About eight physiotherapy and first aid stations are also located at strategic points. Approximately 40 official refreshment stations along the route are stocked with soft drinks, water sachets, energy drink sachets, fruit, biscuits, energy bars, cooked potatoes and other refreshments. The highest point of the race, at 2,850 feet (870 m) above sea level, is situated near the Umlaas Road interchange. On the up run they appear in the following order: Cowies Hill, Fields Hill, Botha's Hill, Inchanga, and Polly Shortts.

The race is run on the roads of KwaZulu-Natal province, marked by 'The Big Five' set of hills. The spirit of the Comrades Marathon is said to be embodied by attributes of camaraderie, selflessness, dedication, perseverance, and ubuntu. During the event an athlete must also reach five cut-off points in specified times to complete the race.

Since 2019 runners over the age of 20 qualify when they are able to complete an officially recognised marathon (42.2 km) in under 4:50 (5 hours before 2019). It was resumed in 2022 with a field of 15,000 entrants. The race was not held from 1941 to 1945 due to World War II, and the in-person edition of the race was cancelled in 20 due to the coronavirus pandemic. With increased participation since the 1980s, the average finish times for both sexes, and the average age of finishers have increased substantially. In all but three runnings since 1988, over 10,000 runners have reached the finish within the allowed 11 or 12 hours. South African runners constitute the greater part of the field, but many entrants hail from the United Kingdom, Zimbabwe, India, the United States, Brazil, Australia, Botswana, Russia, Eswatini and Japan The 2019 field was capped at 25,000 runners, and the entry process closed after one week. The direction of the race alternates each year between the 'up' run (87 km) starting from Durban and the 'down' run (now 90.184 km) starting from Pietermaritzburg. It is the world's largest and oldest ultramarathon race. The Comrades Marathon is an ultramarathon of approximately 89 kilometres (55 mi) which is run annually in the KwaZulu-Natal province of South Africa between the cities of Durban and Pietermaritzburg.

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