IJE Advance Access originally published online on September 19, 2006
International Journal of Epidemiology 2006 35(5):1291; doi:10.1093/ije/dyl205
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Commentary |
Commentary: Stairway to health
Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Suite 1B:84, Baltimore, MD 21224, USA. E-mail: andersen{at}jhmi.edu
This paper1 contributes to the expanding body of work examining point of decision making and physical activity promotion. Consistent with the current public health recommendations for physical activity, individuals should be encouraged to ‘accumulate’ physical activity throughout the day.2 Accumulating short bouts of activity throughout the day (Lifestyle Activity) may lead to the accrual of suggested levels of energy expenditure.3,4 Lifestyle activity has been shown to enhance fitness, improve cardiovascular risk profiles, and help with weight management.4–6 One opportunity for accumulating appropriate levels of physical activity, is to encourage stair use in lieu of riding escalators, moving walkways, or elevators.
In his classic paper Brownell et al.7 showed that a sign placed between stairs and an escalator could successfully encourage commuters to walk up the stairs instead of riding the escalator in an urban subway station. Since then, there have been several other studies, which have found that signs could be used to promote stair use in malls,8 health care facilties,9 campuses,10and worksites.11
In the investigation presented in this issue of the Journal,1 there was no effect of the intervention on stair climbing and baseline rates (0.4%) were much lower than previous studies in Western populations (5.4%). However, a small increase in walking up the travelator, which was restricted to the Asian population (OR = 1.12), confirmed that the intervention materials could alter behaviour. This intervention showed that a Chinese sign could promote climbing in the Asian population but not in non-Asians. This confirms that a ‘one size fits all’ sign will not effectively encourage increased stair use in all populations when used in public areas.7,8 These data also demonstrate the importance of culturally tailored messages in promoting healthy behaviours. To be effective, health promotion materials must address the needs of the audience that they were intended to reach. Those messages that are made relevant will be more effective than those that are not.12
We found that a generic sign encouraging stair climbing for health reasons with a cartoon character was effective in increasing stair use for Caucasian shoppers but not for African Americans.8 In a follow-up study, we conducted several focus groups with African American men and women to help us design a sign to promote stair use among African American commuters. Members of these focus groups helped us create a ‘culturally appropriate’ sign, which featured a fit African American woman climbing the stairs with the message ‘No time for exercise? Try the Stairs!’. This new sign led to significant increases in stair use among overweight and non-overweight, African American men and women in an urban setting.13
Baseline rates of stair climbing were alarmingly low in this population as well. Strategies are clearly needed to promote increases in incidental activity among those who ride the travelator. Sedentarism has become a serious health threat in most industrialized countries around the world. Appropriate posters placed at a point of choice may lead to small changes in stair use, which magnified over time could lead to overall health benefits for the population. In addition, health messages such as this may raise awareness about the importance of regular activity in those who may not be ready to increase their activity at this time.
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1 Eves FF, Masters RSW. An uphill struggle: Effects of a point-of-choice stair climbing intervention in a non-English speaking population. Int J Epidemiol 2006;35:1286–1290.
2 U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
3 Dunn AL, Andersen RE, Jakicic JM. Lifestyle physical activity interventions: history, short- and long-term effects, and recommendations. Am J Prev Med 1998;15:398–412.[CrossRef][Web of Science][Medline]
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8 Andersen RE, Franckowiak SC, Snyder J, Bartlett SJ, Fontaine KR. Can inexpensive signs encourage the use of stairs? Results from a community intervention. Ann Intern Med 1998;129:363–69.
9 Marshall AL, Bauman AE, Patch C, Wilson J, Chen J. Can motivational signs prompt increases in incidental physical activity in an Australian health-care facility. Health Educ Res 2002;17:743–49.
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11 Kerr J, Eves F, Carroll D. Can posters prompt stair use in a worksite environment? J Occup Health 2001;43:205–07.
12 Strecher VJ. Computer-tailored smoking cessation materials: a review and discussion. Patient Educ Couns 1999;36:107–17.[CrossRef][Web of Science][Medline]
13 Andersen RE, Franckowiak SC, Zuzak KB, Cummings ES, Bartlett SJ, Crespo CJ. Effects of a culturally sensitive sign on the use of stairs in African American commuters. Soz Praventiv Med in Press.
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