Multivariable analysis controlling for low-density lipoprotein (LDL), non high-density lipoprotein, and SBP identified that greater physi- cal activity on the Physician-Based Assessment and Counselling for Exercise scale was independently associated with 40% lower risk of stroke, MI, or vas- cular death at 3 years (OR, 0.6 [95% CI, 0.4 0.8]). 2. Physical activity is a complex behavior. The ExStroke Pilot Trial (Physical Exercise After Acute identified no superiority for repeated encouragement and instruction to be physically active over 2 years to information pro- vision after stroke (Physical Activity Scale for the Elderly mean difference [MD], 5.0 [95% CI, 5.8 15.9]). Similarly, wearable activity monitors and smartphone applications demonstrated no clear effect for use in conjunction with other interven- tions in stroke to improve step count in community or inpatient rehabilitation settings (MD, 1400 steps Lifestyle-based interven- tions for stroke secondary prevention111 identified a significant effect for behavioral change interven- tions compared with usual care to increase physi- cal activity participation after stroke (standardized CLINICAL STATEMENTS AND GUIDELINES Kleindorfer reviews identified favorable effects for exercise- based interventions with counseling compared with usual care for reduction in SBP (MD, 5.3 mmHg ; and Exercise interventions initiated within 6 months of stroke/ TIA have a larger effect on SBP ( 8.46 mmHg initiated after 6 months ( 2.33 mmHg [95% CI, 3. Much of the evidence supporting exercise-based programs for stroke secondary prevention is based on participants with ambulatory stroke or TIA.131 134 Many stroke survivors, however, encounter physical and environmental barriers to engaging in regular physical activity for health. Neurological weakness, altered perception or balance, or impaired cogni- tion, for example, may negate their participation in conventional exercises programs. Adaptive equip- ment and skilled personnel can help to overcome many of these barriers to participation. 