Desk based prompts to replace workplace sitting with stair climbing; a pilot study of acceptability, effects on behaviour and disease risk factors.

BACKGROUND: Prolonged sitting is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Occupational sitting accounts for up to 50 h/week for employees. This pilot study assessed the acceptability of stair climbing as an interruption to sitting throughout working hours, and provided preliminary data of the effects on glucose and lipid profiles. METHODS: A quasi-experimental design was conducted involving 16 sedentary office workers (five females and 11 males) for intervention (n = 8) and control groups (n = 8) with mean age of 36.38 (5.58). For the eight-week intervention, a continuous four-floor stair climb and descent was performed eight times/day spread evenly over the working day. A prompt to climb was presented on the participant's computer eight times/day. Participants in the experimental group recorded daily floors climbed and steps (measured using pedometers) in a weekly log sheet. Blood samples were collected pre and post intervention to test effects on fasting glucose and 2 h plasma glucose, triglycerides, and total (TC), LDL and HDL cholesterol. Experimental participants were interviewed at the end of the study. The Wilcoxon signed rank test was used to compare the median changes (pre-post) of the dependent variables. RESULTS: On average, the experimental group climbed 121 floors/week when prompted. There were significant reductions in fasting blood glucose, TC and LDL, as well as the derived measures of 'bad' cholesterol and the TC/HDL ratio in the experimental group. Post-experimental interviews indicated that the interruption to sitting was well tolerated. CONCLUSION: Prompted stair climbing activity had impacts on health outcomes and was found acceptable to employees at work. TRIAL REGISTRATION: Ethics for this study was approved by Science, Technology, Engineering and Mathematics Ethical Review Committee, University of Birmingham with ethics reference number ERN_15_0491.

Daily stair climbing is associated with decreased risk for the metabolic syndrome.

BACKGROUND: Stair climbing can be a vigorous lifestyle physical activity, and is associated with healthier lipoprotein profiles, lower body weight and blood pressure, as well as higher aerobic fitness. The present analysis of data from a cohort of late middle-aged men and women examined the association between daily stair climbing and the metabolic syndrome. METHODS: Data from 782 (423 women) participants (mean (SD) age 58.3 (0.95) years in the Dutch Famine Birth Cohort Study (2002-2004) were used to examine the cross-sectional association between self-reported daily stair climbing and the metabolic syndrome. Stair climbing was assessed by the question 'Do you climb stairs daily?' and the metabolic syndrome was defined using the established five components relating to lipid fractions, blood glucose levels, blood pressure and abdominal obesity. RESULTS: Not climbing stairs daily was associated with an increased incidence of the metabolic syndrome (OR = 1.90, 95% CI = 1.23, 2.92, p = 0.004) and a greater number of its components (F1,780 = 8.48, p = 0.004): these associations were still evident after adjusting for a variety of potential confounders. CONCLUSIONS: The most likely explanation for the current findings is that daily stair climbing may be protective against the metabolic syndrome. This result reinforces public health recommendations for increased stair climbing with evidence from physiological outcomes.

Health Representations, Perceived Valence, and Concept Associations for Symbols as Food Cues: A Mixed-Methods Approach.

Researchers have experimented with a range of point-of-purchase (PoP) interventions in supermarkets, restaurants, and cafeterias. In general, these interventions have employed written materials. This research tested symbols to visually summarize information about the (un)healthiness of food. Study one explored health representations and valence associated with the image of a heart, a bathroom scale, and a running shoe using qualitative field interviews (N = 1200). Study two explored accessibility of a priori concept associations for two of those images, stratified by valence, in a computerized response latency task (N = 40). Study one indicted that the heart was best linked to its intended theme "heart health." Concerning valence, the heart was seen as both positive and negative whereas the scale was less likely to be viewed as positive relative to the running shoe. In study two, the heart was linked to five of the six a priori concepts and there was evidence that three of these were more accessible. Overall, the heart was better linked to positive poles than negative ones. A heart symbol may be useful to prompt heart healthy choices at the PoP. There was evidence that a scale may bias choice away from undesirable foods.

Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial.

BACKGROUND: The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. METHODS: An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.Blood pressure and weight were assessed at baseline and 6 months. RESULTS: Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. CONCLUSIONS: Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed. TRIAL REGISTRATION: The trial is registered as Current Controlled trials ISRCTN07682833.

A novel tool to predict food intake: the Visual Meal Creator.

Subjective appetite is commonly measured using an abstract visual analogue scale (VAS) technique, that provides no direct information about desired portion size or food choice. The purpose of this investigation was to develop and validate a user-friendly tool - the Visual Meal Creator (VIMEC) - that would allow for independent, repeated measures of subjective appetite and provide a prediction of food intake. Twelve participants experienced dietary control over a 5-hour period to manipulate hunger state on three occasions (small breakfast (SB) vs. large breakfast (LB) vs. large breakfast + snacks (LB+S)). Appetite measures were obtained every 60 minutes using the VIMEC and VAS. At 4.5 hours, participants were presented with an ad libitum test meal, from which energy intake (EI) was measured. The efficacy of the VIMEC was assessed by its ability to detect expected patterns of appetite and its strength as a predictor of energy intake. Day-to-day reproducibility and test-retest repeatability were assessed. Between- and within-condition differences in VAS and VIMEC scores (represented as mm and kcal of the "created" meal, respectively) were significantly correlated with one another throughout. Between- and within-condition changes in appetite scores obtained with the VIMEC exhibited a stronger correlation with EI at the test meal than those obtained with VAS. Pearson correlation coefficients for within-condition comparisons were 0.951, 0.914 and 0.875 (all p < 0.001) for SB, LB and LB+S respectively. Correlation coefficients for between-condition differences in VIMEC and EI were 0.273, 0.940 (p < 0.001) and 0.525 (p < 0.05) for SB - LB+S, SB - LB and LB - LB+S respectively. The VIMEC exhibited a similar degree of reproducibility to VAS. These findings suggest that the VIMEC appears to be a stronger predictor of energy intake than VAS.

Developing habit-based health behaviour change interventions: twenty-one questions to guide future research.

OBJECTIVE: Habitual behaviours are triggered automatically, with little conscious forethought. Theory suggests that making healthy behaviours habitual, and breaking the habits that underpin many ingrained unhealthy behaviours, promotes long-term behaviour change. This has prompted interest in incorporating habit formation and disruption strategies into behaviour change interventions. Yet, notable research gaps limit understanding of how to harness habit to change real-world behaviours. METHODS: Discussions among health psychology researchers and practitioners, at the 2019 European Health Psychology Society 'Synergy Expert Meeting', generated pertinent questions to guide further research into habit and health behaviour. RESULTS: In line with the four topics discussed at the meeting, 21 questions were identified, concerning: how habit manifests in health behaviour (3 questions); how to form healthy habits (5 questions); how to break unhealthy habits (4 questions); and how to develop and evaluate habit-based behaviour change interventions (9 questions). CONCLUSIONS: While our questions transcend research contexts, accumulating knowledge across studies of specific health behaviours, settings, and populations will build a broader understanding of habit change principles and how they may be embedded into interventions. We encourage researchers and practitioners to prioritise these questions, to further theory and evidence around how to create long-lasting health behaviour change.

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.

Interrupting Pedestrians in Indonesia; Effect of Climate on Perceived Steepness and Stair Climbing Behaviour.

Increased activity during daily life is one public health initiative to reduce population inactivity. Increasing temperature and humidity influence walking for transport by reducing the blood supply available to exercising muscles. This study investigated effects of temperature and humidity on a perceptual cue, estimated stair slant, that can influence behaviour, and on subsequent speed of climbing. Participants (402 males, 423 females) estimated the slant of a 20.4° staircase at a university in Indonesia. Subsequently, the participants were timed covertly while climbing. As temperature and humidity increased, estimated stair slant became more exaggerated. Females estimated stair slant as steeper than males. For stair climbing, speed was reduced as temperature increased, and females climbed slower than males. Estimates of stair slant were not associated with speed of the subsequent climb. Climate influences estimates of stair slant that precede stair climbing and subsequent speed of the ascent. In this study, perception was unrelated to behaviour.

Specific effects of a calorie-based intervention on stair climbing in overweight commuters.

BACKGROUND: Point-of-choice prompts consistently increase stair climbing; a greater increase in overweight than normal weight individuals was reported in a multi-component worksite campaign. PURPOSE: The purpose of this study is to investigate effects of a multi-component campaign, on stair climbing, in a public access setting. METHODS: In an interrupted-time-series-design, baseline observations (2 weeks) preceded a 2-week point-of-choice prompt. An additional message, positioned at the top of the climb for a further 6-week period, summarised the calorific consequences of a single ascent. Inconspicuous observers recorded traveller's methods of ascent, coded by sex and weight status, twice a week between 08:00 and 09:59. RESULTS: At baseline, the overweight chose stairs less than normal weight individuals. The multi-component campaign targeting weight control reversed this bias, increasing stair climbing only in overweight individuals. CONCLUSIONS: The specificity of the effect confirms the appeal of this lifestyle activity for the overweight. The discussion focuses on how intentions to control weight may be converted into behaviour.

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.

Is the effect of prior exercise on postprandial lipaemia the same for a moderate-fat meal as it is for a high-fat meal?

Moderate-intensity exercise can lower the TAG response to a high-fat meal; however, the British diet is moderate in fat, and no study to date has compared the effect of such exercise on responses to high-fat and moderate-fat meals. The present work investigated the effect of brisk walking performed 13 h before intake of both high-fat and moderate-fat meals on postprandial plasma TAG concentrations. Eight inactive, overweight men completed four separate 2 d trials, i.e. rest (Con) or a 90-min treadmill walk (Ex) on the evening of day 1, followed by the ingestion of a moderate-fat (Mod) or high-fat (High) meal on the morning of day 2. High-fat meals contained 66 % of total energy as fat, while the percentage was 35 % for moderate-fat meals; both the meals were, however, isoenergetic. On day 2, venous blood was sampled in the fasted state, 30 and 60 min after ingesting the test meal and then hourly until 6 h post-meal. Exercise reduced plasma TAG concentrations significantly (P < 0·001), with no exercise × meal interaction (P = 0·459). Walking reduced the total TAG response to a high-fat meal by 29 % (relative to High Con); the same bout of exercise performed before ingesting a moderate-fat meal lowered total TAG by 26 % (compared with Mod Con). The ability of a single moderate-intensity aerobic exercise bout to lower postprandial TAG concentrations is just as great, in percentage terms, when the test meal ingested is of a moderate rather than a high fat content.

Home-Based Stair Climbing as an Intervention for Disease Risk in Adult Females; A Controlled Study.

Cardiovascular disease and the metabolic syndrome are major contributors to health care expenditure. Increased physical activity reduces disease risk. The study compared effects of walking up and down stairs at home with continuous, gym-based stair climbing on the disease risk factors of aerobic fitness, serum lipids, body composition, fasting blood glucose, and resting cardiovascular variables. Sedentary women (31.7 ± 1.4 years) were randomly assigned to home-based (n = 26) or gym-based (n = 24) climbing for five days.week-1 over an eight-week period. Each ascent required a 32.8-m climb, with home-based climbing matching the vertical displacement in the gym. Participants progressed from two ascents.day-1 to five ascents.day-1 in weeks 7 and 8. Relative to controls, stair climbing improved aerobic fitness (V˙O2max +1.63 mL.min-1.kg-1, 95% CI = 1.21-2.05), body composition (weight -0.99 kg, 95% CI = 1.38-0.60), and serum lipids (LDL cholesterol -0.20 mmol.L-1, 95% CI = 0.09-0.31; triglycerides -0.21 mmol.L-1, 95% CI = 0.15-0.27), with similar risk reductions for home and gym-based groups. Only the home-based protocol reduced fasting blood glucose. Discussion focuses on stair climbing bouts as time-efficient exercise and the potential benefits of a home-based intervention. Stair use at home offers a low-cost intervention for disease risk reduction to public health.

Promoting stair climbing in Barcelona: similarities and differences with interventions in English-speaking populations.

This study evaluated the ability of three different messages to encourage stair climbing on the Barcelona underground. Two weeks of baseline were followed by three banner intervention periods with three different messages, each for a 2 week period. Follow-up data was gathered two weeks after removing the messages. Stair climbing increased overall [odds ratio (OR) = 1.45; 95% confidence intervals (CIs) = 1.25-1.68], with no statistical differences between the messages. During follow-up, stair climbing remained elevated (OR = 1.22; 95% CIs = 1.01-1.48). These preliminary data suggest stair climbing interventions, effective in the UK, may prove successful in Catalonia and Spain. Baseline differences, however, outline the magnitude of the task.

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.

Marginally perceptible outcome feedback, motor learning and implicit processes.

Participants struck 500 golf balls to a concealed target. Outcome feedback was presented at the subjective or objective threshold of awareness of each participant or at a supraliminal threshold. Participants who received fully perceptible (supraliminal) feedback learned to strike the ball onto the target, as did participants who received feedback that was only marginally perceptible (subjective threshold). Participants who received feedback that was not perceptible (objective threshold) showed no learning. Upon transfer to a condition in which the target was unconcealed, performance increased in both the subjective and the objective threshold condition, but decreased in the supraliminal condition. In all three conditions, participants reported minimal declarative knowledge of their movements, suggesting that deliberate hypothesis testing about how best to move in order to perform the motor task successfully was disrupted by the impoverished disposition of the visual outcome feedback. It was concluded that sub-optimally perceptible visual feedback evokes implicit processes.

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design.

BACKGROUND: The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation. DESIGN: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention. PARTICIPANTS: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7) or to the SDT-based intervention (n = 6).Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. DISCUSSION: This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling. TRIAL REGISTRATION: The trial is registered as Current Controlled trials ISRCTN07682833.

Accessibility of salient beliefs about the outcomes of physical activity.

OBJECTIVES: Attitudes may influence behaviour through both deliberative and automatic processes. To investigate the automatic influences of attitudes, this study explores the accessibility of modally salient beliefs about physical activity outcomes using response latency measures. DESIGN: Response latencies for modally salient beliefs for physically activity outcomes were compared with latencies for non-salient, hygiene outcomes. Possible relationships between self-report and response latency was assessed between- and within-subjects. METHOD: Regularly active participants (N=148) completed a computer-based response latency task in which they indicated whether an outcome, for example more fit, was a likely or unlikely consequence of six different physical activities, for example go running. Self-reports of the likelihood of these outcomes, their importance, intentions to participate in the physical activities and frequency of participation were obtained. RESULTS: As expected, the physical activity outcomes were more accessible than control outcomes. In addition, the outcome strong heart was less accessible than the outcomes more fit and have fun. There was only weak evidence, however, of any relationship between self-reports and the accessibility of the physical activity outcomes. CONCLUSION: Response latency data may represent a source of between-subject variation that differs from self-report. Discussion focuses on the possible origins of such a discrepancy.

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.

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.

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.