban settings, with running in both settings causing a
signiﬁcant decline in anxiety/depression (F(1,10) = 16.2, p < 0.002, r = 0.78,
eﬀect size = 0.30).
Butryn et al. [104]
(2003)
USA
Pre-post non-controlled
within-subjects
n = 30, non-elite female
distance runners; mean
age 31
Mood, feeling states and
cognition states (Proﬁle of Mood
States, Exercise-Induced Feeling
Inventory and Thoughts During
Running Scale)
Impact of a 4-mile park vs.
urban run on mood
Total mood disturbance scores decreased by 8.97 (p < 0.001), with a similar
eﬀect following the urban run: total mood disturbance scores decreased by
9.13 (p < 0.001).
Kerr et al. [105]
(2006)
Japan
Pre-post non-controlled
n = 22, recreational
runners; mean age 22.7
Stress and emotions (Tension and
Eﬀort Stress Inventory)
Impact of indoor vs. outdoor
5-km run on stress and
emotions
Signiﬁcant pre-post eﬀects irrespective of running condition were found,
with an increase in relaxation (F(1, 21) = 5.60, p < 0.05) and excitement
(F(1, 21) = 24.65, p < 0.001) and a decrease in anxiety (F(1, 21) = 9.90, p < 0.01).
Rose et al. [106]
(2012)
New Zealand
Pre-post controlled
n = 32, all females; 17
sedentary and 15 active;
mean age 45
Self-eﬃcacy (Self-Eﬃcacy for
Exercise Scale)
Impact of self-paced vs.
prescribed pace 30-min
treadmill run on self-eﬃcacy
Higher self-eﬃcacy was observed before the prescribed paced run
compared to the self-paced run (F1,28 = 5.81; p < 0.023; n2 = 0.17).
Reed et al. [107]
(2013)
UK
Pre-post non-controlled
n = 75, children aged 11
and 12
Self-esteem (Rosenberg Self
Esteem Scale)
Impact of rural vs. urban
1.5-mile run on self-esteem
Signiﬁcant increase in self-esteem (F(1,74) = 12.2, p < 0.001) was found,
but no signiﬁcant diﬀerence between the urban or green exercise condition
(F(1,74) = 0.13, p = 0.72) or any signiﬁcant diﬀerence between boys and girls
were found.
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Table 5. Summary of data extraction from the 3 triple-bout studies.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Harte et al. [109]
(1995)
Australia
Pre-post non-randomised
controlled-repeated
measure design
n = 10, male amateur triathletes or
marathon runners with a mean age
of 27.1
Mood (Proﬁle of Mood
States)
Impact of a 12-km outdoor run vs.
indoor treadmill run with
external stimuli vs. an indoor
treadmill run with internal
stimuli on mood
While the two indoor runs had a positive eﬀect on
mood, outdoor running had an even greater beneﬁt to
mood with subjects less anxious (F(3,35) = 14.12,
p < 0.005), less depressed (F(3,35) = 4.16, p < 0.01),
less hostile (F(3,35) = 13.13, p < 0.005), less fatigued
(F(3,35) = 15.09, p < 0.005) and more invigorated
F(3,35) = 13.01, p < 0.005).
Berger, Owen +
Motl [110]
(1998)
USA
Pre-post non- controlled
study
Study 1: n = 71 college students
(32 males and 39 females) with a mean
age of 21.39; study 2: n = 68 college
students (28 males and 40 females)
with a mean age of 22.22
Mood (Proﬁle of Mood
States)
Impact of three 15-min runs of
varying intensities (50, 65 or 80%
age-adjusted HR max) on mood
Signiﬁcant overall mood beneﬁts postexercise
(F(6.57) = 6.43, p < 0.0001) for all intensities but no
signiﬁcant diﬀerences between intensities were found.
Markowitz et al.
[111]
(2010)
USA
Pre-post controlled trial
n = 28, college-aged students; 14 active
vs. 14 sedentary controls; mean age 21
Anxiety (State-Trait
Anxiety Inventory)
Impact of three 20-min treadmill
runs of varying intensities (5%
below, 5% above and directly at
lactate threshold) on anxiety
This was the only triple-bout study with a sedentary
control condition. State anxiety improved postexercise
at 5% below (eﬀect size = −0.38, p < 0.001) and after
exercise at the lactate threshold (eﬀect size = −0.20,
p < 0.001), but anxiety increased at 5% above the lactate
threshold (eﬀect size = +0.13, p = 0.0030).
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3.4. Category 3: Longer-Term Interventions
Thirty-four studies investigated the eﬀects of more than three bouts of running on measures
of mental health ranging from 2-week interventions to 1-year marathon training programmes
(Table 6) [112–144].
Narrative description of 34 studies are available in Table S5 within the
supplementary material.
Eight studies used 2–8 week running interventions [121,122,125,127,128,132,137,139]. Male regular
runners deprived of running for 2 weeks had increased anxiety and depression symptoms compared
to continuing runners [125].
Two 3-week interventions both found that mood improved while
amateur runners had lesser anxiety on running days compared to non-running days; perceived stress
in adolescents did not signiﬁcantly change [132,137]. A 4-week intervention of regular treadmill
running at set paces in moderately trained male runners found that an increase in intensity of runs
was associated with signiﬁcant increase in total mood disturbance while running at a pace with
more economical values was associated with more positive mental health proﬁles [127]. A 7-week
non-controlled intervention of weekly 40-min ﬁxed distance outdoor rural runs increased mood in
both male and female regular exercising university students, with faster runners scoring higher than
slower runners [128]. An 8-week intervention of a combination of weekly group and solo jogging in
middle-aged chronically stressed, sedentary women found lower anxiety and greater self-eﬃcacy than
baseline and compared to relaxation group controls [121]. Two studies used a 8-week intervention
of walking/running with non-treatment controls and found signiﬁcant improvements in mood and
decrease of depression, including in outpatients diagnosed with mild to severe depression [122,139].
Eleven studies used 10–20 week running interventions [114–116,119,123,126,129–131,140,143].
Three 10-week walking/jogging interventions found reductions in anxiety measures, improvement of
well-being and conflicting results for changes in depression measures compared to controls [115,119,129].
Another 10-week running intervention found that depression, trait anxiety and state anxiety all decreased
significantly while mood improved significantly [114]. A further 10-week running intervention found
that, although the exercise group was more likely to use exercise to cope with stress, there were
no significant differences in stress or coping measurements between the running and comparison
group [123]. Three 12-week interventions found significantly reduced stress and improvements in mood
in college students compared to controls, with more mood improvement in males and in females with
higher masculinity [126,130,143]. One 12-week intervention of self-directed running in recreational
runners found that well-being was significantly higher during weeks when individuals ran further and
ran more often while self-efficacy was related to distance ran but not to frequency of running [143].
Running interventions of 14–20 weeks improved mood and self-esteem and lowered emotional stress
reactivity in college/university students compared with controls [116,131,140].
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Table 6. Summary of data extraction from the 34 longer-term intervention studies.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Lion [112]
(1978)
USA
Randomised
controlled trial
n = 6, chronic psychiatric patients;
2 males and 4 females; 3 had the
running intervention and 3 were
controls; middle aged
Anxiety and body image
(State-Trait Anxiety Inventory
and Rorschach Inkblot Test for
body-boundary image)
Impact of running a mile 3 times per
week for 2 months on anxiety and
body image in chronic psychiatric
patients
Post-test anxiety was signiﬁcantly reduced in the jogging group vs. control
group (t = 3.2, df = 4, p < 0.05). Joggers showed an average drop of 9
points on the STAI (39.3 to 30.3) from pre- to post-test, while controls
showed an average rise of 4 points (32.6 to 36.6). No statistical diﬀerence
was found between groups for post-test body image scores.
Blue [113]
(1979)
USA
Pre-post
non-controlled
n = 2 former inpatients of a
psychiatric hospital; 1 male aged
37 and 1 female aged 32
Depression (Zung depression
scale)
Impact of 3 runs per week for 9
weeks on depression
Following running intervention, both patients’ depression scores reduced
from “moderately depressed” to “mildly depressed” (decrease of 18 and
15 points on the Zung Depression Scale).
Young [114]
(1979)
USA
Pre-post
non-controlled
n = 32 adults; 4 groups: young
males (n = 8, mean age 30.13),
middle-aged males (n = 8, mean
age 53.0), young females (n = 8,
mean age 28.25) and middle aged
females (n = 8, mean age 50.25)
Anxiety and depression using the
Multiple Aﬀect Adjective
Checklist
Impact of a 10-week walking/jogging
programme consisting of 1 h 3× per
week on anxiety and depression
Signiﬁcant reductions in pre- to post-test anxiety (F(1,28) = 6.01, p < 0.05)
were found. Results for anxiety and depression both showed signiﬁcant
age diﬀerences in favour of older subjects ((F(1,28) = 5.37, p < 0.05) and
(F(1,28) = 5.21, p < 0.05), respectively). However, there was no signiﬁcant
improvement with subject depression scores.
Blumenthal et al.
[115]
(1982)
USA
Non-randomised
controlled cohort
n = 16 healthy adults; 5 males and
11 females; mean age 45.1
Anxiety and mood (Proﬁle of
Mood States and the State-Trait
Anxiety Inventory)
Impact of 3 times weekly
walking-jogging programme for 10
weeks vs. 10 weeks of sedentary
controls on anxiety and mood
The exercise group exhibited less tension (F(1,30) = 4.49, p < 0.04),
depression (F(1,15) = 4.82, p < 0.04), fatigue (F(1,30) = 3.88, p < 0.05) and
confusion (F(1,15) = 4.40, p < 0.05) but more vigour (F(1,15) = 3.28, p < 0.09)
than sedentary controls. No change was observed for either group on the
POMS anger subscale. After the 10-week programme, exercisers also
exhibited less state anxiety (F(1,26) = 4.15, p < 0.05) and less trait anxiety
(F(1,26) = 6.05, p < 0.02).
Trujillo [116]
(1983)
USA
Randomised
controlled trial
n = 35 female college students;
13 weight trainers, 12 runners
and 10 controls
Self-esteem (Tennessee
Self-concept Scale and the Bem
Sex Role Inventory)
Impact of a 16-week running
programme vs. weight training vs. a
control on self-esteem
Both the running and weight training groups showed a signiﬁcant increase
in self-esteem from pre- to post-programme (t(11) = 2.11, p < 0.05), while
the control group showed a nonsigniﬁcant loss in self-esteem (t(9) = 0.55,
p > 0.05).
Tuckman et al.
[117]
(1986)
USA
Randomised
non-controlled
trial
n = 154 children; aged 9–11
Psychological aﬀects such as
creativity, perceptual function,
behaviour and self-concept
(Alternate Uses Test,
Bender–Gestalt Test, Devereaux
Elementary School Behaviour
Rating Scale and Piers–Harris
Children’s Self-Concept Scale)
Impact of three 30-min runs per week
on an outdoor running track for 12
weeks on psychological aﬀects in
children (creativity, perceptual
function, behaviour and self-concept,
compared to 12 weeks of the school’s
regular physical education
Running signiﬁcantly improved creativity of school children compared to
regular physical education participants (F ratio = 17.00, p < 0.001) but had
no signiﬁcant eﬀect on classroom behaviour, perceptual functioning or
self-concept.
Doyne et al. [118]
(1987)
USA
Randomised
controlled trial
n = 40 women; all with a
diagnosis of minor or major
depression; mean age of 28.52
Depression (Beck’s Depression
Inventory, Hamilton Rating Scale
for Depression and Depression
Adjective Checklists)
Impact of 3 runs per week on an
indoor track for 8 weeks on
depression in women diagnosed with
depression, compared to 8 weeks of
weight lifting vs. control
Running statistically and clinically signiﬁcantly decreased depression
scores (F(4,138) = 14.98, p < 0.01) relative to the wait-list control group,
with improvements reasonably well maintained at 1 year follow-up.
Fremont et al.
[119]
(1987)
USA
Randomised
non-controlled
trial
n = 49; 13 males and 36 females;
aged 19–62
Depression, anxiety and mood
state (Beck’s Depression
inventory, State-Trait Anxiety
Inventory and The Proﬁle of
Mood States)
Impact of 3 runs per week for 10
weeks on depression, anxiety and
mood vs. 10 weeks of counselling vs.
10 weeks of a combination of running
and counselling
Depression, trait anxiety and state anxiety all decreased signiﬁcantly
((F(4,184) = 50.3, p < 0.0001), (F(1, 46) = 27.1, p < 0.0001), (F(1,46) = 21.9,
p < 0.0001), respectively), while mood improved signiﬁcantly over the 10
weeks (F(18,378) = 4.5, p < 0.001).
Hannaford et al.
[120]
(1988)
USA
Randomised
controlled trial
n = 27 male psychiatric patients
with major psychiatric disorders;
age range 25–60; 9 runners, 9 in
corrective therapy for 8 weeks
and 9 waiting list controls
Depression and anxiety (Zung
Self Rating Depression Scale and
State Trait Anxiety Index)
Impact of three 30-min runs per week
for 8 weeks on depression and
anxiety in psychiatric patients with
major psychiatric disorders
Signiﬁcant reductions were observed in depression scores (F(2,23) = 3.61,
p = 0.043) compared to the waiting list controls, and nonsigniﬁcant
reductions were observed in anxiety scores (F(2,23) = 1.085, p = 0.354)
compared to the waiting list control group.
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Table 6. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Long et al. [121]
(1988)
Canada
Randomised
non-controlled
trial
n = 39 chronically stressed,
sedentary working women; mean
age 40; 18 joggers vs. 21
relaxation intervention
Stress, anxiety and self-eﬃcacy
(Trait Anxiety Inventory, Sherer et
al.’s Inventory for Self-Eﬃcacy
and a modiﬁed version of the
Ways of Coping Checklist)
Impact of an 8-week running
programme consisting of a weekly
group session plus twice weekly solo
jogs on stress, anxiety and
self-eﬃcacy
Runners had signiﬁcantly less anxiety and greater self-eﬃcacy than
baseline; 24% of subjects reached clinically signiﬁcant improvements at the
end of treatment, and 36% reached clinically signiﬁcant improvements at
14-month follow-up. The jogging group exhibited higher self-eﬃcacy,
and the time eﬀect for the pre to the post/follow-up average was signiﬁcant
for both self-eﬃcacy and trait anxiety (F(2, 36) = 15.38, p < 0.001), while
total coping scores did not change (F(2, 35) = 2.88, p < 0.07) from pre to
post/follow-up.
Simons et al. [122]
(1988)
USA
Non-randomised
controlled trial
n = 128; 53 experimental subjects
(24 male, 30 female, mean age
44.9); 75 control subjects (28 male,
47 female, mean age of 42.0)
Mood (Proﬁle of Mood States,
Nowicki–Strickland
Internal–External Control Scale
for Adults and Marlowe–Crowne
Social Desirability Scale)
Impact of two 30 min walk/runs per
week for 8 weeks on mood,
compared to a weekly 30-min ﬁtness
lecture for 8 weeks
Signiﬁcant improvement in mood pre- to post-test intervention compared
to non-treatment controls (F(1,126) = 4.46, p < 0.05) as well as signiﬁcant
improvement in pre- to follow-up mood change scores (F(1,98) = 7.63,
p < 0.01) were observed.
Moses et al. [123]
(1989)
UK
Randomised
controlled trial
n = 75 sedentary adult volunteers;
mean age 38.8; four 10-week
conditions: high-intensity aerobic
walk-jog programme (n = 18);
moderate intensity walk-jog
programme (n = 19);
attention-placebo including
strength, mobility and ﬂexibility
exercises (n = 18); or waiting list
control (n = 20).
Mood and mental well-being
(Proﬁle of Mood States and the
Hospital Anxiety and Depression
Scale)
Impact of varying intensity 10 week
walk-jog programmes on mood and
mental well-being
Signiﬁcant reductions in tension/anxiety (F(3,71) = 2.94, p < 0.05) were
reported only by subjects in the moderate exercise condition. Signiﬁcant
diﬀerences in the confusion subscale were found over time (F(1,71) = 3.70,
p < 0.06), with greater decreases in the moderate exercise group than in the
high exercise, attention-placebo or waiting list conditions. No signiﬁcant
eﬀects were found on the perceived coping scales, but there was signiﬁcant
improvement on the physical well-being scale in the exercisers
(F(3,71) = 3.82, p < 0.01) after 10 weeks, while the waiting list group ratings
decreased. At follow-up, only subjects in the moderate exercise condition
reported decreased ratings of depression/dejection (F(2,55) = 3.00, p < 0.06)
and positive changes that approached signiﬁcance for the perceived
coping assets scale (F(2,55) = 2.56, p < 0.08), but this was not the case for the
high exercise or attention-placebo conditions.
Ossip-Klein et al.
[124]
(1989)
USA
Randomised
controlled trial
n = 32 clinically depressed
women; mean age 28.52
Self-concept (Beck Self-Concept
Test)
Impact of running on an indoor track
4 times per week for 8 weeks on
self-concept in clinically depressed
women compared to weight lifting 4
times weekly vs. a delayed treatment
(assessment only) control
Self-concept signiﬁcantly improved in the clinically depressed women
compared to controls (F(3,99) = 7.62, p < 0.0001). Self-concept scores were
also signiﬁcantly higher in those in the running condition compared to the
wait-list condition at post-treatment (F(2, 33) = 4.69, p < 0.05), with
improvements also reasonably well-maintained over time.
Morris et al. [125]
(1990)
UK
Pre-post study
with randomised
comparison
n = 30 male regular runners;
mean age 37; 20 participants
stopped running for 2 weeks vs.
20 continued running as normal
Anxiety and depression (General
Health Questionnaire and short
forms of the Zung Anxiety and
Zung Depression scales)
Impact of stopping running for 2
weeks on anxiety and depression
Somatic symptoms, anxiety/insomnia and social dysfunction, symptoms of
depression (p < 0.05), were all signiﬁcantly greater in deprived than in
continuing runners, and Zung depression (F(1,37) = 22.64, p < 0.001) and
anxiety (F(1,37) = 11.51, p < 0.01) scores were signiﬁcantly higher after the
two weeks. Signiﬁcantly more deprived than non-deprived subjects
exceeded the suggested cutoﬀ score for a psychiatric case after both weeks
of deprivation (x2 = 5.38 and 4.51, respectively, df = 1, p < 0.05), but there
was no statistical diﬀerence between groups once the deprived group
resumed running.
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Table 6. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Friedman et al.
[126]
(1991)
USA
Randomised
controlled trial
n = 387 students; 177 males and
188 females; mean age 20;
84 joggers, 96 relaxation, 100
group interaction and 107
lecture-control
Stress and mood (Proﬁle of Mood
States and Bem Sex Role
Inventory)
Impact of 12 weeks of jogging on
stress and mood
High masculinity male and female joggers reported signiﬁcantly more
mood improvement than those with low masculinity (p < 0.004).
All women joggers reported signiﬁcant reductions in depression after
jogging, but those with high psychological masculinity experienced
signiﬁcantly greater reductions than low masculinity joggers (p < 0.04).
Femininity had a signiﬁcant eﬀect on combined POMS scores
(F(6,297) = 2.79, p < 0.02), with higher psychological femininity associated
with higher tension, depression and fatigue and with lower vigour and
confusion scores compared to those low in femininity. There were
signiﬁcant pre-post session × technique interactions for high and low
masculinity women (F(18,843.36) = 2.47, p < 0.0007; F(18,843.36) = 2.49,
p < 0.0006, respectively). Short-term improvements in POMS scores
depended upon masculinity for women joggers and participants in group
interaction.
Williams et al.
[127]
(1991)
USA
Pre-post
non-controlled
within subject
design
n = 10 moderately trained male
runners; mean age 25.6
Mood (Proﬁle of Mood States)
Impact of 4 weeks of treadmill
running 5 times per week at set paces
reﬂecting 50, 60 and 70% VO2 max on
mood
Regarding within-subject data, an increase in mean VO2 was associated
with a signiﬁcant increase in total mood disturbance (r = 0.88, p < 0.01),
while running at a pace with more economical values was associated with
more positive mental health proﬁles. However, when considered as a
group, there was no relationship between running eﬃciency in moderately
trained male runners and total mood disturbance.
Kerr et al. [128]
(1993)
Holland
Pre-post
non-controlled
n = 32 regular exercising
university students (18 males and
14 females) aged 18–22
Mood (Stress-Arousal Checklist
and Telic State Measure)
Impact of a weekly 40-min ﬁxed
distance run (5 km for females, 6.6
km for males) through a wooded area
for 7 weeks on mood
In both males and females, there were signiﬁcant increases from pre- to
post-running intervention in telic state measure felt arousal scores
(F(1,16) = 52.37, p = 0.0001 and F(1,12) = 16.16, p = 0.002, respectively),
stress-arousal checklist arousal scores (F(1,16) = 15.34, p = 0.001 and
F(1,12) = 25.19, p = 0.0001, respectively) and telic state measure preferred
arousal scores (F(1,16) = 4.49, p = 0.05 and F(1,12) = 11.82, p = 0.005,
respectively). In contrast, telic state measure arousal discrepancy scores
decreased signiﬁcantly for males (F(1,16) = 6.74, p = 0.02) and females
(F(1,12) = 11.86, p = 0.005) pre- to post-running.
Long [129]
(1993)
Canada
Randomised
controlled trial
n = 35; 14 males and 21 females;
mean age 35.6; 12 runners,
9 stress inoculation and 14
wait-list control
Anxiety and stress (Cornell
Medical Symptom Checklist)
Impact of 3 runs per week for 10
weeks on anxiety and stress
Although the exercise group was more likely to report using exercise to
cope with stress, there was no signiﬁcant diﬀerences found between
groups on stress or coping classiﬁcations. There was also no signiﬁcant
diﬀerence in scores of the Cornell Medical Symptom Checklist between the
running group and the stress inoculation treatment groups (F < 1; M = 87.4
vs. M = 86.2, respectively).
Berger and
Friedman [130]
(1998)
USA
Randomised
controlled trial
n = 387 undergraduate college
students; 117 males and 188
females; mean age 20.0; 84
joggers vs. 96 relaxation response
vs. 100 in discussion groups vs.
107 in the control group
Stress and mood (Proﬁle of Mood
States)
Impact of three jogs per week for a
minimum of 20 min over 12 weeks on
stress and mood
Jogging was signiﬁcantly more eﬀective in reducing stress than the control
activity (F(18,280) = 1.79 to 1.85, p < 0.03), and joggers reported larger and
more numerous reductions in tension, depression and anger than the
control group; however, changes in vigour, fatigue and confusion were
sporadic. There were no long-term beneﬁts observed.
Berger and Owen
[131]
(1998)
USA
Pre-post with
comparison
n = 91 college students; n = 67 in
weekly walking/jogging (32 males
and 35 females) vs. n = 24 in a
weekly health science class
(9 males and 15 females)
Mood and anxiety (Proﬁle of
Mood States and State-Trait
Anxiety Inventory)
Impact of twice weekly
walking/jogging for 14 weeks on
mood and anxiety
No signiﬁcant interaction between exercise intensity and pre-post mood
beneﬁts was observed. Joggers reported signiﬁcant short-term mood
beneﬁts following running regardless of exercise intensities (F(6,56) = 4.87,
p < 0.0005). Joggers reported signiﬁcant pre-post exercise changes on all
POMS subscales: tension (F = 15.67, p < 0.0002), depression (F = 15.64,
p < 0.0002), anger (F = 12.77, p < 0.0007), vigour (F = 22.29, p < 0.00005),
fatigue (F = 20.14, p < 0.00005) and confusion (F = 26.34, p < 0.00005).
Int. J. Environ. Res. Public Health 2020, 17, 8059
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Table 6. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Szabo et al. [132]
(1998)
UK
Pre-post
non-controlled
observational
cohort study
n = 40 members of an amateur
running club; 30 males, mean age
40.5, and 10 females, mean age 37
Anxiety and mood, i.e.,
exhaustion, tranquillity, positive
engagement and revitalization
(Commitment to running scale,
Exercise-induced Feeling
Inventory and Spielberger State
Anxiety Inventory)
Impact of running vs. non-running
days on anxiety and mood over 21
consecutive days
Reported diﬀerences (eﬀect sizes ranging from 0.07 to 0.56, all p < 0.05) all
favour running days over non-running days, concluding that, on running
days, runners experienced less anxiety (F(1,38) = 5.22, p < 0.03) and better
subscales of mood: exhaustion (F(1,38) = 4.34, p < 0.04), tranquillity
(F(1,38) = 5.56, p < 0.02), revitalisation (F(1,38) = 18.32, p < 0.001) and
positive engagement (F(1,38) = 11.79, p < 0.001).
Broman-Fulks et al.
[133]
(2004)
USA
Randomised
non-controlled
trial
n = 54 participants with elevated
anxiety sensitivity scores;
13 males and 41 females; mean
age 21.17; 29 high-intensity
aerobic exercisers vs. 25
low-intensity aerobic exercisers
Anxiety sensitivity (Anxiety
Sensitivity Index, State-trait
Anxiety Inventory and Body
Sensations Questionnaire)
Impact of six 20-min treadmill
sessions of either high/low-intensity
aerobic exercise across 2 weeks on
anxiety sensitivity in participants
with elevated anxiety
sensitivity scores
Six 20-min treadmill sessions of both high-intensity and low-intensity
running across 2 weeks reduced anxiety sensitivity (F(2,56) = 42.50,
p < 0.001, n2 = 0.60; F(2, 48) = 13.72, p < 0.001, n2 = 0.36; respectively).
State anxiety also decreased from pre-post high-intensity running (35.10 to
32.03); however, it increased following low-intensity running (42.72 to
42.32), but neither of these eﬀects were signiﬁcant.
Haﬀmans et al.
[134]
(2006)
Holland
Randomised
controlled trial
n = 60 psychiatric patients all
suﬀering from a depressive
disorder; 19 males and 41 females;
mean age 39; 20 runners vs. 21 in
physiotherapy training vs.
19 controls
Depression and self-eﬃcacy
(Hamilton Rating Scale for
Depression, Becks Depression
Inventory, Self-Eﬃcacy Scale and
Physical Self-Eﬃcacy Scale)
Impact of running therapy for 3 days
per week for 12 weeks on depression
and self-eﬃcacy in psychiatric
patients all suﬀering from depression
While after 6 weeks of running, self-eﬃcacy was signiﬁcantly higher
(p = 0.03), after the full 12 weeks of running, there was no signiﬁcant
diﬀerence in depression (26.7 to 25.5, n.s.) or self-eﬃcacy (46.6 to 49.1, n.s.)
scores from baseline.
Thornton et al.
[135]
(2008)
USA
Repeated
measures design
n = 50 runners over age 18
Anxiety (Beck Anxiety Inventory)
The relationship between anxiety and
marathon
Marathon training decreased Beck Anxiety Inventory scores (0.9) initially
from baseline pre-training levels compared to 2 months prior to marathon
day (0.7; 72% had no change from baseline, 22% were less anxious and 6%
were more anxious). However, anxiety scores increased as race day
approached: at 1 month prior to race day (1.4; 46% had no change from
baseline, 19% were less anxious and 35% were more anxious than baseline)
and 1 week prior to race (2.6; 22% had no change from baseline, 14% were
less anxious and 64% were more anxious than baseline, respectively).
Scholz et al. [136]
(2008)
Switzerland
Pre-post
non-controlled
non-experimental
longitudinal study
n = 30 untrained participants;
4 males and 26 females; mean age
41.2
Self-eﬃcacy (4-part
author-created measurement)
Impact of a 1-year marathon training
programme on self-eﬃcacy
The trend between running and self-eﬃcacy had substantial correlation
but was not signiﬁcant. No statically signiﬁcant diﬀerences was observed
in the baseline level, trend or ﬂuctuation of self-eﬃcacy between the
participants who successfully completed the marathon and those who did
not, but the baseline level of self-eﬃcacy was positively associated with
the baseline level in running (correlation analyses = 0.27; p < 0.05; 95%
CI = 0.00; 0.53) and ﬂuctuation in self-eﬃcacy correlated positively with
ﬂuctuation in running (0.39; p < 0.05; 95% CI = 0.03; 0.74). As this was a
non-experimental longitudinal study, no causal statements can be drawn.
Kalak et al. [137]
(2012)
Switzerland
Randomised
controlled trial
n = 51 adolescents; 24 males and
27 females; mean age 18.3;
27 runners vs. 24 controls
Mood and stress (A-a daily mood
log, a questionnaire assessing
positive and negative comping
strategies, and Perceived
Stress Scale)
Impact of daily 30-min morning runs
on weekdays for 3 weeks (i.e., 3 × 5
runs) on stress and mood
Perceived stress did not diﬀer signiﬁcantly between running and control
groups over time (F(1,49) = 1.71, n2 = 0.034, n.s.), while mood in the
morning increased signiﬁcantly over time in the running group compared
with controls (F(5,245) = 16.08, n2 = 0.247, p < 0.05). However, irrespective
of group, mood in the evening improved, and there was no signiﬁcant
diﬀerence of mood in the evening between groups.
Inoue et al. [138]
(2013)
USA
Pre-post
non-controlled
n = 148 homeless people;
134 males and 14 females;
mean age 29.9
Self-suﬃciency (author-created
scale)
Impact of 10 organised runs on
self-suﬃciency in homeless people
Running involvement had a signiﬁcant positive correlation with perceived
self-suﬃciency (r = 0.30, p < 0.01). Results suggested that participants
gained higher levels of perceived self-suﬃciency as they became more
involved with running during the program (F = 3.39, p < 0.01,
Adjusted R2 = 0.08), and increases in running involvement were the sole
signiﬁcant predictor of the outcome (β = 0.29, t = 3.57, p < 0.01).
Samson et al. [76]
(2013)
USA
Pre-post
non-controlled
n = 39 university students who all
had running experience; 11 males
and 28 females; mean age 20.5
General aﬀect and self-eﬃcacy
(Positive and Negative Aﬀect
Scale and author-created
measurements for self-eﬃcacy)
Impact of a 15-week marathon
training program of 3 group training
days per week and one run of 8–20
miles on the weekend on general
aﬀect and self-eﬃcacy
Self-eﬃcacy signiﬁcantly increased over the training programme
(F(12,444) = 5.81, p < 0.01), but there was a signiﬁcant decrease of positive
aﬀect over time (F(12,444) = 8.35, p < 0.01) and no signiﬁcant change was
found for negative aﬀect over the programme.
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Table 6. Cont.
Author
Year
Country
Design
Population
Mental Health Outcome
(Measurement)
Study Aim
Main Findings
Doose et al. [139]
(2015)
Germany
Randomised
controlled trial
n = 46 outpatients diagnosed
with mild to severe depression;
aged 18–65; 30 walker/runner vs.
16 controls
Depression (Hamilton Rating
Scale and Beck Depression
Inventory)
Impact of group walking/running 3
times per week for 8 weeks on
depression
Depression clinically signiﬁcantly decreased on the Hamilton Rating Scale
(Cohen’s d = 1.8; mean change = 8.24; p = <0.0001), and while there were
reductions, they were without clinical signiﬁcance (Cohen’s d = 0.50;
mean change = 4.66; p = 0.09) in the Becks Depression Inventory scores.
Von Haaren et al.
[140]
(2015)
Germany
Randomised
controlled trial,
within subject
design
n = 61 inactive male university
students; mean age 21.4
Stress and mood (a shorten mood
scale based on the
Multidimensional Mood
Questionnaire and a one-item test
for perceived control and stress)
Impact of a 20-week running training
course on stress and mood during
academic examinations, compared to
waiting list controls
Signiﬁcant emotional stress reactivity was observed in both groups during
academic assessment episodes; participants in aerobic training showed
lower emotional stress reactivity compared with the control participants
after the 20-week training programme, with perceived stress of the aerobic
group remaining similar during both exam periods (2.27 to 2.24), while it
increased further in the control group (2.43 to 2.51).
Kahan et al. [141]
(2018)
USA
Pre-post with
comparison
n = 11 children; 9 males and 2
females; aged 9 and 10
Self-esteem and self-eﬃcacy
(50-item, author-created
questionnaire)
Impact of 20 running sessions
alternating between game vs. lap
running on self-esteem and
self-eﬃcacy in children
Means for self-esteem and task-eﬃcacy were 3.63 and 4.16, respectively,
on a 5-point scale, while the mean for task-eﬃcacy was 4.16 on a 5-point
scale, and high inherent-interest participants (i.e., higher
moderate–vigorous physical activity in the running laps condition) had
statistically signiﬁcant higher scores than low inherent-interest
participants on recognition (p = 0.01), ego orientation (p = 0.03) and
expectancy beliefs (p = 0.03) subscales. There were no direct comparisons
of self-esteem and self-eﬃcacy in game vs. lap running.
Keating et al. [142]
(2018)
Canada
Pre-post
non-controlled
n = 46 participants with complex
mood disorders; 11 males and 35
females; 29 youths (mean age
22.1) and 17 adults
(mean age 45.2)
Stress, anxiety and depression
(Cohen’s Perceived Stress Scale,
Becks Depression Inventory,
Becks Anxiety Inventory and
Short Form Survey)
Impact of 12 weeks of twice weekly
running in a group setting that oﬀers
social support supervised by clinical
professionals on stress, anxiety and
depression
Signiﬁcant decreases in depression (F(11,201) = 4.5, p < 0.0001),
anxiety (F(11,186) = 4.8, p < 0.0001) and stress (F(11,186) = 2.3, p = 0.01) from
baseline was observed. Following intervention, mean depression scores
decreased by 39% in adults from high to low levels and by 27% in youths
from moderate to reduced moderate levels. Younger participant age,
younger age at onset of illness and higher perceived levels of friendship
with other running group members (ps ≤ 0.04) were associated with lower
depression, anxiety and stress scores. Higher attendance was linked with
decreasing depression and anxiety (ps ≤ 0.01) scores over time.
Nezlek et al. [143]
(2018)
Poland
Pre-post
observational
cohort study over
3 months with no
control
n = 244 recreational runners; 127
males and 117 females; mean age
32.5
Psychological well-being,
self-esteem, self-eﬃcacy and
aﬀect (Rosenberg Self-esteem
Scale, Satisfaction with Life Scale,
and a circumplex model that
distinguishes the valence and
arousal of aﬀect)
Impact of 3 months of self-prescribed
running on psychological well-being,
self-esteem, self-eﬃcacy and aﬀect
Positive within-person relationships between how much people ran each
week and self-reports of well-being were observed, with well-being
signiﬁcantly higher during weeks when individuals ran more often and
further. Self-eﬃcacy was related to distance run but not to frequency.
For the km that people ran each week, signiﬁcant moderation was found
for weekly Satisfaction with Life Scale (γ11 = −0.0002, p = 0.013),
self-esteem (γ11 = −0.0002, p = 0.015), positive activated aﬀect
(γ11 = −0.0003, p < 0.001), positive deactivated aﬀect (γ11 = −0.0008,
p < 0.01), negative activated aﬀect (γ11 = 0.0002, p = 0.046) and negative
deactivated aﬀect (γ11 = 0.0003, p = 0.01).
Kruisdijk et al.
[144]
(2019)
Holland
Randomised
controlled trial
n = 48 participants with major
depressive disorder; mean age
42.6; 25 runner-walkers vs. 23
controls
Depression (Hamilton
Depression Scale)
Impact of 6 months of
running-walking for one hour twice a
week on depression in subjects with
major depressive disorder
No signiﬁcant diﬀerence or eﬀect on depression in favour of the
intervention group (Cohen’s d < 0.2, F = 0.13, p = 0.73) with only 9
participants (19%) completing the study was found, with low statistical
power and lack of follow-up at six and 12 months.
Int. J. Environ. Res. Public Health 2020, 17, 8059
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A number of studies looked at speciﬁc populations. One investigated the impact of 10 organised
runs on homeless people and found signiﬁcant positive correlation with perceived self-suﬃciency [138].
Two investigated the eﬀects in children and found that running signiﬁcantly improved creativity and
higher self-esteem subscales [117,141]. Three looked at marathon training programmes: one found
a positive correlation between the trend in running and self-eﬃcacy but was not signiﬁcant [136],
while another found a signiﬁcant increase in self-eﬃcacy over the programme [76]. The remaining
study used participants who were already self-enrolled in a marathon, and researchers found that,
while anxiety decreased initially during training, anxiety increased as marathon day approached [135].
Nine studies used subjects with known psychiatric disorders and found that longer-term
interventions generally improved markers of mental health in psychiatric populations, particularly
markers of depression [112,113,118,120,124,133,134,142,144]. Running interventions from 2 to 12 weeks
all resulted in signiﬁcant positive eﬀects on mental health [112,118,120,124,133,142,144]. While an
anti-depressive eﬀect of exercise was apparent in patients with minor to moderate psychiatric problems,
one study found that this was not reﬂected in patients with major depressive disorder due to issues
with compliance and motivation towards the intervention [144].
Summary of Longer-Term Interventions
Overall, running interventions of 2–20 weeks generally show improved markers of a range of
mental health outcomes compared to non-running controls, including mental health outcomes in
psychiatric and homeless populations. The risk of longer-term running interventions on adverse
mental health outcomes remains unclear.
3.5. Summary of Key Findings
The key ﬁndings of the each of the three categories of studies are summarised in Table 7.
Table 7. Summary of key ﬁndings within each of the three categories.
Study Type
Number of Studies
Summary of Evidence
Cross-sectional
47 studies
Consistent evidence was found for a positive association between mental health and
habitual or long-term recreational running compared to non-runners. In contrast,
there was evidence that high or extreme levels of running were associated with
markers of running ill-health compared to levels of moderate running.
Acute: single/double/triple bout
35 studies
Overall, these studies suggest that acute bouts of running can improve mental health
and that the type of running can lead to diﬀerential eﬀects. Evidence suggests that
acute bouts of treadmill, track, outdoor and social running (2.5–20 km and 10–60 min)
all result in improved mental health outcomes. There were few diﬀerences between
high and low intensities. Studies consistently show that any running improves
acute/short-term mood markers but that lack of inactive comparisons limits the
strength of evidence. Little variation in the demographics of participants and small
sample sizes limit generalizability and precision of ﬁndings.
Interventions (2 weeks or more)
34 studies
Overall, running interventions of 2–20 weeks generally show improved markers of a
range of mental health outcomes compared to non-running controls, including mental
health outcomes in psychiatric and homeless populations. The risk of longer-term
running interventions on adverse mental health outcomes remains unclear.
3.6. Evidence Gaps
As well as reporting the available evidence, this review also aimed to identify key gaps in the
evidence base for running and mental health. Consideration of sample demographics in the n = 116
included studies resulted in the following gaps being identiﬁed:
•
lack of studies in those aged under 18 (Only four acute bout studies [89,95,107,108] and two longer
term interventions [117,141] looked directly at children under age 15, while a further 2 studies
looked speciﬁcally at adolescents [70,137]);
•
lack of studies in those aged over 45;
•
lack of gender-speciﬁc approaches;
•
few studies investigating clinical populations; and
•
limited diversity in patient demographics.
Int. J. Environ. Res. Public Health 2020, 17, 8059
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4. Discussion
4.1. Principal Findings
There is a growing body of literature exploring the relationships of running on certain mental health
outcomes. There were variations in methods and outcomes studied, but there were similar overall
beneﬁcial trends. Generally, evidence supported positive eﬀects of a range of lengths and intensities
of running on mental health. However, there was limited diversity in participant demographics.
Attribution was also compromised by the limited number of studies with comparisons/control groups.
Synthesis of quantiﬁed eﬀects is made challenging by large variations in reporting methods. Consistency
and appropriateness of mental health measures was also varied throughout the literature.
The review identiﬁed a smaller evidence-base focused on clinical populations. Behaviour change
and compliance can be challenging in populations with clinical depressive disorders [145], and there
is limited evidence regarding the long-term impact of PA in the treatment of depression [7,146,147].
Further investigations of the eﬀects of running in populations with prior diagnoses of mental health
disorders may help to address the global burden of mental illness.
4.2. Plausible Explanations for Findings
Our ﬁndings suggest that, throughout cross-sectional evidence, acute bouts of running and
longer-term running interventions are associated with improvements in a range of mental health
outcomes. This is likely explained by running supplying a suﬃcient dose of moderate to vigorous
PA to stimulate the known mental health beneﬁts associated with PA. These beneﬁts are thought to
be mediated by neurobiological, psychosocial and behavioural mechanisms, all of which an eﬀective
running intervention of any genre has the potential to inﬂuence [148]. The diﬀerential eﬀects of these
mechanisms remain unclear and may explain the variation in ﬁndings by running duration, intensity,
setting, and social or individual participation.
4.3. Comparison to Literature
This review does not present running and mental health as a novel idea. As early as 1979,
scholars discussed the relationship between psychotherapy and running [149]. An early review by
Vezina et al. (1980) reported that regular running causes positive mood changes, increases self-esteem
and decreases anxiety [150]. Another review by Hinkle (1992) found positive psychological eﬀects
in both adults and children including reductions in depressive mood and anxiety, and enhanced
self-esteem [151]. However, a review by Weinstein et al. (1983) found that the volume of literature
examining running and depression was scarce, and while running appeared to improve a sense of
well-being, there was minimal evidence to strongly support reductions in depression and anxiety [152].
Studies from 1986 [153] and 1991 [154] warned that long-distance running had the potential to
trigger development of eating disorders in people who were psychologically or biologically at risk.
Early research also highlighted that runners should be aware of the possibility of addiction [155] and
that women may be linked more strongly to negative addiction than men [156].
This review agrees with these earlier ﬁndings but is the ﬁrst to use systematic scoping review
methods. This means that it presents a transparent search and inclusion strategy and is less prone to
bias in terms of included studies and resulting ﬁndings. As such, this review has contributed to the
evidence base by demonstrating that the weight of evidence up to 2019 favours positive mental health
relationships with running.
4.4. Strengths and Limitations
The authors acknowledge the limitation that this review was designed to assess the behaviour
of running but that there are ﬁelds of studies including treadmill-based exercise which our review
may not have picked up. However, the strength of this review is that the review does not focus on
laboratory-based exercise but instead on what a healthcare professional may recommend to a free-living
Int. J. Environ. Res. Public Health 2020, 17, 8059
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patient or the general public for mental health beneﬁts. However, subjective measures of running
intensity were not considered in detail, which may impact the conclusions of the review. The authors
acknowledge that the results were not separated by means of running type due to the method of
prioritization used to report the results, and thus, this remains a research gap. As with any scoping
review, it is possible that the search and inclusion strategy led to omission of some key research.
Synthesis of quantiﬁed eﬀects was also made challenging by the large range of reporting methods
used within the studies. This scoping review did not attempt to undertake quality appraisal of the
included studies. The wide range of study designs and methods included within the review does not
allow a statistical synthesis of the eﬀectiveness of the studies.
4.5. Implications
Pharmacological management is often used as a ﬁrst-line of defence for mental health
disorders [157]; however, it is not always eﬀective due to poor adherence and relapse [158].
Ineﬀective management adds to the global burden of poor mental health [159], With increasing
pressures on healthcare budgets, PA oﬀers an augmentative therapeutic option for mental health
management [160]. It is likely that using a cost-eﬀective therapy such as running to improve mental
health would prove economical as well. An integrated lifestyle intervention (i.e., iterative process) may
be more feasible than a single add-on exercise intervention (i.e., addition of an individual behaviour)
for patients with major depressive disorder who are deemed suitable for running therapy by clinicians.
This review presents the eﬀects of running on mental health and can inform healthcare professionals
and psychologists who advise on management of mental health conditions. The authors’ interpretation
of the evidence base is that, with appropriate clinical judgement, practitioners may identify patients
with an interest in running or previous history of running as an ideal candidate for running as a form of
psychotherapy. Findings from this review indicate that characteristics of running to be recommended
may include self-pacing, distance and time feasibility to the individual, and being within the lactate
threshold. There were consistent trends within ﬁndings despite a variety of running interventions,
which suggest that it would be appropriate to recommend track running, outdoor urban and rural
running, and treadmill running to improve mental health. However, a large number of studies used
healthy, active college-aged participants, which may limit the relevance of these recommendations
to other population groups. It is acknowledged that running will not be a suitable recommendation
for everyone and that prescription of running is not as simple as just instructing people to run; it will
require clinical expertise with regard to mental health in the way it is prescribed [161].
4.6. Future Research
This review identiﬁes research gaps regarding patient demographics, but we have further
recommendations about increasing sample sizes, quantitative study design and more coherent mental
health outcomes. There was great variability in mental health outcome measures, particularly within
the acute bout studies, where short-term measures of mental health could have equally been deﬁned
as mood and aﬀect. We recommend that future research seeks more clarity on appropriate outcome
measures. A comparison of types, settings and intensities of running is needed to better inform running
and mental health recommendations.
Recommendations for future research include addressing the eﬀect of running on mental health
of those under 18, those over 50s and clinical populations. A meta-analysis of the subset of study
types such as interventions should be carried out. While the appropriateness of running interventions
in those over 50 may be questioned, there is evidence that older adults do also beneﬁt from the
anti-depressive eﬀect of exercise [162]. We know that children running can be used as a population
intervention, for example, in “The Daily Mile” [163], which signiﬁes the importance of addressing this
gap around the mental health impact of running in those under 18. Future systematic reviews and
meta-analyses are needed to quantify the beneﬁts of running on speciﬁc outcomes.
Int. J. Environ. Res. Public Health 2020, 17, 8059
29 of 39
5. Conclusions
This review is the most recent to comprehensively report the breadth of literature on the relationship
between running and mental health. We conclude that running has important positive implications
for mental health, particularly depression and anxiety disorders, but synthesis of quantiﬁed eﬀects is
made challenging by variation in reporting methods and remains a gap. This scoping review may have
consequences for researchers, practitioners and relevant organisations and may inform the practice
of healthcare professionals. Knowledge gaps concerning running on the mental health of children,
older adults and clinical populations provide guidance for future research
Supplementary Materials: The following are available online at http://www.mdpi.com/1660-4601/17/21/8059/s1,
Table S1: Narrative description of ﬁndings of the 47 cross-sectional studies. Table S2–S4: Narrative description
of ﬁndings of the 35 studies with an acute bout of running. Table S5: Narrative description of ﬁndings of the
34 studies with a longer-term intervention of running.
Author Contributions: P.K., J.R. and F.O. conceived the study. P.K., C.W. and F.O. designed the search strategy.
F.O. conducted searching of databases. J.C., P.K., F.O. and C.W. screened the records. F.O. and P.K. screened the
full texts. F.O. completed all data extraction, and J.R. conducted quality checks. F.O. drafted the full manuscript,
and all authors reviewed and approved ﬁnal submission. All authors have read and agreed to the published
version of the manuscript.
Funding: This research received no external funding.
Acknowledgments: The authors would like to thank a number of people for their assistance during the scoping
review: Thelma Dugmore for her support and administration help within the Edinburgh University Physical
Activity for Health Research Centre (PAHRC), Marshall Dozier for her assistance setting up a Covidence account
for the project to run through, all the staﬀ at PAHRC for being so welcoming and interested in the project and,
ﬁnally, Colin Oswald who was a source of great encouragement and support throughout the project.
Conﬂicts of Interest: The authors declare no conﬂict of interest.
Appendix A
Table A1. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping
Reviews (PRISMA-ScR) Checklist [18].
Section
Item
PRISMA-ScR CHECKLIST ITEM
Reported on Page
Number
Title
Title
1
Identify the report as a scoping review.
1
Abstract
Structured summary
2
Provide a structured summary that includes (as applicable)
background, objectives, eligibility criteria, sources of evidence,
charting methods, results and conclusions that relate to the
review questions and objectives.
1
Introduction
Rationale
3
Describe the rationale for the review in the context of what is
already known. Explain why the review questions/objectives
lend themselves to a scoping review approach.
1–2
Objectives
4
Provide an explicit statement of the questions and objectives
being addressed with reference to their key elements (e.g.,
population or participants, concepts and context) or other
relevant key elements used to conceptualize the review
questions and/or objectives.
1–2
Methods
Protocol and registration
5
Indicate whether a review protocol exists; state if and where it
can be accessed (e.g., a Web address), and if available, provide
registration information, including the registration number.
2
Eligibility criteria
6
Specify characteristics of the sources of evidence used as
eligibility criteria (e.g., years considered, language and
publication status), and provide a rationale.
3
Information sources *
7
Describe all information sources in the search (e.g., databases
with dates of coverage and contact with authors to identify
additional sources) as well as the date that the most recent
search was executed.
4
Search
8
Present the full electronic search strategy for at least 1
database, including any limits used, such that it could be
repeated.
Appendix B
Selection of sources of
evidence †
9
State the process for selecting sources of evidence (i.e.,
screening and eligibility) included in the scoping review.
4
Int. J. Environ. Res. Public Health 2020, 17, 8059
30 of 39
Table A1. Cont.
Section
Item
PRISMA-ScR CHECKLIST ITEM
Reported on Page
Number
Data charting process ‡
10
Describe the methods of charting data from the included
sources of evidence (e.g., calibrated forms or forms that have
been tested by the team before their use and whether data
charting was done independently or in duplicate) and any
processes for obtaining and conﬁrming data from
investigators.
4
Data items
11
List and deﬁne all variables for which data were sought and
any assumptions and simpliﬁcations made.
4
Critical appraisal of
individual sources of
evidence §
12
If done, provide a rationale for conducting a critical appraisal
of included sources of evidence; describe the methods used
and how this information was used in any data synthesis (if
appropriate).
N/A
Synthesis of results
13
Describe the methods of handling and summarizing the data
that were charted.
4
Results
Selection of sources of
evidence
14
Give numbers of sources of evidence screened, assessed for
eligibility and included in the review, with reasons for
exclusions at each stage, ideally using a ﬂow diagram.
4
Characteristics of sources
of evidence
15
For each source of evidence, present characteristics for which
data were charted and provide the citations.
Tables 2–6
Critical appraisal within
sources of evidence
16
If done, present data on critical appraisal of included sources
of evidence (see item 12).
N/A
Results of individual
sources of evidence
17
For each included source of evidence, present the relevant
data that were charted that relate to the review questions and
objectives.
Tables 2–6
Synthesis of results
18
Summarize and/or present the charting results as they relate to
the review questions and objectives.
5–40
Discussion
Summary of evidence
19
Summarize the main results (including an overview of
concepts, themes and types of evidence available), link to the
review questions and objectives and consider the relevance to
key groups.
40–41
Limitations
20
Discuss the limitations of the scoping review process.
41
Conclusions
21
Provide a general interpretation of the results with respect to
the review questions and objectives as well as potential
implications and/or next steps.
42
Funding
Funding
22
Describe sources of funding for the included sources of
evidence as well as sources of funding for the scoping review.
Describe the role of the funders of the scoping review.
43
JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses
extension for Scoping Reviews. * From where sources of evidence (see second footnote) are compiled, such as
bibliographic databases, social media platforms and websites. † A more inclusive/heterogeneous term used to
account for the diﬀerent types of evidence or data sources (e.g., quantitative and/or qualitative research, expert
opinion and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be
confused with information sources (see ﬁrst footnote). ‡ The frameworks by Arksey and O’Malley (1) and Levac and
colleagues (2) and the JBI guidance (3,4) refer to the process of data extraction in a scoping review as data charting.
§ The process of systematically examining research evidence to assess its validity, results and relevance before using
it to inform a decision. This term is used for items 12 and 19 instead of “risk of bias” (which is more applicable to
systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used
in a scoping review (e.g., quantitative and/or qualitative research, expert opinion and policy document).
Appendix References
(1)
Arksey, H.; O’Malley, L. Scoping studies: Towards a methodological framework. Int. J. Soc.
Res. Methodol. 2005, 8, 19–32.
(2)
Levac, D.; Colquhoun, H; O’Brien, K.K. Scoping studies:
Advancing the methodology.
Implement Sci. 2010, 5, 69, doi:10.1186/1748-5908-5-69.
(3)
Peters, M.D.; Godfrey, C.M.; Khalil, H.; McInerney, P.; Parker, D.; Soares, C.B. Guidance for
conducting systematic scoping reviews.
Int.
J. Evid.
Based Healthc.
2015, 13, 141–146,
doi:10.1097/XEB.0000000000000050.
(4)
Peters, M.D.J.; Godfrey, C.; McInerney, P.; Baldini Soares, C.; Khalil, H.; Parker, D. Scoping reviews.
In Joanna Briggs Institute Reviewer’s Manual; Aromataris, E., Munn, Z., Eds.; Joanna Briggs Inst:
Adelaide, Australia, 2017.
Int. J. Environ. Res. Public Health 2020, 17, 8059
31 of 39
Appendix B
Table A2. Details of the search strategy used in all 4 databases.
Notes for Database
Ovid (Embase)
Ovid (Medline)
Sport DISCUS (Ebscohost)
ProQuest Social Science Journals
Ti,ab Searches Title & Abstract
Ti,ab Searches Title & Abstract
AB Searches Abstract
Ab Searches Abstract
Running Search Terms
Run*, Jog*, Sprint*, Park-run, Orienteer,
Orienteering, Marathon, Marathon-running,
Treadmill
Mental Health Search Terms
Mental Health, Mental illness, Mental state,
Emotions, Emotional, Depression, Depressive
disorder, depressive therapy, Postnatal depression,
Postpartum depression, Seasonal aﬀective disorder,
Situational depression, Atypical depression,
Persistent depressive disorder, anxiety, loneliness,
stress, mood, self-eﬃcacy, sleep, psychological,
psychological characteristics, psychology, eating
disorder, disordered eating, anorexia, bulimia,
exercise, health status disparities, quality of life,
motivation, adjustment disorder, sick role.
relaxation, lifestyle, exercise therapy, social support
NOT search Terms
Rodent, mouse, rat, bovine, pig, animal*, horses,
mice, ecology, dermatology, epigenetics, gene*,
molecule*, cell*, phenotype, drug*, hormone*, food,
nutrient*, glucose, imaging, football, tennis,
swimming, heart, troponin, cardiology, lung,
respiratory, bone, cesarean, newborn, breast-feeding,
HIV, cough, rectal, protocol, procedure, surgery,
operation, stroke, sacroiliitis, COPD, asthma,
Apnoea, angina, allergy, railway, falling
Search Syntax
(remember the ‘adj’ function)
(remember the ‘adj’ function)
(remember the ‘adj’ function)
(remember the ‘adj’ function)
(((“mental-health” or “mental-illness” or “mental-state” or emotions
or emotional or depression or “depressive-disorder” or
“depressive-therapy” or “postpartum-depression” or
“seasonal-aﬀective-disorder” or “situational-depression” or
“atypical-depression” or “persistent-depressive-disorder” or anxiety
or loneliness or stress or mood or “self-eﬃcacy” or sleep or
psychological or “psychological-characteristics” or psychology or
“eating-disorder” or “disordered-eating” or anorexia or Bulimia or
exercise or “health-status-disparities” or “quality-of-life” or
motivation or “adjustment-disorder” or “sick-role” or relaxation or
lifestyle or “exercise-therapy” or “social-support”)) AND (run* or
Jog* or sprint* or “park-run” or orienteer or orienteering or marathon
or “Marathon-running” or treadmill) NOT (dermatology OR
epigenetics OR gene* OR drug* OR surgery OR hormone* OR food
OR imaging OR animal* OR football OR tennis OR swimming OR
rodent OR mouse OR rat OR pig OR bovine OR phenotype or Heart
or cardiology OR lung or bone OR caesarean OR HIV OR troponin
OR cough OR protocol OR breast-feeding OR cell* OR sacroiliitis OR
rectal or procedure OR COPD or respiratory OR nutrient* OR glucose
or newborn OR stroke OR asthma OR operation OR horses OR falling
OR railway OR molecule* OR apn?ea OR angina OR allergy OR mice
OR ecology)).ab,ti.
(((“mental-health” or “mental-illness” or “mental-state” or emotions
or emotional or depression or “depressive-disorder” or
“depressive-therapy” or “postpartum-depression” or
“seasonal-aﬀective-disorder” or “situational-depression” or
“atypical-depression” or “persistent-depressive-disorder” or anxiety
or loneliness or stress or mood or “self-eﬃcacy” or sleep or
psychological or “psychological-characteristics” or psychology or
“eating-disorder” or “disordered-eating” or anorexia or Bulimia or
exercise or “health-status-disparities” or “quality-of-life” or
motivation or “adjustment-disorder” or “sick-role” or relaxation or
lifestyle or “exercise-therapy” or “social-support”) and (run* or Jog*
or sprint* or “park-run” or orienteer or orienteering or marathon or
“Marathon-running” or treadmill)) not (dermatology or epigenetics
or gene* or drug* or surgery or hormone* or food or imaging or
animal* or football or tennis or swimming or rodent or mouse or rat
or pig or bovine or phenotype or Heart or cardiology or lung or bone
or caesarean or HIV or troponin or cough or protocol or
breast-feeding or cell* or sacroiliitis or rectal or procedure or COPD
or respiratory or nutrient* or glucose or newborn or stroke or asthma
or operation or horses or falling or railway or molecule* or apn?ea or
angina or allergy or mice or ecology)).ab,ti.
(AB(run* OR jog* OR sprint OR “park run” OR orienteer OR
orienteering OR marathon OR “marathon-running” OR treadmill)
AND AB(“mental health” OR “mental illness” OR “mental state” OR
emotions OR emotional OR depression OR “depressive disorder” OR
“depressive therapy” OR “postpartum depression” OR “seasonal
aﬀective disorder” OR “situational depression” OR “atypical
depression” OR “persistent depressive disorder” OR anxiety OR
loneliness OR stress OR mood OR “self-eﬃcacy” OR sleep OR
psychological OR “psychological characteristics” OR psychology OR
“eating disorder” OR “disordered eating” OR anorexia OR bulimia
OR exercise OR “health status disparities” OR “quality-of-life” OR
motivation OR “adjustment disorder” OR “sick role” OR relaxation
OR lifestyle OR “exercise therapy” OR “social-support”)) NOT
(dermatology OR epigenetics OR gene* OR drug* OR surgery OR
hormone* OR food OR imaging OR animal* OR football OR tennis
OR swimming OR rodent OR mouse OR rat OR pig OR bovine OR
phenotype or Heart or cardiology OR lung or bone OR caesarean OR
HIV OR troponin OR cough OR protocol OR breast-feeding OR cell*
OR sacroiliitis OR rectal or procedure OR COPD or respiratory OR
nutrient* OR glucose or newborn OR stroke OR asthma OR operation
OR horses OR falling OR railway OR molecule* OR apnoea OR
angina OR allergy OR mice OR ecology)
(ab((run* OR jog* OR sprint OR “park run” OR orienteer OR
orienteering OR marathon OR “marathon-running” OR treadmill))
AND ab((“mental health” OR “mental illness” OR “mental state” OR
emotions OR emotional OR depression OR “depressive disorder” OR
“depressive therapy” OR “postpartum depression” OR “seasonal
aﬀective disorder” OR “situational depression” OR “atypical
depression” OR “persistent depressive disorder” OR anxiety OR
loneliness OR stress OR mood OR “self-eﬃcacy” OR sleep OR
psychological OR “psychological characteristics” OR psychology OR
“eating disorder” OR “disordered eating” OR anorexia OR bulimia
OR exercise OR “health status disparities” OR “quality-of-life” OR
motivation OR “adjustment disorder” OR “sick role” OR relaxation
OR lifestyle OR “exercise therapy” OR “social-support”)) NOT
ab((dermatology OR epigenetics OR gene* OR drug* OR surgery OR
hormone* OR food OR imaging OR animal* OR football OR tennis
OR swimming OR rodent OR mouse OR rat OR pig OR bovine OR
phenotype OR Heart OR cardiology OR lung OR bone OR caesarean
OR HIV OR troponin OR cough OR protocol OR breast-feeding OR
cell* OR sacroiliitis OR rectal OR procedure OR COPD OR respiratory
OR nutrient* OR glucose OR newborn OR stroke OR asthma OR
operation OR horses OR falling OR railway OR molecule* OR apnoea
OR angina OR allergy OR mice OR ecology))) AND
(stype.exact(“Scholarly Journals”) AND la.exact(“ENG”))
Search complete?
Yes
Yes
Yes
Yes
Search saved?
Yes
Yes
Yes
Yes
Saved under:
Embase RunningMH
Medline RunningMH
Sport Discus Running MH
ProQuest RunningMH
Number of hits:
10,131 Text results (this had a limit of only human studies, as well as
a limit for articles and articles in press applied to the search)
10,154 text results (this had a limit of human studies applied to the
search)
3461 (this had a limit of English studies only, and academic journal
only applied to the search)
5933 (this search was carried out within the sports medicine and
education index database and in the social sciences database)
Uploaded to Covidence?
Yes
Yes
Yes
Yes
Int. J. Environ. Res. Public Health 2020, 17, 8059
32 of 39
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A Scoping Review of the Relationship between Running and Mental Health.
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