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Myra Sack has always been an athlete. She was picked first for neighborhood basketball games when she was growing up outside of Philadelphia.

Sack, 38, went on regular jogs throughout most of her pregnancy. After Sack’s daughter Havi was born, the little girl loved the movement of the running stroller.

Havi was 15 months old when she was diagnosed with Tay-Sachs, a rare and fatal genetic disease. Sack and her husband had done screening before conceiving, but they said they were given results that turned out to be incorrect.

Havi died in 2021 when she was 2 years, 4 months old.

“I remember someone saying to me, ‘You’re going to meet these incredible people who have also lost children,’” Sack said. “And at the time, I was like, ‘I don’t want to be a part of this community at all. I hate this.’”

Over time, Sack said her grief made her feel like “an alien.” She wanted to talk about Havi but not in the windowless room she imagined when she pictured a grief circle.

A little more than a year after Havi died, Sack reached out to friends, hospitals, and the local running community, and she found 18 people who, like her, had suffered a life-altering loss. The group gathered at mile 21 of the Boston Marathon route with a plan to meet weekly for a couple months to talk and train for a half-marathon.

One of the acquaintances Sack reached out to was Maria Rodrigues, whose 17-year-old son, Jairom, had died in a rock climbing accident while the family was on vacation in her home country of Brazil.

“Of course I said yes,” said Rodrigues, even though she hadn’t been running in years. “And immediately I opened the computer, and I Googled, ‘How does a 60-year-old woman train for a half-marathon?’”

Before their first run, the group members gathered in a circle and introduced themselves with their name and the name of the person they had lost. The group repeated their loved one’s name back to them.

Each week, two or three people would share a brief story about their loved one with the group. Then they went for a run.

The training was difficult, but Rodrigues stuck with it and completed the half-marathon in Newport, R.I.

Rodrigues was surprised she made it across the finish line and said it helped her see she was stronger than she realized.

“There’s a little bit of a parallel,” Rodrigues said. “As hard as this is, grief and the half-marathon, I can do it.”

The loose curriculum of this first running grief group was based on Sack’s research and conversations with grief and trauma experts Joanne Cacciatore and Bruce Perry. It became the blueprint for her nonprofit E-Motion, which trains facilitators to run groups across the country and outside of the United States.

‘This is grief’

When people are grieving, there are physiological changes as well as emotional ones: Heart rate, blood pressure, and the stress hormone cortisol all rise. There’s more inflammation, the immune system is suppressed, and many people experience exhaustion and brain fog.

“You think about grief and you think about sadness, maybe you think about anger, but you don’t ever hear about the physical aspects of grief,” said Sarah McCarthy, a psychologist at Boston Children’s Hospital who helps support families after the sudden loss of a child.

McCarthy was already working in this field when her daughter was diagnosed with leukemia. Even with everything she knew about grief, McCarthy was stunned by the way her body seemed to fall apart after her daughter’s death.

“I was exhausted all the time,” McCarthy said. “I went to my PCP, and I was like, ‘What is wrong with my body?’ Nobody really sat down and said, ‘This is grief.’”

Why exercise helps

McCarthy moved to Boston after her daughter died, and she ended up meeting Sack through her work. Sack encouraged McCarthy to join a running group.

“I actually hate running,” McCarthy said. Sack told her it didn’t matter and that the groups were for people at all levels. McCarthy bought a pair of running shoes and started training for a 10-kilometer race with an E-Motion group. It was as hard as she feared.

“There was one day that I was like, ‘I’m going to quit,’” McCarthy said. “Another mom must have sensed that, and she just ran with me.”

The pair took regular walk breaks. McCarthy stuck with the training and finished the 10K.

“Afterward I told Myra, ‘This is amazing, and we need to study it,’” McCarthy said.

While studies of E-Motion are still in early phases, research for years has shown that exercise is effective at improving mental health. Grief is different from anxiety and depression, but many of the symptoms can look similar, and scientists are beginning to turn their attention to whether exercise could help bereaved people, too.

In research done in the United Kingdom in 2021, psychologists found that physical activity “allowed a sense of freedom” and gave people the opportunity to express emotions while finding more social support.

In 2023, a longitudinal study showed that physical activity can promote resilience and help protect people against some of the most devastating consequences of traumatic loss. The bereaved people in the study who exercised more were less likely to develop chronic depression than those who exercised less.

“I think that a lot of what is happening in grieving is actually not about verbal processing,” said Mary-Frances O’Connor, a grief expert and author of The Grieving Body: How the Stress of Loss Can Be an Opportunity for Healing.

Though O’Connor wasn’t involved in these studies, she has spent much of her career looking at how our bodies and minds respond to grief. In her research, she found that muscle relaxation exercises, in which people tense and release muscles one at a time, are surprisingly effective at helping bereaved people feel better.

She said that in addition to the physiological and mental health benefits of exercise, physical activity gives people a sense of agency at a time when the world feels out of control. Being part of a running or walking group means people are supporting each other and holding each other accountable.

“Those are the things that I think help return us to community life, which is a vital and really difficult and under-discussed aspect of grieving,” O’Connor said.

Connection

Grief can be isolating, often because people don’t know what to say to someone who has been through a terrible loss.

“They’re scared of saying the wrong thing or they’re just too scared of this topic in general, and they just pull away,” McCarthy said.

Sack and McCarthy said groups like E-Motion help people connect with others who have been there.

Rodrigues described how, walking or running side by side, participants fall in and out of conversation. Sometimes they talk about their loved ones but often they don’t.

“You just simply, very fluidly pick up, slow down,” she said.

Most of the E-Motion groups meet weekly for two months or so, but people form deep bonds in that short time. Many see each other between meetings and stay in touch for years, often finding close friends.

“I think the beauty of death is that it cracks you open,” Rodrigues said. “We make connections because we’re vulnerable.”