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Emotion regulation (ER) skills and physical activity (PA) may help prevent adolescents from experiencing depression and anxiety symptoms. In South Africa, accessible and contextually appropriate ER interventions with PA elements for older adolescents are scarce. This study assessed the acceptability and feasibility of a co-adapted ER intervention with PA elements for at-risk, 15–18-year-old adolescents. Eight groups of adolescents ( n = 85) from 4 Western Cape schools participated in a single-arm feasibility study. The task-shared intervention took place weekly, over 7 weeks. Participants completed mental health surveys at baseline, 1-week post-intervention and 3-months post-intervention. Feasibility outcomes were favourable, with 100%, 99%, and 95% survey completion at baseline, 8 weeks, and 3 months, respectively. Eighty-four percent of participants completed the programme. Programme acceptability was high (94%), as were facilitator competency (96%) and content fidelity (86%). Secondary outcomes showed reductions in depression, anxiety, PTSD, and emotional dysregulation (all follow-ups), and increases in self-esteem and PA (at 8 weeks). This study addresses the need for school-based ER interventions with PA elements for at-risk, older adolescents from low-income settings in South Africa. The intervention was feasible and acceptable. The intervention shows preliminary therapeutic potential, but efficacy should be tested in a randomised controlled trial. This feasibility study was registered retrospectively with the Pan African Clinical Trial Registry (PACTR202412659160564, registered 17/12/2024).