Worksite interventions to increase stair climbing; reasons for caution

Psychological Aspects of Stair Use: A Systematic Review

Stair use, a common lifestyle activity, is a moderate-to-vigorous physical activity that, despite often being brief in duration, may contribute to psychological health. A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to summarize psychological aspects related to stair use. Included studies examined at least 1 psychological outcome in relation to either objective measures of stair use, such as time or stair height, or subjective measures of, or measures related to, stair use such as perceived difficulty using stairs. A total of 22 studies met the inclusion criteria; 12 used subjective stair use measures and 10 used objective stair use measures. The limited evidence from studies using self-reports supported that (1) perceived difficulty using stairs was positively associated with increased symptoms of anxiety and depression and (2) stair use was not associated with a reduced incidence of mental illnesses such as depression, suicide, or dementia. Studies using objective measures of stair use supported that (3) elevated symptoms of anxiety and depression are negatively associated with stair use performance. Given the widespread use of stairs, there is surprisingly little data about the extent to which, and for whom, stair use influences psychological health.

Developing healthy cities with urban facility management

Purpose

Most people live in cities and work in offices, two contexts offering many lifestyle-related and environmental health risks. To advance their health, this paper aims to introduce an analogy between urban design and facility design to explore whether health-directed design interventions in cities and facilities are related and to look for applicable cross-overs and opportunities to develop the facility management (FM) profession on the urban level.

Design/methodology/approach

The principles of abductive reasoning as a first phase of scientific investigation were followed, by introducing a new idea and attentively observing phenomena in the communities of FM and urban design. The method was desk research, in the context of discovery.

Findings

Many possible cross-overs exist which offer opportunities for urban planners and facility managers to reinforce each other and interesting market opportunities for the further development of urban FM. However, more systematic research is needed on efficacious and effective interventions. Furthermore, experiences and capacities of the FM sector should be unlocked and applied within a city context, as the knowledge and experiences of facility managers and urban planners can create synergy.

Practical implications

The findings are directly applicable to facility and urban design practices and to FM education by involving students in city design practices.

Originality/value

Cross-overs between facilities and cities are new and can inspire both facility managers and urban planners to work together more closely for the benefit of citizens and employees.

Motivational signage increases stair usage on a Hispanic serving institution

Objective: Stair climbing is considered a good physical activity. Motivational signage has been successful in promoting stair usage in various settings. This study was to investigate the effects of motivational signage on stair usage in a Hispanic serving institution. Participants: A total of 31,067 pedestrians were observed from February to March 2013. Methods: Stair usage was monitored for 9 h per day each week at phase 1 (baseline), 2 (intervention), and 3 (post-intervention). Results: Overall, participants' stair usage was higher during phase 2 (49.0%) and phase 3 (48.0%), compared with phase 1 (39.7%). The participants during phase 2 and 3 were more likely to use the stairs compared to participants during phase 1, regardless of floor level (3-story or 4-story building), status (student or staff/faculty), and time of day (7:30-10:29, 10:30-13:29, or 13:30-16:30) (p < .001). Conclusion: Motivational signage can effectively encourage more stair usage, and hence promote healthy behavior in a predominantly Hispanic-serving institution.

When weight is an encumbrance; avoidance of stairs by different demographic groups

BACKGROUND

Locomotion is an energy costly behaviour, particularly when it entails raising weight against gravity. Minimization of locomotor costs appears a universal default. Avoidance of stair climbing helps humans minimise their energetic costs. In public access settings, demographic subgroups that raise more 'dead' weight than their comparison groups when climbing are more likely to avoid stairs by choosing the escalator. Individuals who minimise stair costs at work, however, can accumulate a deficit in energy expenditure in daily life with potential implications for weight gain. This paper tests the generality of avoidance of stairs in pedestrians encumbered by additional weight in three studies.

METHODS

Pedestrian choices for stairs or the alternative were audited by trained observers who coded weight status, presence of large bags and sex for each pedestrian. Sex-specific silhouettes for BMIs of 25 facilitated coding of weight status. Choices between stairs and a lift to ascend and descend were coded in seven buildings (n = 26,981) and at an outdoor city centre site with the same alternatives (n = 7,433). A further study audited choices to ascend when the alternative to stairs was a sloped ramp in two locations (n = 16,297). Analyses employed bootstrapped logistic regression (1000 samples).

RESULTS

At work and the city centre site, the overweight, those carrying a large bag and females avoided both stair climbing and descent more frequently than their comparison groups. The final study revealed greater avoidance of stairs in these demographic subgroups when the alternative means of ascent was a sloped ramp.

DISCUSSION

Minimization of the physiological costs of transport-related walking biases behaviour towards avoidance of stair usage when an alternative is available. Weight carried is an encumbrance that can deter stair usage during daily life. This minimization of physical activity costs runs counter to public health initiatives to increase activity to improve population health.

Signage Interventions for Stair Climbing at Work: More than 700,000 Reasons for Caution

Increased stair climbing reduces cardiovascular disease risk. While signage interventions for workplace stair climbing offer a low-cost tool to improve population health, inconsistent effects of intervention occur. Pedestrian movement within the built environment has major effects on stair use, independent of any health initiative. This paper used pooled data from UK and Spanish workplaces to test the effects of signage interventions when pedestrian movement was controlled for in analyses. Automated counters measured stair and elevator usage at the ground floor throughout the working day. Signage interventions employed previously successful campaigns. In the UK, minute-by-minute stair/elevator choices measured effects of momentary pedestrian traffic at the choice-point (n = 426,605). In Spain, aggregated pedestrian traffic every 30 min measured effects for ‘busyness’ of the building (n = 293,300). Intervention effects on stair descent (3 of 4 analyses) were more frequent than effects on stair climbing, the behavior with proven health benefits (1 of 4 analyses). Any intervention effects were of small magnitude relative to the influence of pedestrian movement. Failure to control for pedestrian movement compromises any estimate for signage effectiveness. These pooled data provide limited evidence that signage interventions for stair climbing at work will enhance population health.

Nudging physical activity in offices

Purpose

This paper aims to investigate whether and why nudging interventions in an office environment are effective to stimulate stair use of employees.

Design/methodology/approach

This paper is based on a pre-test/post-test case study design at the headquarters of a Dutch online retailer. Observations were conducted to test the impact of two nudge interventions, being footprints and posters, on employees’ stair use in two consecutive pre-test/post-test weeks. An online survey questionnaire was used to assess employees’ overall experience with the nudging interventions after the fifth and again neutral week.

Findings

A total of 14,357 observations were recorded during five weeks. This research shows that footprints as nudging intervention significantly increase stair use of employees, and after removal, significantly decrease stair use again. Moreover, footprints were more effective than posters, of which the latter did not impact stair use significantly. Results from the survey questionnaire, completed by 46.2 per cent of the employees, showed that, in terms of degree of perception, footprints (91.4 per cent) were more noticeable than posters (46.3 per cent).

Originality/value

This paper contributes to the non-conclusive research regarding the effectiveness of nudging interventions on stair use in office environments. It clearly shows that perceptibility in combination with a positive attitude towards the nudge leads to a higher degree of initial behavioural change, yet not to a change of mind.

Learnt effects of environmental cues on transport-related walking; disrupting habits with health promotion?

Background

In Ecological models, physical environments can be important determinants of transport-related walking. With repeated exposure to the same environment, learning of a linkage between the cues in the environment and walking should occur. Subsequent encounters with the cues can prompt the behaviour relatively automatically. No studies have experimentally tested the potential learning of this linkage between cues and behaviour. Choices between stairs and escalators in public access settings were employed to test this premise for transport-related walking.

Methods

Three studies investigated the effects of visual cues on stair/escalator choices (combined n = 115,062). In quasi-experimental, interrupted time-series designs, observers audited choices in public access settings. Design alone phases with art or coloured backgrounds were compared with design plus message phases in which verbal health promotion messages were superimposed on the visual cues. Analyses used bootstrapped logistic regression.

Results

In initial studies, the design alone phases had no effect whereas subsequent design plus message phases reduced escalator choice. In two further studies, a 5–6 week design plus message phase that reduced escalator choice preceded a design alone phase. The visual background behind the successful health promotion message was reintroduced four weeks after the intervention was removed. The visual cue of design alone reduced escalator choice after it had been paired with the verbal health promotion message. There were no differences between art and coloured backgrounds.

Conclusion

These studies demonstrate for the first time a learnt linkage between transport-related walking and environmental cues. Discussion focuses on the mechanisms that may underlie this learning and cues in the environment that are relevant to transport-related walking.

Associations between the Objectively Measured Office Environment and Workplace Step Count and Sitting Time: Cross-Sectional Analyses from the Active Buildings Study

Office-based workers spend a large proportion of the day sitting and tend to have low overall activity levels. Despite some evidence that features of the external physical environment are associated with physical activity, little is known about the influence of the spatial layout of the internal environment on movement, and the majority of data use self-report. This study investigated associations between objectively-measured sitting time and activity levels and the spatial layout of office floors in a sample of UK office-based workers. Participants wore activPAL accelerometers for at least three consecutive workdays. Primary outcomes were steps and proportion of sitting time per working hour. Primary exposures were office spatial layout, which was objectively-measured by deriving key spatial variables: ‘distance from each workstation to key office destinations’, ‘distance from participant’s workstation to all other workstations’, ‘visibility of co-workers’, and workstation ‘closeness’. 131 participants from 10 organisations were included. Fifty-four per cent were female, 81% were white, and the majority had a managerial or professional role (72%) in their organisation. The average proportion of the working hour spent sitting was 0.7 (SD 0.15); participants took on average 444 (SD 210) steps per working hour. Models adjusted for confounders revealed significant negative associations between step count and distance from each workstation to all other office destinations (e.g., B = −4.66, 95% CI: −8.12, −1.12, p < 0.01) and nearest office destinations (e.g., B = −6.45, 95% CI: −11.88, −0.41, p < 0.05) and visibility of workstations when standing (B = −2.35, 95% CI: −3.53, −1.18, p < 0.001). The magnitude of these associations was small. There were no associations between spatial variables and sitting time per work hour. Contrary to our hypothesis, the further participants were from office destinations the less they walked, suggesting that changing the relative distance between workstations and other destinations on the same floor may not be the most fruitful target for promoting walking and reducing sitting in the workplace. However, reported effect sizes were very small and based on cross-sectional analyses. The approaches developed in this study could be applied to other office buildings to establish whether a specific office typology may yield more promising results.

Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements

OBJECTIVE

To identify and evaluate the evidence base for culture of health elements.

DATA SOURCE

Multiple databases were systematically searched to identify research studies published between 1990 and 2015 on culture of health elements.

STUDY INCLUSION AND EXCLUSION CRITERIA

Researchers included studies based on the following criteria: (1) conducted in a worksite setting; (2) applied and evaluated 1 or more culture of health elements; and (3) reported 1 or more health or safety factors.

DATA EXTRACTION

Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted.

DATA SYNTHESIS

Data synthesis focused on research approach and design as well as culture of health elements evaluated.

RESULTS

The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10), or other study approaches. Three of the most frequently studied culture of health elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome.

CONCLUSIONS

A considerable number of cross-sectional studies demonstrated significant and salient correlations between culture of health elements and the health and safety of employees, but more research is needed to examine causality.

A Multicomponent Intervention to Encourage Stair Use in Municipal Buildings

PURPOSE

Evaluate the incremental impact of environmental stairwell enhancements on stair usage in addition to prompts.

DESIGN

Phased, nonrandomized, quasi-experimental intervention.

SETTING

Two 6-story and one 8-story municipal government office buildings-each with 2 stairwells.

PARTICIPANTS

Approximately 2800 municipal employees and 1000 daily visitors.

INTERVENTION

All stairwells received door wraps and point-of-decision and wayfinding prompts. Environmental enhancements were installed in 1 stairwell in each of the 2 buildings: wall paint, upgraded stair treads and handrails, artwork, light-emitting diode (LED) lighting, fire-rated glass doors, and removal of security locks on at least the ground floor.

MEASURES

Staff surveys and focus groups, electronic and direct measures of stair and elevator use occurred at baseline and over 3 years of phased implementation and follow-up.

ANALYSIS

Change in the proportion of vertical movement by stairs using χ² analysis.

RESULTS

The prompts were associated with a significant increase in stair use (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.31-1.41), with an average absolute increase of 3.2%. Environmental enhancements were associated with an additional significant increase in stair use (OR = 1.31; 95% CI: 1.25-1.37) beyond prompts alone with an average absolute increase of a further 3.5% that was sustained for 1 year. The initial increases in stair use with prompts alone were not sustained.

CONCLUSION

Implementing environmental stairwell enhancements in office buildings increased stair usage in a sustained manner beyond that achieved by prompts alone.

Promoting Stair Climbing in a Worksite and Public Setting: Are Footprints Enough?

PURPOSE

To evaluate the impact of footprints on stair climbing in different settings.

DESIGN

Interrupted time-series design.

SETTING

A company (stair/elevator choice) and a mall (stair/escalator choice).

PARTICIPANTS

Employees (n = 5676) and visitors of the mall (n = 12 623).

INTERVENTION

An intervention comprising 3 consecutive phases was implemented-(1) footprints leading to the stairs were stuck on the floor, (2) a health message referring to the footprints was introduced, and (3) passersby were congratulated for their increased stair use.

MEASURES

Stair climbing was observed before (ie, baseline), during, and 6 to 13 weeks after (ie, follow-up) the intervention.

ANALYSIS

Proportions of stair climbers were compared using χ² analyses.

RESULTS

The footprints resulted in a closely significant increase in stair climbing in the company (from 27.7% at baseline to 31.2% in phase 1). However, they did not produce any effect in the mall. Introducing a health message yielded an additional 12.4% increase in stair climbing in the company and a significant 11.4% increase in the mall (22.3% in phase 2). Congratulating people did not further increase stair climbing. At follow-up, the proportions of stair climbers dropped but still exceeded baseline.

CONCLUSION

Footprints tend to increase stair climbing in a worksite setting with a stair/escalator choice but not in a public setting with a stair/elevator choice. Adding a meaningful message seems essential to obtain stronger and longer term effects.

Effectiveness of physical activity intervention among government employees with metabolic syndrome

BACKGROUND/OBJECTIVE

Our study aimed to assess the effects of physical activity interventions via standing banners (point-of-decision prompt) and aerobics classes to promote physical activity among individuals with metabolic syndrome.

METHODS

We conducted a cluster randomized controlled intervention trial (16-week intervention and 8-week follow-up). Malaysian government employees in Putrajaya, Malaysia, with metabolic syndrome were randomly assigned by cluster to a point-of-decision prompt group (n = 44), an aerobics group (n = 42) or a control group (n = 103) based on sample size calculation formula. Step counts were evaluated by Lifecorder e-STEP accelerometers for all participants. Metabolic syndrome was defined according to the 'harmonizing' definition, in which individuals who have at least three of the five metabolic risk factors (waist circumference, high-density lipoprotein cholesterol, triglycerides, fasting glucose levels, systolic and diastolic blood pressure) will be classified as having metabolic syndrome. A total of 80% of the enrolled government employees with metabolic syndrome completed the programme. Data were analyzed using SPSS for Windows (version 20, SPSS, Chicago, IL).

RESULTS

There were significantly higher step counts on average in the aerobics group compared to the control group over assessments. Assessments at baseline, post-intervention and follow-up showed a significant difference in step counts between the intervention and control groups. The greatest reductions in the proportions of individuals with metabolic syndrome were observed in the aerobics group with a reduction of 79.4% in the post-intervention assessment compared to the assessment at baseline.

CONCLUSION

The findings of this study suggest that physical activity intervention via aerobics classes is an effective strategy for improving step counts and reducing the prevalence of metabolic syndrome.

Effects of an Eight-Week Stepladder Exercise Protocol on Lower Limb Muscular Strength of Apparently Healthy Young Adults

Purpose. Backward descent of stairs is associated with improved muscle strength and reduced joint stress, but the effect of backward ascent of stairs on lower limb muscle strength has not been reported. This study compared the effects of forward and backward stair climbing on lower limb muscle strength in apparently healthy young adults. Methods. The total of 31 young volunteers were allocated to either forward or backward stair climbing group (n = 16 and 15, respectively). Dynamic quadriceps and hamstring muscle strength was assessed in addition to thigh girth at baseline and at weeks 4 and 8 with the use of the repetitive maximum method and tape measure, respectively. Results. Between baseline and week 8, muscular strength in both groups (quadriceps: 14.4 ± 3.6 to 16.4 ± 3.4 kg; 14.0 ± 2.9 to 15.3 ± 2.7 kg; hamstring: 12.2 ± 3.2 to 13.4 ± 3.2; 11.7 ± 2.5 to 12.9 ± 2.7 kg) increased significantly (p < 0.05) while the increase in thigh girth was not significant (p > 0.05). The groups were comparable in all three measures post intervention. Conclusions. Forward and backward stair climbing protocols are effective for improving the dynamic strength of the hamstring and quadriceps muscles of apparently healthy young adults. Thus, either protocol could be used for the improvement of lower limbs dynamic muscle strength.

Promoting workplace stair climbing: sometimes, not interfering is the best

BACKGROUND

Stair climbing is a vigorous activity and can lead to several health benefits. Studies seeking to increase stair climbing in various public locations have shown positive effects, while results from similar studies conducted in the workplace are inconclusive. This study examined stair climbing in the workplace, and monitored effects from a single- and a combined intervention. Interventions were inspired by nudging, the libertarian method of influencing behavior.

METHODS

By quasi-experimental design, stair- and elevator traffic in two office buildings was monitored preceding-, during- and following interventions with stair leading footprints alone, and combined with stair-riser banners. Chi square tests were applied to determine differences between baseline and the subsequent periods. Web-based questionnaires were distributed after follow-up period.

RESULTS

Elevators and stairs were used 45 237 times, of which 89.6% was stair use. Intervention site stair climbing at baseline (79.0%) was significantly reduced with footprints (-5.1%, p < 0.001), and footprints with stair-riser banners (-5.7%, p < 0.001) while baseline stair climbing at the control site (94.2%) remained stable (p > 0.027).

CONCLUSIONS

Stair climbing was significantly reduced during the intervention periods. Use of stair leading footprints alone, or combined with stair-riser banners in an attempt to influence stair climbing may be ineffective, or cause a negative reaction, when applied in a workplace with a pre-existing high amount of stair climbing.

A Systematic Review of Interventions to Increase Stair Use

CONTEXT

Stair climbing is an accessible activity that can be incorporated into one's daily lifestyle to increase physical activity levels and provide health benefits. This review summarizes the effectiveness of stair interventions and explores key differences that may influence intervention effectiveness.

EVIDENCE ACQUISITION

Interventions to increase stair use published from January 1990 to July 2015 were identified in PubMed, Sport Discus, Web of Science, Environment Complete, CINAHL, Trial Register of Promoting Health Interventions, Embase, Scopus, and PsycINFO. Eligibility criteria included original studies, published in peer-reviewed journals, targeting adult samples, and clearly describing intervention design and results. Studies were also required to measure the use of stairs compared with an elevator, escalator, or moving stairway at baseline and during at least one timepoint when the intervention was in effect. Studies were required to provide data to determine if the intervention resulted in significant changes in stair use/climbing.

EVIDENCE SYNTHESIS

The search results yielded 2,136 articles in total; 54 articles met the criteria, which resulted in a final sample of 67 studies included in the analyses. Interventions settings included public sites (75%), worksites (21%), or a combination of both (4%). For Phase 1 results, 72% of studies reported significant improvements in stair use (n=10 of 14) and stair climbing (n=38 of 53).

CONCLUSIONS

Evidence from the review demonstrates support for the effectiveness of interventions to increase stair use and stair climbing. Although evidence supports the effectiveness of stair interventions in public settings, less support is provided for worksites.

Effects of Environmental Changes in a Stair Climbing Intervention: Generalization to Stair Descent

Purpose.

Visual improvements have been shown to encourage stair use in worksites independently of written prompts. This study examined whether visual modifications alone can influence behavior in a shopping mall. Climbing one flight of stairs, however, will not confer health benefits. Therefore, this study also assessed whether exposure to the intervention encouraged subsequent stair use.

Design.

Interrupted time-series design.

Settings.

Escalators flanked by a staircase on either side.

Subjects.

Ascending and descending pedestrians (N = 81,948).

Interventions.

Following baseline monitoring, a colorful design was introduced on the stair risers of one staircase (the target staircase). A health promotion message was superimposed later on top. The intervention was visible only to ascending pedestrians. Thus, any rise in descending stair use would indicate increased intention to use stairs, which endured after initial exposure to the intervention.

Measures.

Observers inconspicuously coded pedestrians' means of ascent/descent and demographic characteristics.

Results.

The design alone had no meaningful impact. Addition of the message, however, increased stair climbing at the target and nontarget staircases by 190% and 52%, respectively. The message also produced a modest increase in stair descent at the target (25%) and nontarget (9%) staircases.

Conclusions.

In public venues, a message component is critical to the success of interventions. In addition, it appears that exposure to an intervention can encourage pedestrians to use stairs on a subsequent occasion.

Promoting Stair Climbing: Intervention Effects Generalize to a Subsequent Stair Ascent

Purpose.

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.

Design.

Interrupted time-series design.

Settings.

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).

Interventions.

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.

Measures.

At both sites observers inconspicuously recorded pedestrians' methods of ascent, along with their gender, age, ethnicity, and baggage.

Results.

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.

Conclusions.

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.

Testing messages to promote stair climbing at work

Purpose

– Worksites have been targeted as an important setting for physical activity interventions. A recent emphasis for health promoters is the use of point-of-choice interventions to encourage stair climbing at work. The purpose of this paper is to explore three point-of-choice campaigns to increase stair climbing at work.

Design/methodology/approach

– Ten focus groups and a rating task were conducted with 59 employees from a University and a University Hospital in the UK. Focus groups were structured around three messages and four prompts and sought to explore the motivational power of the resources, identify factors contributing to their effectiveness and provide recommendations to improve and optimize content. Benefits and barriers to stair climbing at work were also explored. Focus groups were recorded, transcribed and coded to identify key themes.

Findings

– Intra-personal factors health, motivation, social norms and time management influence stair climbing at work. Critically, extra-personal factors associated with the worksite itself can also bias a traveler’s choice independently of any intervention. Results suggest that messages targeting heart health have the greatest impact on reported propensity to climb the stairs at work. Messages targeting rate of respiration for fitness, however, may have a negative effect given that most people want to avoid getting out of breath at work.

Originality/value

– Qualitative research is essential for developing and refining the design detail of point-of-choice interventions and tailoring their components to address individuals’ needs in different settings but there is little evidence of this in practice.

Point-of-Decision Signs and Stair Use in a University Worksite Setting: General versus Specific Messages

Purpose.

This study tested the effectiveness of two point-of-decision signs to increase stair use and investigated message content by comparing signs with general and specific messages.

Design.

This study used a quasi-experimental time series design, including a 2-week baseline period: 2 weeks with a general message and 2 weeks with a specific message.

Setting.

The signs were placed in an eight-story university building.

Subjects.

The subjects comprised all adults entering the building. During the study, 2997 observations of stair/elevator choice were made.

Intervention.

A stair-prompt sign with a general message and a sign with a specific message served as the interventions.

Measures.

Observers measured stair/elevator choice, demographics, and traffic volume.

Analysis.

Logistic regression analyses were employed, adjusting for covariates.

Results.

The specific sign intervention showed significantly increased odds of stair use compared to baseline (odds ratio [OR] = 2.04, 95% confidence interval [CI] = 1.46–2.84). The odds of stair use were also significantly greater with the specific sign than the general sign (OR = 1.57, 95% CI = 1.13–2.20).

Conclusion.

Only the specific sign significantly increased stair use. The results indicate that a specific message may be more effective at promoting stair use.

Stair-use interventions in worksites and public settings - a systematic review of effectiveness and external validity

OBJECTIVE

We performed a literature review with the main aims to propose an updated overview of the effectiveness of stair-use interventions and to determine the most effective type of intervention.

METHODS

We systematically searched stair-use interventions performed in worksites or public settings, published up to mid 2013. We used a harvest plot approach to visualize the findings in addition to a quantitative synthesis. We also assessed external validity using the Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM) framework.

RESULTS

Of 8571 articles identified, 50 were included. In worksites (25 studies) and public settings (35 studies), an increase in stair climbing was found during the intervention period in 64% and 76% of studies, respectively. Combining motivational and directional signs in worksites or conducting a second intervention phase in public settings increased stair climbing in 83% and 86% of studies, respectively. Elements of external validity were overall largely under-reported.

CONCLUSION

There is evidence that stair-use interventions are effective to increase stair climbing in public settings, but evidence of such effect is limited in worksites. Issues regarding the best sequencing of interventions or the potential importance of environmental interventions should be addressed in future studies. Process evaluation should be an integral part of interventions.

Is there any Proffitt in stair climbing? A headcount of studies testing for demographic differences in choice of stairs

The apparent slope of a hill, termed geographical slant perception, is overestimated in explicit awareness. Proffitt (2006) argued that overestimation allows individuals to manage their locomotor resources. Increasing age, fatigue, and wearing a heavy back pack will reduce the available resources and result in steeper reports for a particular hill. In contrast, Durgin and colleagues have proposed an alternative explanation for these effects based on experimental design—particularly, the potential effects of experimental demand. Proffitt’s resource-based model would predict that pedestrians with reduced resources should avoid climbing a hill that would further deplete their resources if the opportunity arose. Within the built environment, stairs are the man-made equivalent of relatively steep hills (20°–30°). In many public access settings, pedestrians can avoid climbing the stairs by opting for an adjacent escalator. Observations of pedestrian behavior in shopping malls reveal that 94.5 % do so. This article summarizes the effects of demographic grouping on avoidance of stairs in public health research. Observations in shopping malls (n = 355,069) and travel contexts (n = 711,867) provide data consistent with Proffitt’s resource model. Women, the old, and those carrying excess body weight or large bags avoid the stairs more than do their comparison groups. Discussion focuses on differences in physiology that may underlie avoidance of stair climbing in order to highlight the pedestrian behavior that psychology needs to explain.

The daily 10 kcal expenditure deficit: a before-and-after study on low-cost interventions in the work environment

OBJECTIVES

To evaluate whether four types of low-cost interventions in the working environment can promote the small everyday lifestyle adaptations that can halt the epidemics of obesity and hypertension when maintained long term.

DESIGN

A single-blind uninterrupted time-series intervention study consisting of four study periods: run-in (2 weeks), baseline (2 weeks), intervention (2 weeks), and after intervention 2 weeks).

SETTING

University Medical Centre with over 11 000 employees, over 1000 hospital beds and over 2000 customers visiting the hospital restaurant each day.

PARTICIPANTS

Hospital staff and visitors.

INTERVENTIONS

(1) Point-of-decision prompts on hospital elevator doors promoting stair use. (2) Point-of-purchase prompts in the hospital restaurant promoting reduced-salt soup. (3) Point-of-purchase prompts in the hospital restaurant promoting lean croissants. (4) Reversal of the accessibility and availability of diet margarine and butter in the hospital restaurant.

MAIN OUTCOME MEASURES

(1) Number of passages through 15 different parts of the hospital staircases. (2) Number and ratio of normal-salt and reduced-salt soup purchased. (3) Number and ratio of butter croissants and lean croissants purchased. (4) Number and ratio of diet margarine and butter purchased.

RESULTS

Elevator signs increased the mean 24-h number of stair passages per measurement site (baseline: 992 ± 479 on week days and 208 ± 116 on weekend days) by 11.2% (95% CI 8.7% to 13.7%). This effect was maintained at least 2 weeks after the point-of-decision prompts were removed. Point-of-purchase prompts promoting low-salt soup and lean croissants did not result in altered purchase behaviour. The ratio between the purchase of margarine and butter was changed sevenfold (p<0.01) by reversing the positions of these products in the hospital restaurant.

CONCLUSIONS

Healthy lifestyle adaptations in the working environment can be effectively promoted by making healthy choices easier than unhealthy ones. Educational prompts at points-of-decision moderately increase stair climbing, but do not affect healthy food choices.

PROTOCOL REGISTRATION

Clinicaltrials.gov identifier number: NCT01574040.

A multi-component stair climbing promotional campaign targeting calorific expenditure for worksites; a quasi-experimental study testing effects on behaviour, attitude and intention

Background

Accumulation of lifestyle physical activity is a current aim of health promotion, with increased stair climbing one public health target. While the workplace provides an opportunity for regular stair climbing, evidence for effectiveness of point-of-choice interventions is equivocal. This paper reports a new approach to worksite interventions, aimed at changing attitudes and, hence, behaviour.

Methods

Pre-testing of calorific expenditure messages used structured interviews with members of the public (n = 300). Effects of multi-component campaigns on stair climbing were tested with quasi-experimental, interrupted time-series designs. In one worksite, a main campaign poster outlining the amount of calorific expenditure obtainable from stair climbing and a conventional point-of-choice prompt were used (Poster alone site). In a second worksite, additional messages in the stairwell about calorific expenditure reinforced the main campaign (Poster + Stairwell messages site). The outcome variables were automated observations of stair and lift ascent (28,854) and descent (29,352) at baseline and for three weeks after the intervention was installed. Post-intervention questionnaires for employees at the worksites assessed responses to the campaign (n = 253). Analyses employed Analysis of Variance with follow-up Bonferroni t-tests (message pre-testing), logistic regression of stair ascent and descent (campaign testing), and Bonferroni t-tests and multiple regression (follow-up questionnaire).

Results

Pre-testing of messages based on calorific expenditure suggested they could motivate stair climbing if believed. The new campaign increased stair climbing, with greater effects at the Poster + Stairwell messages site (OR = 1.52, 95% CI = 1.40-1.66) than Posters alone (OR = 1.24, 95% CI = 1.15-1.34). Follow-up revealed higher agreement with two statements about calorific outcomes of stair climbing in the site where they were installed in the stairwell, suggesting more positive attitudes resulted from the intervention. Future intentions for stair use were predicted by motivation by the campaign and beliefs that stair climbing would help weight control.

Conclusions

Multi-component campaigns that target attitudes and intentions may substantially increase stair climbing at work.

Promoting routine stair use: evaluating the impact of a stair prompt across buildings

BACKGROUND

Although studies have demonstrated that stair prompts are associated with increased physical activity, many were conducted in low-rise buildings over a period of weeks and did not differentiate between stair climbing and descent.

PURPOSE

This study evaluated the impact of a prompt across different building types, and on stair climbing versus descent over several months.

METHODS

In 2008-2009, stair and elevator trips were observed and analyzed at three buildings in New York City before and after the posting of a prompt stating "Burn Calories, Not Electricity" (total observations=18,462). Sites included a three-story health clinic (observations=4987); an eight-story academic building (observations=5151); and a ten-story affordable housing site (observations=8324). Stair and elevator trips up and down were recorded separately at the health clinic to isolate the impact on climbing and descent. Follow-up was conducted at the health clinic and affordable housing site to assess long-term impact.

RESULTS

Increased stair use was seen at all sites immediately after posting of the prompt (range=9.2%-34.7% relative increase, p<0.001). Relative increases in stair climbing (20.2% increase, p<0.001) and descent (4.4% increase, p<0.05) were seen at the health clinic. At both sites with long-term follow-up, relative increases were maintained at 9 months after posting compared to baseline: 42.7% (p<0.001) increase in stair use at the affordable housing site and 20.3% (p<0.001) increase in stair climbing at the health clinic.

CONCLUSIONS

Findings suggest that the prompt was effective in increasing physical activity in diverse settings, and increases were maintained at 9 months.

Promoting stair climbing in public-access settings: an audit of intervention opportunities in England

OBJECTIVE

Introducing message prompts at the 'point-of-choice' (POC) between stairs and escalators increases stair choice in 'public-access' settings (e.g. malls). For nationwide campaigns, plentiful POCs appear needed. We audited the availability of POCs in public-access settings across England.

METHODS

Boundaries for 25 urban areas (population=6,829,874) were verified using Ordinance Survey maps, which showed all airports and train/tram stations. Malls and bus stations were identified from commercial listings and local authority web-pages. From September 2010-March 2011 two investigators visually inspected all venues (N=410), counting 'true' POCs and 'quasi' POCs (i.e. instances where stairs were visible from, but not adjacent to, escalators).

RESULTS

5% of venues had ≥1 true POC (quasi POC=3%). Aggregating across areas, there was a true and quasi POC for every 243,924 and 379,437 people, respectively. There were regional variations; one area had 10 true/quasi POCs, whilst 10/24 remaining areas had none. POCs were more common in airports (4/6 venues) than malls (11/85) and train stations (4/215).

CONCLUSION

Although public-access POCs reach sizeable audiences, their availability in England is sporadic, precluding nationwide campaigns. Interventions should be considered locally, based on available POCs. Work/community venues (e.g. offices, hospitals), where pedestrians choose between stairs and elevators, may provide greater intervention opportunities.

Step it UP: A Multicomponent Intervention to Increase Stair Use in a University Residence Building

Purpose.

Examine the effects of a multicomponent intervention on stair usage.

Design.

Nonrandomized controlled intervention.

Setting.

Two multistory university dormitories.

Subjects.

Total of 5711 direct observations of university dormitory residents.

Intervention.

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.

Measures.

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.

Analysis.

The proportions of ascending stair and elevator users were compared using χ2 analyses.

Results.

Baseline stair use was equal between intervention and control dormitories (24.9% and 27.8%, respectively; χ2[1, N = 1849] = .08; p = .77). Stair use significantly increased from baseline in the intervention dormitory to 33.24% (χ2[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%; χ2[1, N = 2297] = .08; p = .78). There were no significant differences between genders.

Conclusion.

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.

Promoting physical activity in a low socioeconomic area: results from an intervention targeting stair climbing

OBJECTIVE

To compare rates of stair climbing in a high and low socioeconomic (SE) area, and to assess the efficacy of a stair climbing intervention in each area.

METHODS

From March to May 2009 ascending stair/escalator choices (N=20,315) were observed in two underground train stations located in a high, and low, SE area of Glasgow. Baseline observations preceded a 4-week intervention in which posters, promoting stair choice, were installed. Follow-up observations were collected 1 week after poster removal.

RESULTS

Baseline stair climbing rates were 12.2% and 7.1% at the high and low SE stations, respectively. Overall, pedestrians at the high SE station were around twice as likely to climb the stairs as those at the low SE station (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.70-2.15). Across sites, the rate of stair climbing was higher during the intervention relative to baseline (OR = 1.48, CI = 1.34-1.63) and remained elevated at follow-up (OR = 1.24, CI = 1.11-1.39). Absolute increase in stair climbing was similar at both stations (high SE, +4.7%; low SE, +4.5%), indicating equivalent poster effects in each area.

CONCLUSION

Pedestrians in lower SE areas appear less likely to climb stairs than pedestrians in high SE areas. Nevertheless, a stair climbing intervention was equally effective in both areas.

Effectiveness and Cost of Two Stair-Climbing Interventions—Less is More

Purpose.

The current study compared two interventions for promotion of stair climbing in the workplace, an information-based intervention at a health information day and an environmental intervention (point-of-choice prompts), for their effectiveness in changing stair climbing and cost per employee.

Design.

Interrupted time-series design.

Setting.

Four buildings on a university campus.

Subjects.

Employees at a university in the United Kingdom.

Interventions.

Two stair-climbing interventions were compared: (1) a stand providing information on stair climbing at a health information day and (2) point-of-choice prompts (posters).

Measures.

Observers recorded employees' gender and method of ascent (n = 4279). The cost of the two interventions was calculated.

Analysis.

Logistic regression.

Results.

There was no significant difference between baseline (47.9% stair climbing) and the Workplace Wellbeing Day (48.8% stair climbing), whereas the prompts increased stair climbing (52.6% stair climbing). The health information day and point-of-choice prompts cost $773.96 and $31.38, respectively.

Conclusion.

The stand at the health information day was more expensive than the point-of-choice prompts and was inferior in promoting stair climbing. It is likely that the stand was unable to encourage stair climbing because only 3.2% of targeted employees visited the stand. In contrast, the point-of-choice prompts were potentially visible to all employees using the buildings and hence better for disseminating the stair climbing message to the target audience. (Am J Health Promot 2011;25[4]:231–236.)

An informational stair climbing intervention with greater effects in overweight pedestrians

Previous interventions have successfully increased levels of stair climbing in public-access settings (e.g. malls). This study used robust methods to establish the magnitude of intervention effects among a specific target group-the overweight. Ascending stair/escalator users (N = 20 807) were observed in a mall. A 2-week baseline was followed by a 5-week intervention in which message banners, promoting stair climbing, were attached to the stair risers. Standardized silhouettes were used to code individuals as normal/overweight. Logistic regression analyses were conducted with stair/escalator choice as the outcome variable and weight status entered as a moderator alongside condition, gender, ethnicity and 'pedestrian traffic volume'. Overall, the intervention significantly increased the rate of stair climbing [odds ratio (OR) = 1.28, 95% confidence intervals (CI) = 1.08-1.53], with the effects sustained over 5 weeks. There were differential effects between weight categories, with greater increases in overweight (OR = 1.95, CI = 1.34-2.83) versus normal weight individuals (OR = 1.29, CI = 1.09-1.53). In conclusion, message prompts produced larger effects among overweight individuals, who could benefit most from stair climbing. The public health value of these interventions may, therefore, be greater than realized. The heightened effects among the overweight were likely due to the salience of the current message, which linked stair climbing with the target of weight control.

Effects of load carrying methods and stair slopes on physiological response and postures during stairs ascending and descending

The purpose of this study was to examine the effects of load carrying methods, stair slopes and walking speeds on heart rate and walking postures. Nine participants climbed up and down stairs with various stair slopes (24°, 30° and 36°), walking speeds (72, 96, and 132 steps per minute), and using different load carrying methods (empty loads, backpack, and hand-held). The effects of these factors on heart rate, Borg-RPE and flexion angles of knee joints, hip joints and trunk angles were investigated. This study demonstrated that increased stair slopes and walking speed were associated with increased heart rate and RPE. The heart rate for empty loads subjects was lowest, followed by backpack load and hand-held load. Climbing stairs with larger inclination was associated with smaller knee joint flexion angle and larger trunk and hip joint flexion angle. In conclusion, it is easier for subjects to carry a load of the same weight up stairs by backpack than by hand. However, the stair slope should be less than 30°. Thus, the standard fixed stair slope (30° of stair slope) on recommended for riser height and tread depth are 160 mm (6.5 inches) and tread depth 280 mm (11 inches).

Review Article: Increasing physical activity with point-of-choice prompts--a systematic review

AIMS

Stair climbing is an activity that can easily be integrated into everyday life and has positive health effects. Point-of-choice prompts are informational or motivational signs near stairs and elevators/escalators aimed at increased stair climbing. The aim of this review was to assess the effectiveness of point-of-choice prompts for the promotion of stair climbing.

METHODS

In a systematic search of the literature, studies that assessed the effectiveness of point-of-choice prompts to increase the rate of stair climbing in the general population were identified. No restrictions were made regarding the setting, the duration of the intervention, or the kind of message.

RESULTS

A total of 25 studies were identified. Point-of-choice prompts were predominantly posters or stair-riser banners in public traffic stations, shopping malls or office buildings. The 25 studies reported 42 results. Of 10 results for elevator settings, only three reported a significant increase in stair climbing, whereas 28 of 32 results for escalator settings reported a significant increase in stair climbing.

CONCLUSIONS

Overall, point-of-choice prompts are able to increase the rate of stair climbing, especially in escalator settings. In elevator settings, point-of-choice prompts seem less effective. The long-term efficacy and the most efficient message format have yet to be determined in methodologically rigorous studies.

A public health approach to winning the war against cancer

The "war on cancer" in the United States has been viewed primarily as an effort to develop and disseminate cancer cures, but cancer is far more easily prevented than cured. There are three major approaches to cancer prevention: Primary prevention, through reduction in risk factors and changes to the environment that reduce human exposure to widely-consumed cancer-promoting agents. The most important actions for primary prevention of cancer are those that reduce tobacco use through taxation, smoke-free environment policies, advertising restrictions, counter-advertising, and cessation programs. The World Health Organization's MPOWER package outlines these actions, each of which covered less than 5% of people in the world in 2007. Similarly, cancer can be prevented by reducing alcohol consumption through policies such as alcohol taxes and limits on alcohol sales, and restoring caloric balance through policies such as creating healthier food environments and engineering the built environment to increase opportunities for physical activity. Vaccination is an effective approach to preventing specific virus-associated cancers, such as using human papillomavirus vaccine to prevent cervical cancer and hepatitis B virus vaccine to prevent hepatocellular cancer. Secondary prevention reduces cancer mortality through screening and early treatment; this approach has been used successfully for breast and cervical cancer but is still underused against colon cancer. Progress can be made in all three approaches to cancer prevention, but will require a greater emphasis on public health programs and public policy. Winning the war on cancer will require a much larger investment in prevention to complement efforts to improve treatment.

The built environment, climate change, and health: opportunities for co-benefits

The earth's climate is changing, due largely to greenhouse gas emissions resulting from human activity. These human-generated gases derive in part from aspects of the built environment such as transportation systems and infrastructure, building construction and operation, and land-use planning. Transportation, the largest end-use consumer of energy, affects human health directly through air pollution and subsequent respiratory effects, as well as indirectly through physical activity behavior. Buildings contribute to climate change, influence transportation, and affect health through the materials utilized, decisions about sites, electricity and water usage, and landscape surroundings. Land use, forestry, and agriculture also contribute to climate change and affect health by increasing atmospheric levels of carbon dioxide, shaping the infrastructures for both transportation and buildings, and affecting access to green spaces. Vulnerable populations are disproportionately affected with regard to transportation, buildings, and land use, and are most at risk for experiencing the effects of climate change. Working across sectors to incorporate a health promotion approach in the design and development of built environment components may mitigate climate change, promote adaptation, and improve public health.

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

OBJECTIVES

Commuters leaving a station often choose the stair as a quicker exit than the escalator. This paper models the effects of speed leaving the station and stair width on choice of the stairs or escalator.

METHODS

Aggregated data from previous studies (n=82,347) revealed a plateau at about 45% stair use as the number leaving each train rose. Subsequently, the time taken by passengers on the stairs and escalator was measured in a station in Birmingham, UK in 2007 (n=5848). The resulting transport rates (passengers s(-1)) for stairs and escalators at the average commuting traffic were used to estimate the effects of increases in stair width on choice of the stairs.

RESULTS

Average transport rates were higher for the escalator (0.93+/-0.33 passengers s(-1)) than the stairs (0.58+/-0.24 passengers s(-1)). Modelling of the effects of transport rate with multiple regression suggested 40.1% of passengers would use the stairs, a figure close to the observed rate. Using similar calculations, a doubling of width of the stairs could result maximally in a 17.2% increase in stair use.

CONCLUSIONS

Changes to the width of stairs could produce a permanent increase in lifestyle physical activity immune to the effects of time on healthy intentions.

A poster-based intervention to promote stair use in blue- and white-collar worksites

OBJECTIVE

Previous studies have generally shown the effectiveness of prompts to promote stair use in worksites that mainly consist of white-collar workers. The present study tested whether an intervention using prompts is effective in stimulating stair use in two types of worksites: one consisting mainly of white-collar workers and one mainly of blue-collar workers.

METHOD

In 2005, elevator and stair use (stair climbing and descent) was monitored in two types of worksites in the Netherlands, namely one office building (n=150 white-collar workers) and one paper factory (n=800 blue-collar workers). The study used a simple time-series design of collecting data in three waves: before, during and after implementation of posters containing prompts stimulating stair use.

RESULTS

A total of 6771 choices between stairs and elevator were observed. There was a significant difference between stair use at baseline and during the poster intervention in both types of worksites. There was no worksite-by-intervention interaction, implying that the prompts were equally effective in both types of worksites. After removal of the posters stair use decreased significantly to a level that was not significantly different from baseline.

CONCLUSION

Stair use can be positively influenced in both blue- and white-collar workers by a short-term low-cost intervention using prompts on posters.

The NHF-NRG In Balance-project: the application of Intervention Mapping in the development, implementation and evaluation of weight gain prevention at the worksite

Very few examples of theory-driven and systematically developed weight gain prevention interventions for adults have been described in the literature. The present paper systematically describes the development, implementation and evaluation framework of a weight gain prevention programme directed at young adults at the worksite, namely the NHF-NRG In Balance-project. It not only can be used as a guide to systematically develop weight gain prevention interventions, but also gives an overview of the current theoretical and empirical knowledge-base in the field of obesity prevention. The outline of the paper follows the Intervention Mapping protocol, which includes a systematic inventory of important health issues, their risk behaviours and determinants of these risk behaviours, and specification of the proximal objectives of the programme directed at both energy intake and energy expenditure. The objectives are translated into behaviour change methods and strategies, which are combined in a stepwise intervention programme, and used for a detailed evaluation plan (process and effect evaluation). The NHF-NRG In Balance-project combines mass media and individually tailored communications with worksite environmental changes to raise awareness, to motivate and to enable energy balance behaviour changes. A quasi-experimental pre-test-multiple post-test control group design was applied in 12 worksites (>500 employees).

A workplace intervention to promote stair climbing: greater effects in the overweight

OBJECTIVE

Stair climbing is a lifestyle physical activity that uses more calories per minute than jogging. This study tested an intervention designed to promote stair climbing in a workplace. Because previous studies provide only equivocal evidence of the effects of increased stair climbing in worksites, a formal comparison of the effects of the intervention on stair ascent and descent was made.

RESEARCH METHODS AND PROCEDURES

In a five-story public sector building, a 2-week baseline was followed by 6 weeks of an intervention involving a 23(1/2)- x 16(1/2)-inch poster in the lobby, the same poster and six messages affixed to the stair risers between floors, and an 11(3/4)- x 8(1/4)-inch point-of-choice prompt at the elevators. Stair and elevator choices (n = 26,806) were videotaped throughout and subsequently coded for direction of travel, traveler's sex, and traveler's load. Weight status was coded using silhouettes beside the computer monitor.

RESULTS

A significant effect of the intervention on stair climbing was greater in those coded as overweight (+5.4%; odds ratio = 1.33) than in individuals of normal weight (+2.5%; odds ratio = 1.12). Although stair descent was more common than ascent, the intervention had similar effects for both directions of travel.

DISCUSSION

Stair climbing at work has few barriers and seems to be a type of physical activity that is acceptable to overweight individuals. The relatively weak effect of workplace interventions compared with results for public access staircases may reflect uncontrolled effects such as the immediate availability of the elevator for the traveler.

An uphill struggle: Effects of a point-of-choice stair climbing intervention in a non-English speaking population

BACKGROUND

Increases in lifestyle physical activity are a current public health target. Interventions that encourage pedestrians to choose the stairs rather than the escalator are uniformly successful in English speaking populations. Here we report the first test of a similar intervention in a non-English speaking sample, namely the Hong Kong Chinese.

METHODS

Travellers on the Mid-Levels escalator system in Hong Kong were encouraged to take the stairs for their health by a point-of-choice prompt with text in Chinese positioned at the junction between the stairs and the travelator. Gender, age, ethnic origin, and walking on the travelator were coded by observers. A 2 week intervention period followed 2 weeks of baseline monitoring with 57 801 choices coded. Specificity of the intervention was determined by contrasting effects in Asian and non-Asian travellers.

RESULTS

There was no effect of the intervention on stair climbing and baseline rates (0.4%) were much lower than previous studies in Western populations (5.4%). Nonetheless, a modest increase in walking up the travelator, confined to the Asian population (OR = 1.12), confirmed that the intervention materials could change behaviour.

CONCLUSIONS

It would be unwise to assume that lifestyle physical activity interventions have universal application. The contexts in which the behaviours occur, e.g. climate, may act as a barrier to successful behaviour change.