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.

Summary of Task Force Recommendations & Findings

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.

Task Force Finding

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%).

Find a Research-tested Intervention Program (RTIP) about the use of point-of-decision prompts to increase physical activity (What is an RTIP?).

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity.

Supporting Materials

• Research gaps
• Summary evidence table [PDF - 77KB]
• Included studies
• Search strategy

Publications

Soler RE, Leeks KD, Ramsey Buchanan L, et al. Point-of-decision prompts to increase stair use: a systematic review update. [PDF - 1.59MB] Am J Prev Med 2010;38(2S):292-300.

Task Force on Community Preventive Services. Recommendation for use of point-of-decision prompts to increase stair use in communities. [PDF - 44KB] Am J Prev Med 2010;38(2S):290-291.

Kahn EB, Ramsey LT, Brownson R, et al. The effectiveness of interventions to increase physical activity: a systematic review. [PDF - 3.14MB] Am J Prev Med 2002;22(4S):73-107.

Task Force on Community Preventive Services. Recommendations to increase physical activity in communities. [PDF - 70KB] Am J Prev Med 2002;22 (4S):67-72.

CDC. Increasing physical activity. A report on recommendations of the Task Force on Community Preventive Services. MMWR 2001;50 (RR-18):1-16.

Task Force on Community Preventive Services. Physical activity. [PDF - 302KB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:80-113.

More Community Guide publications about Promoting Physical Activity

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Environmental and policy approaches to physical activity: point-of-decision prompts to encourage use of stairs. www.thecommunityguide.org/pa/environmental-policy/podp.html. Last updated: MM/DD/YYYY.

Original review completed in 2002. Update completed June 2005.