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.

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.

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.

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.

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.

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.

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.

Targeting Postprandial Hyperglycemia With Physical Activity May Reduce Cardiovascular Disease Risk. But What Should We Do, and When Is the Right Time to Move?

Physical inactivity and excessive postprandial hyperglycemia are two major independent risk factors for type 2 diabetes and cardiovascular-related mortality. Current health policy guidelines recommend at least 150 min of physical activity per week coupled with reduced daily sedentary behavior by interrupting prolonged sitting with bouts of light activity every 30-min. This evidence-based strategy promotes health and quality of life. Since modern lifestyle enforces physical inactivity through motorized transportation and seated office working environments, this review examines the practical strategies (standing, walking, stair climbing, and strength-based circuit exercises) for reducing sitting time and increasing activity during the workday. Furthermore, since postprandial hyperglycemia poses the greatest relative risk for developing type 2 diabetes and its cardiovascular complications, this review examines a novel hypothesis that interrupting sitting time would be best focused on the postprandial period in order to optimize blood glucose control and maximize cardiometabolic health. In doing so, we aim to identify the science gaps which urgently need filling if we are to optimize healthcare policy in this critical area.

Dietary intake is independently associated with the maximal capacity for fat oxidation during exercise.

Background: Substantial interindividual variability exists in the maximal rate of fat oxidation (MFO) during exercise with potential implications for metabolic health. Although the diet can affect the metabolic response to exercise, the contribution of a self-selected diet to the interindividual variability in the MFO requires further clarification.Objective: We sought to identify whether recent, self-selected dietary intake independently predicts the MFO in healthy men and women.Design: The MFO and maximal oxygen uptake ([Formula: see text]O2 max) were determined with the use of indirect calorimetry in 305 healthy volunteers [150 men and 155 women; mean ± SD age: 25 ± 6 y; body mass index (BMI; in kg/m2): 23 ± 2]. Dual-energy X-ray absorptiometry was used to assess body composition with the self-reported physical activity level (SRPAL) and dietary intake determined in the 4 d before exercise testing. To minimize potential confounding with typically observed sex-related differences (e.g., body composition), predictor variables were mean-centered by sex. In the analyses, hierarchical multiple linear regressions were used to quantify each variable's influence on the MFO.Results: The mean absolute MFO was 0.55 ± 0.19 g/min (range: 0.19-1.13 g/min). A total of 44.4% of the interindividual variability in the MFO was explained by the [Formula: see text]O2 max, sex, and SRPAL with dietary carbohydrate (carbohydrate; negative association with the MFO) and fat intake (positive association) associated with an additional 3.2% of the variance. When expressed relative to fat-free mass (FFM), the MFO was 10.8 ± 3.2 mg · kg FFM-1 · min-1 (range: 3.5-20.7 mg · kg FFM-1 · min-1) with 16.6% of the variability explained by the [Formula: see text]O2 max, sex, and SRPAL; dietary carbohydrate and fat intakes together explained an additional 2.6% of the variability. Biological sex was an independent determinant of the MFO with women showing a higher MFO [men: 10.3 ± 3.1 mg · kg FFM-1 · min-1 (3.5-19.9 mg · kg FFM-1 · min-1); women: 11.2 ± 3.3 mg · kg FFM-1 · min-1 (4.6-20.7 mg · kg FFM-1 · min-1); P < 0.05].Conclusion: Considered alongside other robust determinants, dietary carbohydrate and fat intake make modest but independent contributions to the interindividual variability in the capacity to oxidize fat during exercise. This trial was registered at clinicaltrials.gov as NCT02070055.

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.

Carrying a biological "backpack": Quasi-experimental effects of weight status and body fat change on perceived steepness.

The apparent steepness of hills and stairs is overestimated in explicit perception. These overestimations are malleable in that when physiological resources are compromised, apparent steepness is further overestimated. An alternative explanation of these experimental findings attributes them to demand characteristics. This article tests the relationship between estimated steepness and naturally occurring differences in body composition. A quasi-experimental field study revealed more exaggerated reports of staircase steepness in overweight than in healthy-weight participants in a situation where experimental demand would be an implausible explanation for any differences. A longitudinal follow-up study used dual X-ray absorptiometry to objectively measure participants' body composition at the beginning and end of a weight-loss program (N = 52). At baseline, higher levels of body fat were associated with steeper explicit estimates of staircase steepness. At follow-up, changes in body fat were associated with changes in estimated steepness such that a loss of fat mass co-occurred with shallower estimates. Discussion focuses on the malleability of perceived steepness at an individual level and the implication of these findings for the debate surrounding "embodied" models of perception. (PsycINFO Database Record

Promoting Healthy Choices in Workplace Cafeterias: A Qualitative Study.

OBJECTIVES: To develop 3 point-of-choice campaigns to influence food choice in workplace cafeterias. DESIGN: Eight focus groups were conducted to guide campaign development. SETTING: Focus groups were conducted in the workplace. PARTICIPANTS: University employees (n = 36) aged 23-58 years (mean, 33.8 years). PHENOMENON OF INTEREST: To explore ways to prompt changes in behavior. ANALYSIS: Transcripts were analyzed using thematic analysis. RESULTS: This study identified calories and saturated fat as information that would have the greatest influence on food selection. Participants want this information at the time the choice is made. Participants reported limited time to eat at work, so converting nutrient density per 100 g or per serving to per portion consumed from point-of-choice labels was not a priority. Participants said that they have more time to read information in places where they line up for food, so at this point they are more open to persuasive messages. Effective messages urge the reader to take immediate action and explain why they should choose the behavior and how it will help them achieve health. CONCLUSIONS AND IMPLICATIONS: Point-of-choice campaigns were well received, but factors such as cost, time, and availability of healthy food at work may shape choices to a greater extent than nutrition information.

Summarizing slant perception with words and hands; an empirical alternative to correlations in Shaffer, McManama, Swank, Williams & Durgin (2014).

The paper by Shaffer, McManama, Swank, Williams & Durgin (2014) uses correlations between palm-board and verbal estimates of geographical slant to argue against dissociation of the two measures. This paper reports the correlations between the verbal, visual and palm-board measures of geographical slant used by Proffitt and co-workers as a counterpoint to the analyses presented by Shaffer and colleagues. The data are for slant perception of staircases in a station (N=269), a shopping mall (N=229) and a civic square (N=109). In all three studies, modest correlations between the palm-board matches and the verbal reports were obtained. Multiple-regression analyses of potential contributors to verbal reports, however, indicated no unique association between verbal and palm-board measures. Data from three further studies (combined N=528) also show no evidence of any relationship. Shared method variance between visual and palm-board matches could account for the modest association between palm-boards and verbal reports.

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.

When what we need influences what we see: choice of energetic replenishment is linked with perceived steepness.

The apparent steepness of the locomotor challenge presented by hills and staircases is overestimated in explicit awareness. Experimental evidence suggests the visual system may rescale our conscious experience of steepness in line with available energy resources. Skeptics of this "embodied" view argue that such findings reflect experimental demand. This article tested whether perceived steepness was related to resource choices in the built environment. Travelers in a station estimated the slant angle of a 6.45 m staircase (23.4°) either before (N = 302) or after (N = 109) choosing from a selection of consumable items containing differing levels of energetic resources. Participants unknowingly allocated themselves to a quasi-experimental group based on the energetic resources provided by the item they chose. Consistent with a resource based model, individuals that chose items with a greater energy density, or more rapidly available energy, estimated the staircase as steeper than those opting for items that provided less energetic resources.

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.

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.

Does perceived steepness deter stair climbing when an alternative is available?

Perception of hill slant is exaggerated in explicit awareness. Proffitt (Perspectives on Psychological Science 1:110-122, 2006) argued that explicit perception of the slant of a climb allows individuals to plan locomotion in keeping with their available locomotor resources, yet no behavioral evidence supports this contention. Pedestrians in a built environment can often avoid climbing stairs, the man-made equivalent of steep hills, by choosing an adjacent escalator. Stair climbing is avoided more by women, the old, and the overweight than by their comparators. Two studies tested perceived steepness of the stairs as a cue that promotes this avoidance. In the first study, participants estimated the steepness of a staircase in a train station (n = 269). Sex, age, height, and weight were recorded. Women, older individuals, and those who were heavier and shorter reported the staircase as steeper than did their comparison groups. In a follow-up study in a shopping mall, pedestrians were recruited from those who chose the stairs and those who avoided them, with the samples stratified for sex, age, and weight status. Participants (n = 229) estimated the steepness of a life-sized image of the stairs they had just encountered, presented on the wall of a vacant shop in the mall. Pedestrians who avoided stair climbing by choosing the escalator reported the stairs as steeper even when demographic differences were controlled. Perceived steepness may to be a contextual cue that pedestrians use to avoid stair climbing when an alternative is available.

What hands know about objects; taking perception of hills out of context: a response to Durgin (2013).

In a recent paper, we provided independent evidence on the accuracy of 'haptically' measured geographical slant perception (Taylor-Covill & Eves, 2013). Durgin (2013) argues that the devices used in our work, namely the palm-board, and palm-controlled inclinometer (PCI), are not measures of perception. In response, we outline four failures of replication in the laboratory work of Durgin and colleagues on which they base their model of slant perception. We also highlight fundamental differences between the perceptual tasks Durgin and colleagues ask of participants relative to those of Proffitt and colleagues' traditional measures. These subtle differences might help explain how the two groups have arrived at discrepant conclusions.