A Multicomponent Intervention to Encourage Stair Use in Municipal Buildings.

The American College of Sports Medicine recommends regular participation in moderate to vigorous physical activity for all adults. However, the majority of the population does not meet these recommendations. Stair use is one recommended method of accumulating regular moderate physical activity. PURPOSE: To determine the effectiveness of a stair use promotion strategy in visible and hidden stairwells on a university campus. METHODS: Motivational and directional signs were placed near elevators in four university buildings for a three-week intervention. Observations (n=8,433) were made of stair and elevator use for one week prior, during the intervention and at two and four weeks post intervention. Logistic regression analyses were used to test whether stair versus elevator use varied by intervention phase and stairwell visibility. RESULTS: Stair use increased significantly (12% from 35.5% baseline) during the intervention period (OR 1.65, 95% CI 1.47-1.85; p < .001) and remained elevated at week two (OR 1.37, 95% CI 1.19-1.59) and week four (OR 1.75, 95% CI 1.51-2.03) after the intervention signs were removed, at 7.6% and 13.4% respectively. The increase in stair use during the intervention was similar in hidden and visible stairwells. During all phases of the study, participants were more likely to use visible stairs (OR 4.68, 95% CI 4.19-5.21). However, the interaction between visibility and study phases was not significant (χ2(1) = 1.26, p = 0.74), suggesting a comparable increase in use of hidden and visible stairwells at each study phase. CONCLUSIONS: Motivational and directional signage can significantly increase stair use on a university campus. Furthermore, stairwell visibility is an important aspect of stair use promotion.

This study tested the effectiveness of a stair use promotion strategy in visible and hidden stairwells during intervention and post intervention follow up. A quasi-experimental study design was used with a 1 week baseline, a 3 week intervention, and post intervention at 2 and 4 weeks in 4 university buildings in San Antonio, Texas with stairwells varying in visibility. Participants were students, faculty, staff, and visitors to the 4 buildings. A total of 8431 observations were made. The intervention incorporated motivational signs with direction to nearby stairwells placed by elevators to promote stair use. Stair and elevator use was directly observed and recorded. Logistic regression analyses were used to test whether stair versus elevator use varied by intervention phase and stairwell visibility. Stair use increased significantly (12% units) during the intervention period and remained above baseline levels during post intervention follow-up. At baseline, visible stairs were 4 times more likely to be used than hidden stairs; however, the increase in stair use during intervention was similar in both types of stairwells. Motivational and directional signage can significantly increase stair use on a university campus. Furthermore, stairwell visibility is an important aspect of stair use promotion.

A quasi-experimental field study was undertaken to examine whether the source credibility of point-of-decision (POD) prompts would affect their effectiveness in increasing stair use. POD prompts attributed either to a more credible source, a less credible source, or nothing were randomly installed in three student halls of residence at a public university in Hong Kong (plus a control). The stair and elevator use of residents were recorded by view-from-top surveillance cameras and counted using motion-detection software, resulting in 14,189 observations. The findings show that all the POD prompts can yield, as hypothesized, a significant positive effect on stair use. The relative increase in stair use was 2.49% on average. However, contrary to our second hypothesis, the POD prompt attributed to the more credible source was not the most effective intervention. The implications of these findings are discussed in conclusion.

Examine the effects of a multicomponent intervention on stair usage. Nonrandomized controlled intervention. Two multistory university dormitories. Total of 5711 direct observations of university dormitory residents. The 2-week "Step It UP" intervention used poster prompts and fun/competitive challenges with incentives to encourage residents to take the stairs instead of the elevators. Ascending stair and elevator use was directly observed and coded for gender at high traffic times in intervention and control dormitories for 14 nonconsecutive hours over 1 week each at baseline, midintervention, and 1 week postintervention. The proportions of ascending stair and elevator users were compared using χ(2) analyses. Baseline stair use was equal between intervention and control dormitories (24.9% and 27.8%, respectively; χ(2)[1, N = 1849] = .08; p = .77). Stair use significantly increased from baseline in the intervention dormitory to 33.24% (χ(2)[1, N = 2192] = 18.44; p < .001) compared with no change in the control. Stair use returned to baseline in the intervention dormitory at postintervention (25.4%; χ(2)[1, N = 2297] = .08; p = .78). There were no significant differences between genders. This multicomponent, short-duration intervention significantly increased stair usage in a university dormitory relative to the control but was unable to sustain the increase when prompts were removed. Campaigns to sustain stair use are needed. Formative assessment is required to determine what combinations of components may yield the most cost-effective approach for future interventions.

Examine the effects of an interactive environmental intervention on stair usage. A nonrandomized, quasi-experimental intervention. Two three-story office buildings. Approximately 200 employees at the intervention site and 140 at the comparison site. The stairwell was decorated with interactive paintings such as maps, storyboards, and wish lists to encourage employees to take the stairs rather than the elevator. Daily stair and elevator usage were measured using electronic sensors or door-access card counters for 2 weeks prior to the intervention and 6 weeks after. The daily counts of stair use were modeled using a Poisson regression to estimate the effect of the intervention on staircase use. At baseline, the mean proportion of stair use relative to stair plus elevator use at the intervention site was 31.5% (95% confidence interval [CI], 30.3%-32.7%). During the 6-week intervention period, this proportion increased significantly to 66.2% (95% CI, 64.4%-67.9%). There was no significant change in stair use at the comparison site. In a Poisson regression of the daily number of stair users, the incidence rate ratio associated with the intervention was 2.57 (95% CI, 2.35-2.82). This interactive environmental intervention increased stair usage in an office setting relative to the comparison site, and this increase was sustained over a 6-week period. Adding interactive components to motivational or environmental change interventions shows promise in increasing stair usage.

Objective: The authors evaluated whether motivational signage influenced rates of stair use relative to elevator use on a college campus. Participants: In March and April 2004, the authors observed students, faculty, staff, and any visitors accessing a college campus building. Methods: During Phase I, the authors monitored ascending stair and elevator use at the same time each weekday (Monday-Friday). During Phase II, the authors placed motivational signs encouraging stair use at the bottom of the stairs and outside and inside the elevators. During the third week (Phase III), the authors removed the signs. Results: The authors observed 18,389 ascending trips during the 3 weeks of the study. Motivational signs significantly contributed to an 18.6% increase in stair use in the second week, which was maintained in the following week. Conclusions: The signage intervention successfully enhanced physical activity on a college campus by providing educational health tips that may have served as motivation to choose the stairs.

Recent recommendations suggest that health benefits can also be derived from regular daily activities of moderate intensity which accelerate breathing, such as climbing stairs. The purpose of this study was to examine the effect of an intervention programme on behaviour change in stair use in a working environment. Intervention field workers were instructed to offer attractive or pull actions. 338 employees of four offices of the Swiss federal government were involved in the evaluation. Two methods were used to assess stair and lift use both before and after the four month intervention period: a non-covered personal observation and an automatic measurement. Taking all four offices together, a significant increase in stair use, from 61.8% to 67.1% (p = 0.028), was found between the baseline and the follow-up observation. The automatic measurement during observation time reveals a change in stair use from 68.8% to 71.4% (p = 0.268). The pattern of stair use examined for 24 hours by automatic means, however, was not so consistent. Due to the proportion of stair use in each office it is assumed that environmental factors influences the behaviour. The highest percentage of stair use at baseline (86.2%) was identified in an office with a bright stairwell and a small number of steps between floors. The lowest proportion (31.4%) was observed in an office with a dark stairwell, a large number of steps between floors and a stairwell accessible only with a key. However, our findings indicate that intervention with "rewarding" elements encourage individuals to use stairs.

Six-Month Observational Study of Prompted Stair Climbing

Background and context Regular activity is recognised to have powerful health maintaining and promoting effects but two thirds of adults in developed countries remain unhealthily sedentary. This research was undertaken as part of the Newcastle Healthy Medical School Project (NHMSP), a multi-dimensional health promotion initiative based in the Faculty of Medicine at the University of Newcastle upon Tyne, United Kingdom. Objective To use a theoretically based, systematic approach to design and evaluate a stair promotion intervention in conjunction with the target group. Design and methods A series of five small scale studies, using both quantitative and qualitative methods, was conducted to: choose an outcome measure, gather an evidence base, and design and evaluate a stair promotion intervention. Setting One stair-lift complex in the medical school of the University of Newcastle upon Tyne. Target group All users of the stairs and lifts in the target setting, including students, staff and visitors. Results A stair promotion intervention comprising four posters was designed and evaluated in conjunction with the target group. Stair use comprised 20.1 per cent of all upward journeys pre-intervention, 20.6 per cent at week one and 19.5 per cent at week four (p&gt;0.05). Conclusion No increase in stair use was measured in response to the intervention. This may be due to an inadequate measure of stair use, the possibility of stair distance thresholds, the targeting of a relatively active group or the unauthorised removal of many of the posters.

Objective Determine the temporal and spatial characteristics of stairs versus elevator use in a university residence hall to inform future physical activity promotion efforts. Participants All residents and visitors for a single, four-story residence hall dormitory building located on a college campus in Orange, CA. Methods Smart mat systems capable of detecting pedestrian traffic were placed in front of the stairs and elevators on each floor plus a basement. Generalized additive mixed models (GAMMs) were used to compare stair versus elevator usage at different times of the day and on different floors. Results Stair versus elevator use varied much more throughout the day on floors nearest to the ground floor, with stair use most common in the morning. Overall, the elevator was used more frequently on higher floors, with less variation throughout the day. Conclusion To be most effective, future stair promotion interventions should target residents on higher floors and in the morning.

Promoting Routine Stair Use: Evaluating the Impact of a Stair Prompt Across Buildings

This study aimed to analyze the effect of interventions to increase stair use. Systematic review and meta-analysis. An online search was conducted in January 2021 in five databases (Web of Science, SPORTDiscus, MedLine/PubMed, PsycINFO, and CINAHL). Experimental studies (randomized and non-randomized) conducted in adults, which provided stair use measures with pre- and post-intervention periods were included. A random-effect meta-analysis, as well as subgroup analyses were conducted to evaluate the quantitative effect of interventions on stair use. Overall, 34 studies were included in qualitative analyses, and 15 in the meta-analysis. Most of the studies were conducted in Europe and private settings (e.g., office buildings). Overall, interventions increased stair use in adults (odds ratio (OR) 1.48; 95% confidence intervals (CI) 1.38-1.58; I2 = 99.6%). Subgroup analyses showed that interventions increased stair use regardless of the continent and observer type (manual or electronic). However, different settings (shopping malls and office buildings), as well as studies (time of intervention) and intervention characteristics (sign size and location, message characters) were associated with increased stair use. Different interventions can increase stair use in several continents and settings. Sign and message characteristics should be considered when designing interventions or policies to promote physical activity by increasing stair use.

The US government initiated a national health campaign targeting 100 'small step' lifestyle changes to combat obesity. Small Step #67 advocates stair instead of escalator usage in public settings. The aim of this study is to evaluate the effects of motivational signs prompting stair use over escalator use on pedestrians' stair usage in commuter settings. Eight studies, testing the effects of motivational prompts on stair vs. escalator usage in public settings, were reviewed. Participant and study attributes were descriptively coded. Effect size was calculated as the change in percent units of stair users during the intervention phases vs. the baseline phase. The average study included approximately 45,000 observations that were recorded across an average of 15 weeks of intervention. The mean +/- SD change in percent units of stair users was 2.8% +/- 2.4% (P < 0.001), and effects were twice as large in females (4.8%) as in males (2.4%). The number of stairs/building, baseline stair use, and total intervention weeks predicted change in stair use, although the effects were clinically miniscule. In a hypothetical city intervention, we projected that a 2.8% increase in stair usage would result in a weight loss and/or weight gain prevention of 300 g/person/year among new stair users. In sum, point-of-decision motivational signs may help communities attain Small Step #67. However, the singular impact of this community intervention on correcting energy imbalance may be minimal, having slight impact itself on reducing the national obesity prevalence.

Studies report a significant increase in stair use when message prompts are introduced at the "point of choice" between stairs and escalators. Climbing one set of stairs, however, will not confer meaningful health dividends. Therefore, this study examined whether exposure to point of choice prompts also encouraged individuals to climb the next set of stairs that they encountered. Interrupted time-series design. Two separate stair/escalator pairings within a U.K. shopping mall (the "intervention" site and the "generalization" site), separated by a 25-m long atrium. Subjects. Ascending pedestrians (intervention site n = 29,713; generalization site n = 47,553). Two weeks of baseline monitoring were followed by a 13-week intervention in which banners carrying health promotion messages were introduced at the intervention site only. At both sites observers inconspicuously recorded pedestrians' methods of ascent, along with their gender, age, ethnicity, and baggage. Banners increased stair climbing at the intervention site by 161%. Results also suggested a simultaneous increase of up to 143% at the generalization site, where no prompt was in place. At both sites stair use remained significantly elevated 5 weeks after the banners were removed. It appears that exposure to point of choice prompts can encourage pedestrians to climb stairs when they are encountered in a subsequent setting. Consequently stair-climbing interventions are likely to engage the public in more physical activity than previously realized.

Modelling effects of stair width on rates of stair climbing in a train station