Individual Study Results

• Summary of the Research
• Research Gaps
• References

What does the Research says about Stairway interventions to increase Physical Activity and Health? Nine Published studies are identified below.

Description of Existing Published Studies

1. Brownell, Stunkard and Albaum, (1980)

   The earliest study had two components: the first dealing with the effects of a sign at a stair-escalator choice point and the second with the long-term maintenance of change. In the first part, over 21,000 observations were made in a shopping mall, train station and bus terminal in Philadelphia, PA. The stairwells had 30 steps at the shopping mall, 18 at the train station and 24 at the bus terminal. The sign encouraging stair use had cartoon pictures of an unhealthy and a healthy heart with captions "Your heart needs exercise" and "Here's Your Chance." The sex, race (black/white), age (over 30/ under 30) and weight (obese/ non-obese) of each subject were recorded based on observer judgement. An ABAB design was followed: a baseline phase followed by intervention phase with the sequence repeated twice. As in all succeeding studies, subjects who were carrying heavy or bulky items, or who appeared to be disabled, were not included in the analysis.

   The sign increased the percentage of subjects using the stairs which more than doubled from an average of 6% to 14%. Of the three settings, the mall had the highest proportion of users. At baseline, obese people, women, and older subjects were less likely to use the stairs. The intervention was equally effective in increasing stair use for obese and non-obese, male and female, and older and younger subjects.

   The second study investigated the effects of repeated exposure to the sign and the long-term maintenance of change. Over 24,000 observations of rail commuters at a downtown station were made using an ABA design - a baseline period of 5 days, sign use for 15 days, withdrawal of the intervention for 10 days, and follow-up observation periods at one month and three months. Highest stair use occurred when the sign was in place, with effects persisting at one month. By three months the percentage using the stairs returned to baseline levels. The overall percentage using the stairs was 11.6% during baseline, 18.3% during the intervention, 15.6% at one month post-intervention, and 11.9% at 3 months.

2. Blamey, Mutrie and Aitchison, (1995)

   This Scottish study examined the effects of signs posted at a stair-escalator flight of 15 stairs at an underground (subway) station. The signs read "Stay Healthy", Save Time, Use the Stairs". Observations were made from 8:30 to 10:00 a.m. three days a week for 16 weeks. The study design had a one-week baseline period, 3 weeks with the sign, and follow-ups 2 and 4 weeks after removal of the sign. Overall, stair use increased from about 8% at baseline to 15-17% during the three weeks of sign use. This gradually declined after removal of the signs but at twelve weeks was still higher than at baseline. The authors conclude that stair use "...can make an important contribution to an accumulated daily activity programme..." and noted that the Health Education Board for Scotland had distributed posters to promote it in Scottish workplaces.

3. Anderson, Franckowiak, Snyder, Bartlett and Fontaine (1998)

   This study was conducted in a Baltimore suburban shopping mall and compared two motivational signs, one emphasizing a health message, the other a weight-control message. The stairwell had two flights of 10 stairs with a landing between them. The health sign "...featured a caricature of a heart at the top of a flight of stairs and the message "Your heart needs exercise, use the stairs." The weight control message showed a cartoon of a slim woman at the top of a flight of stairs with a caption "Improve your waistline, use the stairs." A three-phase design was used with a baseline period of one month; the health message sign for one month; then the weight-control sign for one month. Subjects were observed from 10:30 a.m. to 9:00 p.m. all days of the week for a total of almost 18,000 observations. Subjects had their age (over 40/ under 40), sex, ethnicity (race) and weight status (obese/ non-obese) recorded based on observer's judgement. Overall, use of the stairs at baseline was 4.8%, increasing to 6.9% with use of the health sign and to 7.2% when the weight-control sign was used. No significant differences were seen between men and women. Older subjects were more likely to use the stairs in response to both signs than those under 40. White subjects were more likely than black subjects to change their behaviour based on the signs. The authors conclude that their data show a significant increase in stair use using signs and that a weight-control message is equally or more effective than a health message in stimulating change.

4. Russell, Dzewaltowski and Ryan, (1999)

   This study was conducted at a midwestern USA university library which had an elevator and adjacent stairs to go up three floors. The intervention involved first replacing a placard marked "elevator" along with the symbol for physical disability and braille with no placard, then after two weeks with a placard stating "Elevator for physically challenged and staff use only -others use stairs please." The overall observation period was 11 weeks, with a 6-week baseline phase (combining the old placard phase with the no placard phase) and a five-week intervention phase. Age (under and over 30) and sex were recorded based on observer judgement. Observations were made between 2:30 and 4:30 p.m daily culminating in a total sample of 6216 observations.

   Overall, stair use increased from 39.7 % to 41.9%, a small but statistically significant increase. Age and sex affected the original level of stair use with younger men having the highest original level, younger women second, older men third and older women last. All groups except older women increased their stair use after the intervention.

   The authors acknowledge several limitations. One was that library staff were generally older and also more entitled to use the elevators, a factor which may have distorted the age effect?.

5. Russell and Hutchinson, (2000)

   This study by the same principal investigator was conducted at a US midwest regional airport. It compared two poster messages, a health promotion message ("Keep your heart healthy, use the stairs") and a deterrent message ("Please limit escalator use to staff and those unable to use the stairs"). During a five-week observation period, no signs were used in weeks 1,3 and 5; the health promotion sign was used in week 2; and deterrent sign in week 4. A total of 3,369 choices were observed by trained observers who categorized subjects by sex and age (over/under 40).

   Stair use increased during both interventions: from 8.2% in the no sign condition to 14.9% with the health promotion sign and 14.4% with the deterrent sign. The latter difference was not statistically significant. The authors conclude that both types of signs were effective.

6. Kerr, Eves and Carroll (2000, 2001a, 2001b)

   These investigators have published several reports based on their studies in Birmingham, England. The main study (2001a) was a six-months observational study of 45,361 escalator-stair choices in a shopping mall. Age, gender and ethnicity were recorded based on observer judgment. The intervention consisted of motivational messages on the stair risers. The design featured a 2-week baseline period followed by a 12-week intervention with follow-ups at two weeks and eight weeks. Observations were conducted between 11 a.m. and 1:00 p.m two days a week.

   At baseline, younger men were most likely to use the stairs followed by younger women, older men and older women. All groups increased stair use during the intervention, approximately doubling the proportion of stair use. Younger men and older men and women increased their use in the second six weeks of the intervention before starting to decrease. Younger women increased during the first six weeks then began to decrease. However, all four groups remained above baseline at eight weeks after the intervention stopped.

   Another study by these authors (2000) featured the use of posters, rather than messages on stair risers, to encourage stair use. As well, interviews were conducted with the subjects to get information on their current physical activity level and stage of change. A total of 658 people provided interviews including 270 stair users and 388 escalator users. A baseline period of 2 weeks was followed by four weeks of exposure to the poster.

   Stair use increased significantly during the intervention Less active people were encouraged to use the stairs more, but in terms of the subject's stage of change, precontemplators tended to miss seeing the sign more than the others.

   Another sub-study (2001b) compared the effectiveness of stair-riser banners with posters. This study found that banners were more effective. The authors attribute this to the banners' higher visibility - 76% saw them as opposed to only a third who saw the posters. Also, while the posters had only health messages, the banners had somewhat more varied messages (see box below).

   Stair Riser Messages
   Take the Stairs	Keep fit
   Daily exercise	Work your legs
   Free exercise	Stay healthy
   Easy exercise	Be active
   Exercise your heart	Well done!

   
   

   Another study by the authors (2001c) examined whether posters could encourage stair use in a workplace environment. This study used a hidden camera to record elevator or stair use in the 9-storey office building of an accountancy firm for two hours in the morning (8:00-10:00 a.m) and two at lunchtime (12:00-14:00). Over 12,000 choices were observed. There was no significant effect of the poster intervention on ascending stairs (20.7% used the stairs at baseline, 21.5% after the intervention) but there was an increase in use for descending (25% to 30%).

   A second accountancy firm in a 4-storey office building was also investigated. A researcher observed stair or elevator use twice a week at the same time of day as the previous studies. Again, the use of stairs for ascent did not increase significantly (19.0% to 23.2%) but the use for descent did (40% to 52%).

   The authors note that the environment can inhibit stair use - workers were willing to climb only 3.5 flights of stairs so those on higher floors were less likely to use the stairs from the ground floor. Messages should have emphasized using the stairs for going from floor to floor. Poster messages are context specific.

7. Titze, Martin, Seiler and Marti, (2001)

   Another worksite study of prompts encouraging people to use stairs was conducted among 338 employees in four offices of the Swiss federal government. The intervention included formation of committees, distribution of brochures on daily life activities and health, and "action-days" during which apples or other fruit were distributed to stair users and a "game of chance" was used. The intervention was based on the Transtheoretical Model and focused on "attractive or pull options".There was a four-month intervention period using two methods of observation, a human observer and an automatic photoelectric counting system. The action-days were concentrated during the first third of the intervention period.

   A large difference was found in baseline level of use according to the physical environment, with 86.2% using the stairs in an office with a bright stairwell and a small number of steps between floors, and the lowest (31.4%) in an office with a dark stairwell, a large number of steps and the need of a key for access. A significant overall increase in stair use from 61.8% to 71.4% took place during the intervention.

   One puzzling aspect of this study was that the results differed according to whether a human observer of the automatic system was used. The latter showed less change. The authors state that although the human observer may also have influenced behaviour, the automatic system was subject to manipulation and/or insensitive and is thus not the best choice to assess behaviour.

8. Boutelle, Jeffery, Murray and Schmitz , (2001)

   This study comparing stair and elevator use was conducted in a midwestern university office building with eight floors and 700 employees. This building required a key card to access the stairwell. Observers were stationed at the choice point on Mondays, Wednesdays and Fridays for 3 hours a day and recorded of the number of people entering and leaving the stairwell or the elevator, their direction of travel, and their sex. A total of 35,475 observations were made. The design had a two-week baseline period, a first intervention of four weeks, a second intervention of the same duration and a further four-week follow-up.

   The first intervention consisted of a sign saying "Take the stairs for your health." Signs were placed above all the elevator /buttons. Signs were also placed on the stairwell doors identifying that the stairs were within. In the second intervention, artwork and music were added to the signs. The art was changed every week. Music was from a CD player on the second floor and could be heard throughout the stairwell.

   The percentage using the stairs was 11.1% at baseline, rising to 12.7% with the signs alone and to 15.5% with the addition of music and artwork. It remained at 13.8% in the four-week follow-up. The change between baseline and signs was not statistically significant, but the music and artwork produced a significant increase. Initially, more of the trips were in a downward, rather then upward direction and women were more likely than men to use the stairs. There was no significant difference between men and women or in trip directions due to the interventions. The authors conclude that making the environment more attractive through music and art can significantly increase stair use.

9. Coleman and Gonzales, (2001)

   This study was done in El Paso Texas, a predominantly Hispanic community in the U.S. Southwest with high rates of obesity. Two types of signs were compared; one type similar to the Brownell, Stunkard and Albaum (1980) version with an individual health message, and the other with a family theme which was felt to be more culturally-appealing to the Spanish-American community (See box below). Both sets of signs were in English and Spanish. The research sites included an airport, a bank, an office building and a university library. The research design featured a baseline phase, a first intervention phase, a washout/second baseline phase, and a second-intervention phase. Student observers recorded the subjects taking stairs or elevators.

   Individual Messages:
   Your heart needs exercise Here's your chance Watch Your Step
   Family-Tailored Messages
   Do it! For the life of your family Use the stairs Watch your step

   
   

   Stair use at baseline varied widely across the different settings from 1-2% at the bank to 30-40% at the university library and office building. Overall, stair use increased from 6 % to 9 %. The family-tailored intervention was found to be no more effective than the individual intervention in increasing stair use.

Recommendation From Task Force on Community Preventive Services (2001)

A recent review by the US Task Force on Community Preventive Services of the Effectiveness of Physical Activity Interventions provides a positive assessment of stair use interventions. The Task Force found that there was enough evidence to provide positive recommendations for six types of physical activity interventions. Two informational approaches were recommended: community -wide campaigns (strong recommendation), and point-of-decision prompts that encourage people to use the stairs. To be selected as one of only six physical activity interventions recommended by the Task Force speaks well of stair use interventions.

The Guide to Community Preventive Services (2001) gives the following findings from their systematic review of the effectiveness of point-of-decision prompts that encourage people to use the stair.