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Stair prompts: evidence and guidance

The use of stair prompts to encourage physical activity is recommended by leading health authorities across the world.

The reasons are simple. First, the evidence-base for stair-prompts is one of the strongest in the area of preventative health and includes a host of high quality trials and several systematic reviews. Second, the health benefits of regular stair climbing are considerable and equally well documented in the scientific literature.

On this page you will find a summary of the evidence base for stair prompts, together with links to the original research. You will also find the results of StepJockey’s own evaluation, plus insights on the behavioural triggers and barriers to staff engagement in workplace wellness.

Use the information on this page in conjunction with our ROI calculator to create a business case for your organisation. 

Who recommends stair prompts?

The following authorities all recommend the use of stair prompts for increasing incidental physical activity in multi-storey buildings:

  • Public Health England - "There is strong evidence for the effectiveness of interventions to increase stair use"..."The strongest evidence for this impact comes from signs placed to encourage stair use".¹
  • National Institute for Health and Care Excellence (NICE) - "Ensure staircases are clearly signposted and are attractive to use²; Put up signs at strategic points … to encourage [staff] to use the stairs rather than lifts".³
  • US Centers for Disease Control and Prevention (CDC) - "Every workplace has an existing physical activity environment waiting to be optimized... changes need not be drastic, and might be as simple as placing signs to encourage stair use".⁴
  • Center for Active Design  - "Research and evaluation studies have overwhelmingly shown that placing motivational signs at points of decision – such as at the base of stairways or at elevator banks – can successfully prompt people to use the stairs".⁵
  • US Community Preventive Services Task Force - "Recommends point-of-decision prompts on the basis of strong evidence of effectiveness in increasing the percentage of people choosing to take the stairs rather than an elevator or escalator".⁶
  • National Public Health Partnership of Australia - "There is good evidence for point of decision prompts for example signage to encourage the use of stairs".⁷
  • Each of the major healthy building certification standards (WELL, Fitwel, LEED).

What are the health benefits of stair climbing?

We have a separate page dedicated to the health benefits of stair climbing but in summary climbing just eight flights of stairs a day is associated with a significantly lower risk of stroke and early mortality.⁸ Stair climbing also:

  • Burns more calories per minute than jogging
  • Reduces the risk of heart disease, diabetes, cancer and osteoporosis
  • Helps control weight, cholesterol and blood pressure
  • Reduces stress, anxiety and feelings of depression
  • Promotes psychological well-being, better cognition and social interaction

Stair climbing is also an accessible and habit forming exercise. It is open to almost everyone and can be easily integrated into the working day, indoors and out. It is for these reasons that it is so often recommended by workplace health professionals.

What is the evidence that stair prompts work?

Stair prompts have a robust evidence base. They have been shown in controled trials to increase stair use from 5% to 128%, with a median relative increase of 50.0%.¹⁰

The first published studies were conducted by Dr Frank Eves a public health psychologist at the University of Birmingham. Of 41 trials his team has tracked, 37 have been successful in increasing stair use.

Individual trials are a powerful form of evidence but systematic reviews, that analyse trial results together, are the gold standard. The first systematic review of stair prompts was conducted by the US Community Preventive Services Task Force (CPSTF) in 2000 and updated in 2010.¹⁰

Published in the peer-reviewed American Journal of Preventive Medicine, it recommended point of decision prompts on basis of "strong evidence of effectiveness in increasing the percentage of people choosing to take the stairs rather than an elevator or escalator". Detailed findings included:

  • In 10 of the 11 studies reviewed stair prompts were effective
  • Stair use was increased by a median relative increase of 50%
  • Stair-prompts were effective in office buildings, shopping malls, train & subway stations, airports, banks and libraries
  • A wide variety of population subgroups were engaged, including men and women, younger, older, obese and non-obese

How long does the impact last?

Stair prompts have a lasting impact. A large scale study on stair prompts was conducted by the New York City Department of Health and Mental Hygiene and published in 2012, also in the American Journal of Preventive Medicine.(9)

This study evaluated the impact of a prompt using the call to action 'Burn calories, not electricity' across different building types over nine months. It found that:

  • Stair prompt worked in different building types, increasing stair use by 20-40%
  • Prompts encouraged both stair ascent and descent even where baseline stair use was high
  • The impact was maintained over full nine month span of the trial

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

How did StepJockey’s trial results compare?

StepJockey ran trials of its prompts in three large office buildings in London and the Hertfordshire ahead of launch in 2013 as part of a UK Department of Health funded evaluation¹¹. More than 250,000 stair and lift journeys were recorded over a six-week period.

As well as the impact on stair use of the prompts alone, the trial tested the impact of 'gamification' - stair climbing challenges - on stair climbing in two sub-groups. The headline results of the trial were as follows:

  • The presence of the prompts alone resulted in significant relative increases in stair usage across all three buildings (p < 0.0001)
  • Upward journeys were more influenced than downward, the highest uplift being 29%
  • Gamification increased stair use 500% over baseline (non-incentivised) and 800% when incentivised with prizes for the winners
  • Those most influenced by the intervention were groups that are often harder to reach:
    • Overweight (BMI > 25)
    • Infrequent takers of physical activity (< 2 x per week)
    • Women
  • There was no evidence of compensatory behavior and 92% of new stair climbers reported stair climbing had become habitual/ingrained

Why do stair prompts work so well?

Stair prompts, like much advertising, borrow from behavioural science which posits that much of what we do is as human is determined by subconscious environmental cues or 'nudges'.

As Eves puts it: "They translate good intentions into action by intervening at the point in time where action can be taken. Thus, point-of-choice prompts circumvent the problems of memory and planning that may prevent translation of good intentions into behaviour".

It follows that the most effective stair prompts are:

  • Eye catching, or in the language of behavioural economics "salient"
  • Positioned at key decision points - by lift call buttons and stair doors
  • Commanding and persuasive, carrying messages that resonate and engage

Another subconscious cue which helps explain the power of stair prompts is the ‘herd’ effect, our tendency to follow others. It means that when a few people starting taking the stairs others start to follow their example. 

How do stair prompts help with engagement?

Unlike most corporate wellness interventions which are hidden on intranet sites or wristbands, stair prompts are visible to all and impact everyone.

Put another way, stair prompts engage the 'whole office' and not just the healthy-minded minority.

This is important because the potential gains to be made in workplace and corporate wellness are almost entirely dependent on organisations engaging those who are often hardest to reach.

A corporate wellness intervention which engages at scale needs a physical presence to provide a constant call to action. 

Why does stair climbing have such broad appeal?

Stair climbing appeals - not just to sporty types - but to the quiet majority; those who shy away from gym and sports-based activities.

Just as the evidence-base shows that visual prompts provide 'reach', it is also clear that for the majority there exist real barriers to becoming more active¹²,¹³. The most frequently reported are:

  • Lack of time
  • Poor physical skills/fitness - "I'm not the sporty type"
  • Self-consciousness

Stair climbing avoids these barriers by providing a powerful physical activity, which:

  • Can be integrated into our lives, saving time rather than eating into it
  • Can be done indoors where we spend up to 90% of our time
  • Does not require any special skills or sporting prowess
  • Does not involve changing/performing in front of others

How does stair climbing save time?

It is on average almost always quicker to take the stairs than wait for a lift or elevator up to about seven floors.

You may have noticed how lift and elevators have evolved to grab your attention. They flash, they ping and their mirrored doors not only draw you in but occupy you with your reflection while you stand waiting for them.

Several studies show that taking the stairs can save workers considerable time in their working day:

  • The IBM Smarter Building survey in 2010 found that office workers in US cities waited for a combined total of 91 years for lifts or elevators¹⁴
  • The same survey calculated that US office workers had spent a cumulative 92 years waiting for lifts or elevators over the previous 12 months and a further 33 years trapped in them when they broke down
  • A study in a Canadian hospital found that staff would save 15 minutes each per day or 3% of their working time by taking the stairs rather than the lift or elevator¹⁵
  • Westmeier-Shuh and colleagues found that university students took twice as long to ascend or descend one floor by elevator compared with stairs (17.4 and 15.8 seconds v. 34.1 and 37.6, respectively)¹⁶

Every building should promote its stairs and StepJockey can help with that. Climbing up stairs builds stronger leg muscles, joints and hearts

Professor Sir Muir Gray, former Chief Knowledge Officer to the NHS
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References

1. PHE. Everybody active, every day What works – the evidence. 2014

2. NICE. Public health guideline: Physical activity and the environment. 2008

3. NICE. NICE. Public health guideline: Physical activity in the workplace. 2008

4. CDC. Healthier Workplaces Initiative. 2010

5. Center For Active Design. Checklist building design. 2013

6.US Community Preventive Services Task Force. Physical Activity: Point-of-Decision Prompts to Encourage Use of Stairs 2005

7. NPHP. Be Active Australia: A Framework for Health Sector Action for Physical Activity. 2005

8. Lee I-M & Paffenbarger RS. Associations of Light, Moderate, and Vigorous Intensity Physical Activity with Longevity; The Harvard Alumni Health Study. American Journal of Epidemiology. 2000

9. Lee et al. Promoting Routine Stair Use Evaluating the Impact of a Stair Prompt Across Buildings American Journal of Preventive Medicine. 2012

10. Soler et al. Point-of-Decision Prompts to Increase Stair Use A Systematic Review Update. American Journal of Preventive Medicine. 2010

11. Monkey See Research Ltd. StepJockey trial results. 2013

12. CDC. Barriers to promoting Physical Activity. 1999

13. Zunft H-J, et al. Perceived benefits and barriers to physical activity in the European Union. Public Health Nutrition. 1999 

14. IBM. Smarter buildings survey. 2010

15. Shah S, et al. Elevators or stairs? CMAJ  2011 

16. Westmeier-Shuh J, et al. Time required for stair and elevator use: implications for a physical activity intervention. Medicine & Science in Sports & Exercise. 2007