Interventions Aimed at Changing Patient Behavior Recommendations for Behavior Change Interventions Referenced studies that support recommendations are summarized in online Data Supplements 63 and 64. COR LOE Recommendations In patients with ischemic stroke or TIA, behavior change interventions targeting stroke literacy, lifestyle factors, and medica- tion adherence are recommended to reduce In patients with ischemic stroke or TIA, teaching self-management skills or using behavior change theory (eg, motivational interviewing) can be ben- eficial in improving medication adherence.840 843 In patients with stroke or TIA, combined exercise-based and behavior change interven- tions are probably indicated in preference to behavior interventions alone, exercise interven- tions alone, or usual care to reduce physiologi- cal stroke risk factors such as SBP.111 113,829 In patients with TIA or nondisabling stroke, engagement in targeted secondary prevention programs (eg, cardiac rehabilitation programs or exercise and lifestyle counseling programs) can be beneficial to reduce risk factors and recurrent ischemic events.133,134 For patients with disabling stroke who are discharged from acute services, engaging in targeted secondary prevention programs (eg, an adapted cardiac rehabilitation program or struc- tured exercise including aerobic activity and healthy lifestyle counseling) can be beneficial to reduce vascular risk factors and mortality.111,844 Benefit B-R In patients with stroke or TIA, provision of health information or advice about stroke prevention is essential; however, information or advice alone, in the absence of a behavioral intervention, is not an effective means to change modifiable, lifestyle-related risk factors in order to reduce future ischemic events.129,829,845 Synopsis Hypertension, smoking, T2D, physical activity, diet, psy- chosocial factors, abdominal obesity, alcohol, cardiac causes, and apolipoproteins account for 91.5% of the PAR for ischemic stroke, similar across world regions, sexes, and ages.5a,846 One in 3 US citizens has at least 1 of these risk factors,847 which can be modulated by health behaviors, indicating a focus for stroke second- ary prevention and self-care.848 Changing entrenched behavior is difficult, and sustaining change over time is challenging. 