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. 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. 