Prompting Increases in Stair Climbing at Work to Target Weight Control

Lead Research Organisation: University of Birmingham
Department Name: Sport, Exercise & Rehabilitation Science

Abstract

Obesity is a major problem facing society, with increased exercise on approach to the issue. In the UK, only 40% of men and 28% of women meet the minimum amount of exercise suggested by the Chief Medical Officer. One simple answer to this problem may be increased stair climbing at work. Few people think of stair climbing as exercise but it actually burns more calories per minute than jogging. Increased stair climbing can reduce both the risks of heart disease and weight. Most adults spend half their waking life at work and regular stair climbing could help combat the rise in obesity.

Recent research by the team has produced a 50% increase in stair climbing in one workplace, a major advance as the previous best was a 5% increase. Instead of simply encouraging people to stay healthy, we converted the science behind stair climbing into lay terms. For example, an average man going upstairs in his house an extra ten times every day for a year expends energy equivalent to three pounds of fat. We place signs at the choice point between stairs and lifts outlining the benefits that stair climbing brings. Two recent studies by the team have produced greater increases in stair climbing in overweight individuals. This project will explore the best way to promote stair climbing. First, we will compare the merits of different types of messages. For this, we will interview people at their place of work and then test the different messages in workplaces. Second we will investigate new ways of delivering this message so that people continue to respond to it. Typically people get used to health advice and the messages lose their impact. The project will test whether changing the message regularly can reverse any decline in response. All the studies set out to encourage working people to be more active.

Recent estimates put the annual cost of obesity in England at about #4.2 billion to the NHS and weight problems at around #16 billion to the overall economy. Obesity is bad for our health and the nation?s wealth. When rolled out nationally, the cost of stair climbing campaigns for a five storey workplace would be about #25, which equates to 5p an employee for a workforce of 500. This cost-effective approach to exercise promotion could make a significant difference to rising levels of obesity and its associated health problems.

Technical Summary

The seminal Harvard Alumni study demonstrated dose-response effects of stair climbing on health, observations subsequently supported by experimental work. Increased stair climbing at work can reduce both cardiovascular risk and weight. To increase stair climbing, messages are positioned at the point-of-choice between the stairs and lift, outlining the health benefits. These prompts function by interrupting habitual behaviour at the point of occurrence allowing its replacement with a health enhancing alternative. Two recently completed interventions recast the science behind stair climbing in lay terms. For the first time, the messages specified the amount of stair climbing required to achieve the benefits. Further, the main campaign message was reinforced by additional messages in the stairwell. This approach produced greater effects in overweight individuals, a finding recently confirmed in a metro station. Stair climbing may be a particularly attractive method of exercise to overweight individuals.

The project will improve further the effectiveness of these simple interventions. Optimal message content will be explored with focus groups followed by product testing in field interviews. For the intervention phase, quasi-experimental interrupted time series designs will be used. For example, a 3-week baseline is followed by an intervention, with a step change at the point of interruption in the time series providing strong evidence of effectiveness. Matched comparison sites can test the relative merits of different interventions whereas workforce details allow estimates of threats to generalisation. Stair and lift use will be monitored with automated counters. For the main messages, a balanced design will compare three different messages in six workplaces. Two further studies of message delivery will assess the effects of changing the message on adaptation of its effects. In the first study, simultaneous presentation of three main messages for 12 weeks will be compared with a matched worksite where a single main message is changed every four weeks. The second study on message delivery will compare simultaneous presentation of six additional stairwell messages with a single stairwell message that changes each week.

Rolled out regionally, these interventions are cheap ? 5p per employee for a 500-strong workforce. Links with Directors of Public Health in Birmingham ensures dissemination to practitioners at a regional and national level. A reciprocal arrangement to share materials with NHS Health Scotland, ongoing consultation with DoH, Catalunya and the PIs membership of the working group on worksite health promotion for the Health Enhancing Physical Activity network (HEPA Europe) ensure wider dissemination.
 
Description Bupa Multi-Country Competition Grant
Amount £359,359 (GBP)
Organisation BUPA 
Department BUPA Foundation
Sector Private
Country United Kingdom
Start 02/2012 
End 01/2015
 
Title Multi-component intervention 
Description Developed a campaign for the stairwell in which each extra floor climbed increased the proportion of calories expended towards daily requirement for PA to avoid weight gain 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2013 
Provided To Others? No  
Impact None to date 
 
Title New theme for stair climbing campaign for worksites 
Description As a result of focus group work, we have developed a new campaign that uses potential fitness effects to encourage stair climbing. Research and evaluation is ongoing. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2013 
Provided To Others? No  
Impact Currently being tested 
 
Description CLIMBs at Work 
Organisation University of Vic
PI Contribution PI on the Grant
Collaborator Contribution Links to Department of Health in Barcelona
Impact none to date
Start Year 2012
 
Description FoodSteps2; Worksite Intervention in the Netherlands 
Organisation Netherlands Organization for Applied Scientific Research (TNO)
Country Netherlands 
Sector Public 
PI Contribution help with design of the interventions and particularly in monitoring of stair and lift behaviour. Data collection is currently ongoing. I will be key to the analyses of these data to include the uncontrolled effects of minute-by-minute pedestrian traffic, building occupancy and time of day.
Collaborator Contribution Involvement in a combined calorific intake and stair climbing project in which hard outcomes (weight, BP) are measured before and after an intervention for stair climbing and calorific intake in a works canteen. New approaches to inervention developed by the research team in Leiden.
Impact none so far
Start Year 2010
 
Description Habit and Active Transport 
Organisation Maastricht University (UM)
Department Faculty of Psychology and Neuroscience
Country Netherlands 
Sector Academic/University 
PI Contribution Ongoing discussion about an EU project for Horizon 2020 and exchange of data
Collaborator Contribution Ongoing discussion and exchange of data
Impact None to date
Start Year 2013
 
Description Habit and Active Transport 
Organisation University College London
Department Division of Psychology & Language Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Ongoing discussion for an EU project for Horizon 2020
Collaborator Contribution Ongoing discussions with expertise from the active house project
Impact None to date
Start Year 2013
 
Description Motivational and Volitional Aspects of Habits 
Organisation Free University of Berlin
Country Germany 
Sector Academic/University 
PI Contribution Invited talk and scoping visit to document the uBahn and SBhan network
Collaborator Contribution Mapping and details of potential stations with stair escalator complexes that were adjacent
Impact n.a.
Start Year 2014
 
Description Research collaboration 
Organisation Cornell University
Department Department of Communication
Country United States 
Sector Academic/University 
PI Contribution Design of research protocol to investigate individual contributors to stair choice within the TPB
Collaborator Contribution Joint design
Impact Had a PhD studentship application in submission but was unsuccessful.
Start Year 2012
 
Description Testing a workplace multi-component intervention to interrupt sitting 
Organisation University of Sheffield
Department School of Health and Related Research (ScHARR)
Country United Kingdom 
Sector Academic/University 
PI Contribution Research and intervention design, particularly for the stair climbing component, and overview of analysis
Collaborator Contribution Ran the pilot investigation
Impact Mackenzie, K. , Goyder, E., & Eves, F.F. (2015) Acceptability and feasibility of a low-cost, theory-based and co-produced intervention to reduce workplace sitting time in desk-based university employees. BMC Public Health, 15:1294. DOI 10.1186/s12889-015-2635-z
Start Year 2015
 
Title New multi-component stair climbing campaign 
Description Incremental calorific expenditure messages for separate floors of a workplace. Extends Lewis & Eves (2011) public access research to the workplace. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Initial development
Year Development Stage Completed 2013
Development Status Actively seeking support
Impact None to date 
 
Title New stair climbing campaign 
Description A stair climbing campaign based on potential fitness effects of stair usage 
Type Therapeutic Intervention - Psychological/Behavioural
Current Stage Of Development Refinement. Non-clinical
Year Development Stage Completed 2013
Development Status Under active development/distribution
Impact Very positively viewed in focus groups 
 
Title Refinement of two previous stair climbing campaigns 
Description Improvements to previously developed heart health and calorific expenditure campaigns 
Type Therapeutic Intervention - Psychological/Behavioural
Current Stage Of Development Refinement. Non-clinical
Year Development Stage Completed 2011
Development Status Under active development/distribution
Impact very positive feedback in focus groups 
 
Description Advice to Health Promotion Department, Nottingham Council 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Advising on design of intervention and monitoring of outcome

none to date as just started
Year(s) Of Engagement Activity 2012
 
Description Business Community 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Industry/Business
Results and Impact An article was published in the Birmingham Chamber of Commerce Magazine about the potential energy saving of increased stair climbing for business

Improved recruitment of potential business to research programme
Year(s) Of Engagement Activity 2011
 
Description Conference Paper on focus group results 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Other audiences
Results and Impact A systematic approach to the development of a point-of-choice prompt intervention to increase stair climbing at work for UKSBM meeting

none to date
Year(s) Of Engagement Activity 2012
 
Description Intervention design for Worcester County Council 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Currently designing the point-of-purchase part of the inetrvention for the work canteen

None to date
Year(s) Of Engagement Activity 2013
 
Description Intervention for Dudley Country Council 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Designed and installed an intervention for the council in their main office

None to date thouhg well received by employees, we were told
Year(s) Of Engagement Activity 2012
 
Description Intervention run for Nottingham Country Council 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Designed and run a multi-component stair climbing intervention in two worksites

None to date
Year(s) Of Engagement Activity 2013
 
Description Panel member 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Type Of Presentation Workshop Facilitator
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Influenced recommendation of Working Group

Recruited to join as member of the Local Government Association
Year(s) Of Engagement Activity 2010
 
Description Recrited to advise Unilever on worksite health promotion 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Advise to the worksite health promotion section

Just started
Year(s) Of Engagement Activity 2012
 
Description Recruited by CDC to advise on stair climbing interventions 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Advice on multi-component stair climbing interventions

Changed design of intervention
Year(s) Of Engagement Activity 2011
 
Description Recruited to advise Behaviour Change unit of Cabinet Office 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Advice on design and content of 'nudge' approaches to health

Recommending my research signage as a the text for verbal nudges
Year(s) Of Engagement Activity 2011