Longitudinal Associations Between Physical Activity Behavior and Structural Brain MRI Features After Stroke: A Sub-Study From the Nor-COAST Project

Journal article

Background: Post-stroke physical activity (PA) behavior may partly explain inter-individual differences in cortical and sub-cortical brain volumes and brain age estimates. Objective: To investigate longitudinal associations of post-stroke PA behavior with structural brain MRI features. Methods: Data were from a multicenter longitudinal cohort study. PA estimates were based on accelerometer measurements. Separate linear mixed models assessed average daily step count at 18 and 36 months, and longitudinal PA trajectory groups as measured at 3, 18, and 36 months after stroke, as primary and secondary exposures. Dependent variables included brain age gap (BAG), representing the discrepancy between brain MRI predicted age and chronological age, and MRI-based cortical, hippocampal, and thalamic volumes at 18- and 36 months post-stroke. Models accounted for age, sex, education, stroke severity, intracranial volume, and MRI scanner. Results: We included 146 participants (age, mean [SD]: 70.3 [11.1]; 45.7% female) with predominantly mild strokes. Every +1000 steps/day were associated with −1.15 (95% CI: −1.76 to −0.53) lower BAG, 2.63 mL (95% CI: 0.31-5.00) larger cortical volume, and 0.07 mL (95% CI: 0.03-0.11) larger hippocampal volume. The association between step/day and thalamic volume was curvilinear, with the largest volumes observed at 4700 steps/day. Out of 4 PA trajectory groups, participants in the most active group had −7.44 years (95% CI: −2.86 to −12.01) lower BAG and 0.90 mL (95% CI: 1.48-0.33) larger thalamic volumes than the least active group. Conclusions: Higher PA levels post-stroke were associated with larger brain volumes and younger-appearing brains.

Authors: Luzum, G; Aamodt, EB; Allore, H; Alnæs, D; Beyer, MK

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: SAGE Publications
• Journal: Neurorehabilitation and Neural Repair
• Volume: 40
• Issue: 1
• Pages: 75-87
• Article number: 15459683251399125
• Publication date: 2026-01-09
• DOI: 10.1177/15459683251399125
• EISSN: 1552-6844
• ISSN: 1545-9683
• Language: English
• Keywords: secondary prevention; brain maintenance; brain age; physical activity; neuroimaging