Is ultra-distance running bad for mental health?

Craig Newland

According to a recent systematic review, ultra-distance runners seem to be more frequently affected by eating disorders and exercise addiction compared with the general population. Also, depressive symptoms and anxiety are quite commonly seen.

But is it possible that running actually HELPS these people to manage such symptoms and improve both their psychological AND physical health?

A 2023 systematic review completed by Thuany et al. (2023) debated this topic, and found that among the general population, those involved in prolonged strenuous exercise ‘may’ be at increased risk of mental health issues. Research into this topic has increased over the last 10 years, with eating disorders, exercise addiction, stress, depressive symptoms, sleep orders, anxiety and psychological health being the most studied in ultra-distance runners. Prevalence ranges from 11.5% to 18.2% for exercise addiction, 12.8% to 18.6% for depressive symptoms, and from 32% to 62.5% for eating disorders; while the prevalence of sleep disturbance and anxiety were 24.5% and 12.8%, respectively.

The higher incidence of eating disorders among ultra-distance runners found in this systematic review could be related to the fact running emphasizes leanness as a performance-related factor. Not surprisingly, comparisons between elite athletes and the general population showed a higher prevalence of eating disorders among the elite group.

Interestingly, exercise addiction was strongly related to exercise in an unstructured space (i.e. street, public space), younger age, and lower BMI. No association between weekly run volume and exercise addiction in ultra-distance runners was observed. Additionally, there was also no association between psychological variables and runners’ performance.

Two studies included in this systematic review investigated depressive symptoms in ultra-distance runners, with the prevalence ranging from 12.8% to 18.6%. Running however has always been associated with physical and mental health benefits. A scoping review reported that runners presented with lower depression and anxiety, lower stress, and higher psychological well-being compared with non-runners. A 12-week group-based running program showed positive outcomes for people presenting with complex mood disorders, with a decrease in depression, stress, and anxiety. A dose–response relationship highlighted a decline of about 33% in the risk of psychological distress in groups involved in sports practice more than four times a week.

SO.....Physical activity in general has a prophylactic and therapeutic capacity to diminish depression and anxiety. Furthermore, physical activity can also prevent and reduce insomnia.  However, the relationship between physical activity and mental health follows a U-shaped curve, with higher levels of physical activity potentially having damaging effects on mental health. This could be due to the pressure of the sport (or any sport) and the high demands of ultra-distance running. 

For further information email [email protected]


Thuany, M., Viljoen, C., Gomes, T.N. et al. Mental Health in Ultra-Endurance Runners: A Systematic Review. Sports Med 53, 1891–1904 (2023).

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