The Great North Run got under way with a service of remembrance and a minute's silence for the Queen.
Some 60,000 people are taking part in the famous half marathon from Newcastle to South Shields, first held in 1981.
While other events have been cancelled in the wake's of the Queen's death, organisers of the run's 41st outing said it would go ahead in a "subdued" and "respectful way".
About £25m is expected to be raised for various charities.
The usual fly-by of the Red Arrows has been cancelled and organisers said "elements of the runner and spectator experience will be more subdued".
The national anthem was also sung followed by a round of applause before the run was started by champion runner Eilish McColgan at about 10:45 BST.
The run has returned to its usual route after the 2021 event was changed to start and end in Newcastle due to Covid stipulations.
The Right Reverend Mark Wroe, Bishop of Berwick and acting Bishop of Newcastle, was among several religious leaders taking part in the short service at the start line.
He said it was "important" the event went ahead, adding: "It's a huge community event, a huge part of the North East."
He told BBC Breakfast all the runners had their own "individual stories" with many running for a "really good cause" or in memory of their own lost loved ones.
"The Queen has touched people really deeply and that has brought to the surface a lot of our own feelings of loss," the bishop said.
"Today is a wonderful opportunity for people to come together to share that sense of loss and our individual stories where we are feeling grief and bit forlorn."
He said the run was going ahead "in the spirit of wanting to pay tribute to Her Majesty and her life and service".
Hari Shukla, former director of the Tyne and Wear Racial Equality Council, was also at the service.
He said he met the Queen three times and each occasion was one he could "never forget".
Mr Shukla said: "She was so very much interested in what I was saying and she cared for everyone."
Kenya's defending champion Hellen Obiri won the elite women's race, completing the 13.1 mile (21km) course in one hour seven minutes and five seconds.
Uganda's Jacob Kiplimo, the world record holder and reigning world half marathon champion, won the men's race, completing his first ever Great North Run in 59 minutes 33 seconds.
Eden Rainbow-Cooper won the women's wheelchair elite race by seven hundredths of a second ahead of Samantha Kinghorn.
David Weir won the men's elite wheelchair completing the course in 42 minutes 59 seconds, two seconds ahead of Daniel Sidbury.
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