CDC COMMUNITY GUIDE: Environmental and Policy Approaches to Increase Physical Activity: Point-of-Decision Prompts to Encourage Use of Stairs

Point-of-decision prompts are motivational signs placed in or near stairwells or at the base of elevators and escalators to encourage individuals to increase stair use. These signs:
• Inform people about health or weight loss benefits from taking the stairs, and/or
• Remind people already predisposed to becoming more active, for health or other reasons, about an opportunity at hand to do so.

Interventions evaluated in this category involved prompts used alone or in combination with stairwell enhancements (e.g., music in stairwells) to increase stair use.

The 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. There were not enough studies to determine if stair or stairwell enhancements (e.g., paint, carpet, art, signs, and music) increased the effectiveness of these interventions.

Results from the Systematic Reviews:
Eleven studies qualified for the review of point-of-decision prompts when used alone.

In 10 of the 11 studies reviewed more people used the stairs when point-of-decision prompts were posted.
• Stair use during the intervention period in these study arms ranged from 4.0% to 41.9% of potential users.
• Stair use increased by a median 2.4%, a relative increase of 50% (interquartile interval: 0.83% to 6.7%; 21 study arms).
• Findings from several of the studies suggest that tailoring the prompts to describe specific benefits or to appeal to specific populations may increase the intervention's effectiveness.
• This intervention was shown to be effective in a range of settings, including shopping malls, train, subway, and bus stations, airports, banks, office buildings, and university libraries, and in a variety of population subgroups, including men and women, younger, older, obese and non-obese people, and among various racial/ethnic subgroups.

Only two studies qualified for the review of use of point-of-decision prompts when used with stair or stairwell enhancements, and both were conducted in office buildings.
• In one study, all interventions (paint, carpet, art, signs, and music) together led to a relative increase in stair use of 8.8% (baseline use 2.14 mean trips per day per occupant).
• In the other study, use of point-of-decision prompts with artwork and music resulted in a 39.6% relative increase in stair use (percent of people using stairs at baseline: 11.1%).