Some Neurological Benefits of Hiking, As Told by Someone Who’s Thru-Hiked Before and After Brain Surgery

After undergoing brain surgery last winter, I figured I could use my recovery time to start training for another thru-hike (or two). Thru-hiking has always been something I turn to when I’m feeling a need for healing or structure. I hiked the Te Araroa in 2018 during a time when I felt I needed to do some walking and thinking, and I hiked the CDT immediately afterward when I realized the walking and thinking weren’t finished.

Ed. note: We’re hikers, not doctors. The information in this post is not medical advice: always consult a qualified healthcare provider regarding medical conditions.

On the Wind River High Route (mid-CDT) back in 2018, when my biggest medical concern was a shin splint. Photo taken by DH.

A few years ago, I was diagnosed with a rare brain condition called moyamoya syndrome. This condition affects blood vessels in the brain, often reducing blood flow. Parts of these vessels gradually become narrowed.

The name “moyamoya” comes from the Japanese term for a puff of smoke, which describes the appearance of blood vessels in scan images. A brain not receiving adequate blood flow can try to grow additional, often weak, collateral vessels to try to compensate. These tiny vessels look a bit like a puff of smoke in imagery. Moyamoya can be caused by certain health conditions, genetic factors, infections, or some combination of these. Despite extensive testing, a cause for my condition has never been found.

My symptoms have always been alarmingly minor. I first noticed moments of strange dizziness and slight weakness in my right foot and hand. In retrospect these were probably mini-strokes, or transient ischemic attacks (TIAs), which occur when the brain isn’t getting enough blood. During one of these episodes, I noticed the right side of my face drooping and decided to go to the hospital.

Because moyamoya is relatively uncommon and because mine was at an early stage, it took about a year and a half of testing and regular brain scans to diagnose. During this time I gradually started feeling comfortable with hiking again. I hiked a few short sections of the Pacific Northwest Trail (PNT) in 2022 and then thru-hiked the PCT in 2023. Several weeks after finishing the PCT, my diagnosis of moyamoya was confirmed and I was scheduled for brain surgery.

During the process of diagnosis, I started getting really interested in brain stuff. These days, I spend about the same amount of time reading neurology research papers as I do looking at topo maps, which is to say a lot of time. There’s a large body of research suggesting that hiking, walking, and exercise in general can have neurological benefits. While I’m certainly no neurologist, I am a person who has directly benefited from hiking during recovery from strokes, brain damage, and brain surgery. The following information is a mix of personal experience and research.

Wrist stabilization after a cerebral angiogram (an imaging procedure), which necessitated climbing over logs one-handed for a few days.

Getting the Blood Flowing

In January of 2024, I had brain surgery to try to treat my condition by increasing blood flow to my brain. This involved creating a hole in my skull and rerouting some of my arteries.

Less than two days post-surgery, my doctors encouraged me to start taking short walks around the hospital. Walking increases a person’s heart rate, allowing more oxygen to reach the brain and helping to speed recovery after brain damage by improving the function of brain cells. Knowing that it could speed my recovery, I took advantage of these hospital walks. Forty-two laps around the neurology ward is about a mile, and it flies by quickly in the presence of a good friend. After finally being released from the hospital, I began to incorporate hiking into my process of recovery, although at first, I was never without my helmet, inReach, meds, and a healthy dose of fear. 

Hiking, thanks to factors including uneven terrain and elevation, has the potential to increase a person’s heart rate similarly, and perhaps to a greater degree, than walking. Before and immediately after surgery, my condition made me especially sensitive to changes in heart rate. Activities involving quick changes in heart rate, such as running, yoga, and climbing triggered dizziness and limb weakness for me if I didn’t watch my heart rate carefully. (The worst of these symptoms came as I tried to stand after blowing up an inflatable Therm-a-Rest sleeping pad. My sleeping pads are exclusively foam these days.)

This experience of dizziness was similar to orthostatic hypotension — that feeling of dizziness when you stand up too quickly — although in my case, it was directly related to my brain issue. In terms of heart rate, hiking was the sweet spot for me during surgery recovery. It allowed me to get my blood pumping without having to be constantly focused on my heart rate, which I found really helpful for my recovering brain. 

Exercise can also stimulate the growth of new blood vessels, which is beneficial to long-term health for most people. Especially for someone who is specifically trying to encourage her brain to grow a little garden of new blood vessels.

Post-surgery brain scan images, showing the hole in my skull, temporary sutures, and a typical amount of post-surgical swelling on the incision side.

Moving and Balancing

While beneficial to brain health in general, walking and hiking can be absolutely exhausting to a brain recovering from damage. In my initial period of surgery recovery, the factor limiting my distance was mental, rather than physical, fatigue. My muscles felt fine and my cardiovascular limits were not being pushed, but by the time I got off the trail, my brain would feel as though I’d just attended a multi-hour physics lecture. 

Having a conversation while hiking was almost impossible, thanks to the mental space occupied by moving my feet. The process of controlling the body’s movements with the brain is typically somewhat automatic and subconscious — you know how your body is positioned without having to look.

This sense of the body in space is called proprioception. Have you ever mentally zoned out while picking your way through talus, up a rocky streambed, or over tangles of roots? Thanks to the automatic process of proprioception, the body is able to regulate muscle tension to maintain balance. This allows you to walk and hike without constant mental engagement. Strokes, traumatic brain injuries (TBIs), and various other neurological conditions can impact proprioception.

Proprioceptive training can reduce risk of injury and improve motor function. Stroke recovery programs often incorporate various activities with proprioceptive elements. Activities such as dance, yoga, walking, and hiking have all been found to be beneficial in stroke recovery. During recovery, I noticed a gradual improvement in the mental fatigue that came with moving my body. I went from hospital laps to park walks to longer hikes. By three months post-surgery, scrambling and snow travel started to feel more comfortable. After five months I was feeling good enough to thru hike the Pacific Northwest Trail (PNT) and the Colorado Trail (CT), albeit with the presence of a very supportive partner.

If this timeline seems quick, it’s because it was. I’m lucky to have had such a speedy recovery, and processes of neurological recovery can be far longer and more challenging. As with many types of recovery, the process also isn’t linear. There are still some days when I need to be in the dark with an empty mind and not speak to anyone, but I don’t think I’m alone in that. 

My partner Barilla on the PNT in the Olympic Mountains during early summer of 2024, five months after my brain surgery.

Improving Mental Health

You don’t need to have a medical condition to mentally and neurologically benefit from hiking, which of course you likely know already. Studies suggest that hiking can decrease stress levels, improve cognitive function, and restore mental and emotional health, among other things.

For me, being back on the trail helped me to clear my mind of stress and regain some of the trust I had lost in my body and my health. Long-distance walks can decrease emotional distress, allowing a person to focus on their own needs and on their personal strength. On my first night alone in the woods in 2022 after my brain issues had begun, I remember lying awake in a bivy listening to what I called “the whooshing.” This was pulsatile tinnitus, the strange sound of blood flow that I heard constantly in my head in the early days of my brain issues.

I was terrified to fall asleep in the backcountry, which was something I had been so comfortable with before all the brain problems started. But gradually, with more time spent outside, I started to feel at home again in my body. It’s a wonderful feeling to look down from a snowy ridge after doing the sort of sketchy stuff you weren’t sure you’d be able to do again.

Social interactions and relationships impact mental health, and can even influence the structure of certain brain regions. The interactions I’ve had with people I meet in the backcountry are often supportive and energizing.

The people I hiked NOBO with on the PCT in the Sierras during the high snow year were the reason I felt comfortable engaging with a somewhat elevated level of risk on that section of trail. We talked openly about risk, route decisions, and individual capabilities. I shared with these friends the details of my brain issues and was met with understanding and support. This made it possible for me, as a person with a serious brain issue, to feel solid about moving through continuous snow for weeks. Weeks that comprised one of the most concentrated periods of fun I’ve had so far.

Heading up Forester Pass in 2023 with Cinder and Speedo, who made one heck of a Sierra team. Photo taken by JR.

I’ve found that talking with people about my medical issues can cause them to open up about their own struggles, medical and otherwise. Realizing that so many people within the outdoor community are out here adapting to their individual challenges has been empowering for me. So whether you are out here with a brain that is recovering, healing, resting, or doing just fine, know that there is certainly a place for you in the outdoors and that you are not alone.