A Scoping Review of the Relationship between Running and Mental Health

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.


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][6][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 well-being and satisfaction with physical health, facilitating socialisation and community connectedness, and reducing loneliness [12][13][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

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].

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.

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.
Table 1.Definitions of the mental health outcomes included within the review: the outcomes were informed by Kelly et al. (2018) [8].

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].

Identify Relevant Studies
Studies were included based on the following criteria: 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) • 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 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.

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.

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.

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.

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.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.

Category 1: Cross-Sectional Studies
Forty-seven studies utilised cross-sectional designs (with and without non-running comparison groups) (Table 2) .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.

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 [ 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.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).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.= 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] (  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 [ 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.

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).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.

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. 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.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).

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 ( 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 (R 2 change = 0.16, p < 0.001) and barriers to self-efficacy (R 2 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 (R 2 change = 0.06, p < 0.05) and self-identity (R 2 change = 0.06, p < 0.04) were significant predictors of maintenance duration.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  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.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).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).

Runners Only
Nineteen studies only included runners [30,31,34,35,39,44,48,49,51,55,58,[65][66][67]70,[74][75][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][66][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].

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].

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].

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.

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.

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) .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][85][86][88][89][90][91][92][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].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
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][104][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].

Triple Bouts
Three studies used three bouts of running (Table 5) [109][110][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].

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.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).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 (F 1,28 = 5.81; p < 0.023; n 2 = 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.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).

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) .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][115][116]119,123,126,[129][130][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].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.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 (x 2 = 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.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.
[ Regarding within-subject data, an increase in mean VO 2 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.Long [ 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] ( 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).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.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).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.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, n 2 = 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,n 2 = 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. [  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 (γ 11 = −0.0002,p = 0.013), self-esteem (γ 11 = −0.0002,p = 0.015), positive activated affect (γ 11 = −0.0003,p < 0.001), positive deactivated affect (γ 11 = −0.0008,p < 0.01), negative activated affect (γ 11 = 0.0002, p = 0.046) and negative deactivated affect (γ 11 = 0.0003, p = 0.01).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.

Summary of Key Findings
The key findings of the each of the three categories of studies are summarised in Table 7.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.

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]

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.

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.

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.

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 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.

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].

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.

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.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.

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.

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.

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.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 § 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

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.
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.

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.

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).
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 ( 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

Figure 1 .
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.

Figure 1 .
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.

Author 3
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.IntroductionRationaleDescribe 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.

Table 2 .
Summary of data extraction from the 47 cross-sectional studies.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.< 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.= 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).

Table 2 .
Cont. = 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,

Table 2 .
Cont. = 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).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.

Table 5 .
Summary of data extraction from the 3 triple-bout studies.
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).
= 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.
= 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.

Table 6 .
Cont.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.= 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.

Table 7 .
Summary of key findings within each of the three categories.
(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 apnoeaOR angina OR allergy OR mice OR ecology))) AND (stype.exact("ScholarlyJournals") AND la.exact("ENG"))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)