Several systematic reviews examine lifestyle interventions after stroke; optimal approaches to reduce recurrent stroke remain unknown.112,840,841,849 Guidance on changing behaviors associated with chronic disease at an individual level is available850 ; however, a Delphi consensus identified that interventions to self-manage lifestyle risk factors after stroke need to be contextual- ized to the capacities, needs, and personal priorities of the individual and their families.851 Lifestyle change after stroke is more attainable when the lifestyle counseling is interactive, the advantages of behavior change are perceived as beneficial, and the counselor has sufficient resources (eg, availability of healthcare professionals time; appropriate counseling materials; knowledge and skills), highlighting a training need for healthcare staff to ensure good-quality counseling and patients adherence to healthier behavior.852 Recommendation-Specific Supportive Text 1. Longer-term follow-up in behavioral interventions after stroke addressing recurrent events is lack- However, meta-analysis (from 4 iden- =0) demonstrates that multimodal interventions addressing active educa- tion about risk factors, medications, and medication compliance and interventions to modify 1 lifestyle risk factors decrease the odds of recurrent cardiac no significant difference in the odds of recurrent TIA/stroke was reported in this review.840 Two small multimodal RCTs show promise for reducing cardiovascular end points. However, the small trial numbers dictate that results must be interpreted with caution pending larger, more definitive trials. A 24-week Japanese RCT (N=70)134 compris- ing exercise, salt restriction, and nutrition advice compared with usual care terminated at a median follow-up of 2.9 years when the prespecified effi- cacy point for the intervention was reached for the primary end point (composite stroke death, cardiac death, and hospitalization for stroke recurrence, MI, angina pectoris, or peripheral artery disease; (adjusted HR, 0.194 [95% CI, 0.121 0.737]). 