Increasing Stair Use in an Office Worksite through an Interactive Environmental Intervention

Stair versus elevator use in a university residence hall setting

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.

Active Design: Architectural Interventions for Improving Occupational Health Through Reducing Sedentary Behavior - A Systematic Review

OBJECTIVES

To systematically review architects' literature concerning stair promoting design interventions for reducing sedentary behavior and improving occupational health.

DATA SOURCES

English language, manuscripts published between 2000 and 2022 in Google scholar, Science Direct, PubMed, CINAHL, and ERIC.

STUDY INCLUSION AND EXCLUSION CRITERIA

The criteria for inclusion in this review include; Presence of two words from the searching term in the title, a study conducted by an architect (or at least one architect author), English language, published after 2000, investigate built environment and design features that influence stair use in the building.

DATA EXTRACTION

The data extraction process included; Author (year), country, study design, type of buildings, the population of the study, duration of the study, measured variables (dependent and independent), measurement tool, analysis and outcomes.

DATA SYNTHESIS

Extracted data were synthesized in a tabular format and analytical figures with narratives summary.

RESULT

Nine features of the built environment that affect stair use determined from the literature; safety, motivations, appeal and comfort, and legibility were the most common features in the studies, followed by connectivity, building codes, and elevator programming. The good quality of mentioned features positively affects stair use level and vice versa. However, the review also reports a shortage of architects in both practice and research concerning active stair design.

CONCLUSION

Stair use is of great importance in increasing physical activity and improving occupational health in the workplace. Architects and designers should pay special attention to the design of staircases and encourage their everyday use by considering the largest number of features that encourage stair use.

Measuring “Nudgeability”: Development of a Scale on Susceptibility to Physical Activity Nudges among College Students

Background: The current college lifestyle create more opportunities for students to develop unhealthy behaviors, especially physical inactivity. Nudging could be an effective tool to improve physical activity behaviors by changing college settings. One-nudge-fits-all leads to ineffective nudges, so it is necessary to develop a reliable and valid instrument capable of measuring the “nudgeability” of physical activity nudges for college students, which is for a higher level of nudge efficacy. Method: Developing the College Physical Activity Nudges Susceptibility Scale (CPANSS) that integrated the nudge method with the Likert scale, which is the first attempt to measure the susceptibility to nudges directly by a scale. There are four steps for developing CPANSS, including Scale Dimensions, Item Generation, Exploratory Factor Analysis (n = 294), and Confirmatory Factor Analysis (n = 293) with appropriate procedures. Results: The five-factor 21-item CPANSS with good reliability and validity fitted the data reasonably well. Conclusion: The CPANSS was to provide a new tool for policymakers to design effective nudges in changing and promoting physical activity in college settings, and to provide a method for scholars to promote other healthy behaviors for different target groups.

Nudges used to promote physical activity and to reduce sedentary behaviour in the workplace: Results of a scoping review

Physical inactivity is one of the most important risk factors for non-communicable diseases. Workplace health promotion is therefore of growing interest to support an active day using nudges. The scoping review aims to (a) analyse how frequently nudges are applied in workplace health promotion to increase physical activity and/or reduce sedentary behaviour, and (b) characterise the nudges used. A systematic database search was conducted for the period 2009 to June 2020. According to predefined inclusion and exclusion criteria, studies promoting physical activity and/or reducing sedentary behaviour using nudges were included. Nudges were classified according to MINDSPACE and TIPPME. A study protocol was previously published. Of the 256 studies identified, 26 used nudges. Most studies were conducted in Europe (n = 12) and the USA (n = 8). N = 18 studies targeted physical activity and n = 8 studies targeted sedentary behaviour. In most studies promoting physical activity, prompts were given to climb stairs (n = 11). Interventions targeting sedentary behaviour were more diverse, using digital interventions or mixed approaches (n = 8). Although nudges can help increase physical activity and reduce sedentary behaviour, there are still gaps in terms of their effective and efficient use. There is a lack of long-term studies that analyse habituation and behavioural changes beyond the intervention period. In addition, the potential of digital and mixed approaches is not yet fully exploited. Further studies from low- and middle-income countries with different climates and working conditions are needed to investigate the feasibility of approaches and advance the fight against physical inactivity.

Activity space, office space: Measuring the spatial movement of office workers

A key to the development of more effective interventions to promote movement and reduce physical inactivity in office workplaces may be to measure and locate individual's spatial movement. Using an activity space estimation method, high resolution location data collected from 15 office workers over 12 days were used to estimate and analyse the location and extent of their daily spatial movement whilst in an office work-based setting. The results indicated that the method, kernel density estimation, combined with location data offers significant opportunities to not only measure and compare spatial movement behaviours but also simultaneously identify the locations where the behaviours occur. Combined with other data streams, this method will allow researchers to further investigate the influence of different environmental characteristics on these behaviours, potentially leading the development of more effective, longer lasting interventions to promote movement and reduce stationary behaviour, ultimately improving the health of office workers.

Identifying interior design strategies for healthy workplaces – a literature review

Purpose

It is widely recognized that interior office space can affect health in several ways. Strategic and evidence-based design, including explicit design objectives, well-chosen design solutions and evaluation of results, aid realization of desired health effects. Therefore, this paper aims to identify possibly effective interior design strategies and accompanying design solutions and to provide examples of effectiveness measures.

Design/methodology/approach

A literature sample of 59 peer-reviewed papers published across disciplines was used to collect examples of workplace design features that have positively influenced workers’ well-being. The papers were grouped by their health objective and design scope successively and their theoretical assumptions, measures and findings were analyzed.

Findings

Four main workplace design strategies were identified. Design for comfort aims at reducing or preventing health complaints, discomfort and stress, following a pathogenic approach. It has the longest tradition and is the most frequently addressed in the included papers. The other three take a salutogenic approach, promoting health by increasing resources for coping with demands through positive design. Design for restoration supports physical and mental recovery through connections with nature. Design for social well-being facilitates social cohesion and feelings of belonging. Design for healthy behavior aims at nudging physical activity in the workplace.

Originality/value

By drawing complementary perspectives and offering examples of design solutions and effectiveness measures, this paper encourages workplace designers, managers and researchers to take a transdisciplinary and evidence-based approach to healthy workplaces. It also serves as a starting point for future empirical research.

Choice architecture interventions to change physical activity and sedentary behavior: a systematic review of effects on intention, behavior and health outcomes during and after intervention

BACKGROUND

Choice architecture interventions, which subtly change the environment in which individuals make decisions, can be used to promote behavior change. This systematic review aimed to summarize studies on micro-environmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and to describe the effectiveness of those interventions on these behaviors - and on related intentions or health outcomes - in presence of the intervention and after removal of the intervention (i.e. post-intervention, regardless of the time elapsed).

METHODS

We systematically searched PubMed, Embase, PsycINFO and the Cochrane Library for (quasi) experimental studies published up to December 2019 that evaluated the effect of choice architecture interventions on physical activity and sedentary behavior, as well as on intentions and health outcomes related to physical activity/sedentary behavior. Studies that combined choice architecture techniques with other behavior change techniques were excluded. All studies were screened for eligibility, relevant data was extracted and two independent reviewers assessed the methodological quality using the QualSyst tool.

RESULTS

Of the 9609 records initially identified, 88 studies met our eligibility criteria. Most studies (n = 70) were of high methodologic quality. Eighty-six studies targeted physical activity, predominantly stair use, whereas two studies targeted sedentary behavior, and one targeted both behaviors. Intervention techniques identified were prompting (n = 53), message framing (n = 24), social comparison (n = 12), feedback (n = 8), default change (n = 1) and anchoring (n = 1). In presence of the intervention, 68% of the studies reported an effect of choice architecture on behavior, whereas after removal of the intervention only 47% of the studies reported a significant effect. For all choice architecture techniques identified, except for message framing, the majority of studies reported a significant effect on behavioral intentions or behavior in presence of the intervention.

CONCLUSIONS

The results suggest that prompting can effectively encourage stair use in adults, especially in presence of a prompt. The effectiveness of the choice architecture techniques social influence, feedback, default change and anchoring cannot be assessed based on this review. More (controlled) studies are needed to assess the (sustained) effectiveness of choice architecture interventions on sedentary behavior and other types of physical activity than stair use.

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.

Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. Instead of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google's rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most-but not all-nudges in most-but not all-circumstances.

Development and Validation of the Policies, Opportunities, Initiatives and Notable Topics (POINTS) Audit for Campuses and Worksites

Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions (administered, monitored, reviewed) were completed. Results: Cronbach's Alpha for the student-focused POINTS audit was α = 0.787 (34 items, possible points = 65), and for the employee-focused POINTS audit was α = 0.807 (26 items, possible points = 50). A total of 115 student-focused and 33 employee-focused audits were completed. Although there was little evidence of policy presence beyond stimulant standards (smoking and alcohol), there were extensive examples of health initiatives. The student-focused POINTS audit was validated using the Healthier Campus Initiative's survey. Conclusions: POINTS is a web-based audit tool that is valid and useful for pre-assessment, advocacy, benchmarking, and tracking policies for health and well-being for students (campus) and employees (worksite).

Are motivational signs to increase stair use a thing of the past? A multi-building study

Issue addressed Only half of Australia's adult population is sufficiently physical active. One method thought to increase incidental physical activity at work is the use of stair-promoting interventions. Stairs are readily available and stair climbing is considered vigorous physical activity. Motivational signs have been extensively and effectively trialled to increase stair use, but are they suitable for contemporary populations? Methods Participants were occupants of three selected University of Sydney buildings using the elevators or stairs. Infrared people counters were installed to monitor stair and elevator use for 24 h/day during two baseline weeks, followed by two intervention weeks, where motivational and directional signs were placed at points of choice. Results At baseline there was a large between-building variation in the change in stair to elevator proportion, where we observed a small increase in two buildings (81-84%, odds ratio (OR): 1.16 (1.09, 1.23), and 26-27%, OR: 1.09 (1.03, 1.15)), and a decrease (30-25%, OR: 0.75 (0.72, 0.77) in the third building. Conclusions Differences in stair use among buildings could be due to building design and function. Motivational and directional signs to promote stair use showed small or nil effects. The future of interventions promoting stair use in occupational settings may need more interactive or personalised intervention methods. So what? The implications of this study are that posters to promote stair use might be a thing of the past and this should be considered in future workplace health promotion efforts to increase physical activity. More novel and interactive methods using new media are recommended.

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.

Stair walking is more energizing than low dose caffeine in sleep deprived young women

INTRODUCTION

The acute energizing effect of exercise and caffeine has never been examined in a single study of adults with chronic sleep deprivation but evidence from a study of this type could help individuals choose between these two common alertness-enhancing options.

AIM

The apriori primary aim of this experiment was to compare the influence of 10-min of low-to-moderate intensity stair walking to the consumption of capsules containing 50mg caffeine or flour (placebo) on feelings of energy in physically active, college female caffeine users with chronic insufficient sleep. Effects on secondary outcomes related to feelings of energy also were assessed.

MATERIAL-METHOD

A repeated measures crossover experiment was conducted with 18 college women (18-23years) who reported (i) daily caffeine consumption that was not extreme (40-400mg), (ii) typical leisure time physical activity that was not extreme (at least 2 weekly mild 15-min or longer bouts and no >5 strenuous 15-min or longer bouts), and (iii) sleeping <45h per week. Mood states (POMS-BF), focused on energy feelings (vigor), as well as working memory (N-back), sustained attention (CPT), simple reaction time (SRT), and motivation to complete the cognitive tasks were measured before and after a 10-min exercise condition (20min seated rest followed by 10min of low-to-moderate intensity stair walking) and compared to both a caffeine condition (50mg caffeine capsule followed by 30min of seated rest) and a similar flour (placebo) capsule condition. Condition (exercise, caffeine, placebo)×Time (Baseline, Post-1, Post-2, and for mood Post-3) ANCOVAs (controlling for Condition order) tested the hypothesized effects.

RESULTS

Condition×Time interactions showed that stair walking increased POMS-BF vigor at Post-1 compared to both placebo and caffeine. Other interactions were not significant.

CONCLUSION

A brief bout of low-to-moderate intensity stair walking has transient energizing effects that exceed a low dose of caffeine for active young women with chronic insufficient sleep.

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.

Worksite Food and Physical Activity Environments and Wellness Supports Reported by Employed Adults in the United States, 2013

PURPOSE

To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size.

DESIGN

Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA.

SETTING

Worksites in the United States.

PARTICIPANTS

A total of 2101 adults employed outside the home.

MEASURES

Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments.

ANALYSIS

Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size.

RESULTS

Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers.

CONCLUSION

Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers.

A multistage controlled intervention to increase stair climbing at work: effectiveness and process evaluation

BACKGROUND

Stair climbing helps to accumulate short bouts of physical activity throughout the day as a strategy for attaining recommended physical activity levels. There exists a need for effective long-term stair-climbing interventions that can be transferred to various worksite settings. The aims of this study were: 1) to evaluate short- and long-term effectiveness of a worksite stair-climbing intervention using an objective measurement of stair climbing and a controlled design; and 2) to perform a process evaluation of the intervention.

METHODS

We performed a controlled before-and-after study. The study was conducted in two corporate buildings of the same company located in Paris (France), between September, 2013 and September, 2014. The status of either "intervention site" or "control site" was assigned by the investigators. Participants were on-site employees (intervention site: n = 783; control site: n = 545 at baseline). Two one-month intervention phases using signs (intervention phase 1) and enhancement of stairwell aesthetics (intervention phase 2) were performed. The main outcome was the change in stair climbing, measured with automatic counters and expressed in absolute counts/day/100 employees and percent change compared to baseline. Qualitative outcomes were used to describe the intervention process.

RESULTS

Stair climbing significantly increased at the intervention site (+18.7%) but decreased at the control site (-13.3%) during the second intervention phase (difference between sites: +4.6 counts/day/100 employees, p < 0.001). After the intervention and over the long term, stair climbing returned to baseline levels at the intervention site, but a significant difference between sites was found (intervention site vs. control site: +2.9 counts/day/100 employees, p < 0.05). Some important facets of the intervention were implemented as intended but other aspects had to be adapted. The main difficulty reported by the company's staff members lay in matching the internal communications rules with critical intervention criteria. The program was maintained at the setting level after the end of the study.

CONCLUSIONS

This study shows a successful stair-climbing intervention at the worksite. The main barriers to adoption and implementation were related to location and visibility of posters. Process evaluation was useful in identifying these barriers throughout the study, and in finding appropriate solutions.

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.