Long-term treatment strategies, including medication, psy- chological counseling, and community-based pro- grams, are effective in the management of drug Lifestyle Knowledge Gaps and Future Research Lifestyle recommendations in stroke secondary pre- vention draw from convincing primary prevention data and broader CVD populations. Recurrent stroke lacks robust evidence supporting interventions addressing smoking and diet/nutrition,96,103,183 are limited to non- disabling stroke in physical activity,110 and are absent for substance use. Optimal time windows to deliver lifestyle interventions after stroke are unknown. Future research in established stroke or TIA is required for the following: To identify the effects on recurrent stroke of proven dietary interventions (eg, Mediterranean or DASH diets) compared with usual care. To identify the effect on recurrent stroke of dietary sodium reduction or potassium increase, including the most efficacious and safe target. To establish whether higher recurrent stroke rates in underweight individuals184 are attenuated with nutritional supports. To trial activity-based interventions (including breaking sedentary time), inclusive of individuals with mobility impairment, exploring the role of adap- tive/electromechanically assisted devices when required. CLINICAL STATEMENTS AND GUIDELINES Kleindorfer To establish optimal physical activity prescription (frequency, intensity, time, and type [aerobic, resis- tance, mixed]) for secondary prevention. Potential synergistic effects of aerobic exercise combined with resistance-based strengthening exercises in stroke secondary prevention are unknown. To further develop stroke registries to address knowledge gaps in recurrent stroke, including the contribution of continued smoking (currently lim- ited to Asian and older populations), heavy alcohol consumption (currently lacking), and substance use (currently lacking). To identify the longer-term cardiovascular conse- quences of newer tobacco products, for example, electronic nicotine delivery systems (electronic cig- arettes/vaping), which are not currently known. 