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Physical Activity: Point-of-Decision Prompts to Encourage Use of Stairs


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 11 studies (search period 1980 - 2005).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity. This review updates and replaces the previous CPSTF finding on point-of-decision prompts to increase physical activity.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 1.59 MB].

Eleven studies were included in the systematic review of point-of-decision prompts.

  • In 10 of the 11 included studies more people used the stairs when point-of-decision prompts were posted.
    • Stair use during the intervention period ranged from 4.0% to 41.9% of potential users.
  • Stair use increased by a median 2.4 percentage points, a relative increase of 50% (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 intervention effectiveness.

Two studies qualified for the systematic review of point-of-decision prompts 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 increased stair use by 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 increased stair use by 39.6% (percent of people using stairs at baseline: 11.1%).

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.


This intervention approach should be effective across diverse settings and population groups as long as care is taken to adapt the messages for each setting or population.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What effect does varying the message or format of the prompt have on boosting stair use among the targeted population?
  • What type of prompt is most effective? What effect does format or size have, if any?
  • Is there a "critical distance" from the elevator or escalator to the stairs, in which the effect of signage on stair use is reduced?
  • Are there a minimum or maximum number of flights that stair users must walk in order for the prompt to be effective?
  • How many individuals read the point-of-decision prompt and react (i.e., increase their use of the stairs) as a result, as opposed to reacting to other knowledge that the intervention is occurring?
  • What strategies can be used to maintain the intervention effect after the intervention ends? Are periodic “boosters” necessary or helpful?
  • Are there significant differences in effectiveness based on the level or scale of an intervention?
  • How do interventions affect various population subgroups, such as age, gender, race, or ethnicity?
  • Are there any key harms?
  • What is the cost-effectiveness of these interventions?
  • How can effectiveness in terms of health outcomes or quality-adjusted health outcomes be better measured, estimated, or modeled?
  • How can the cost benefit of these programs be estimated?
  • How do specific characteristics contribute to economic efficiency?
  • What are the physical or structural (environmental) barriers to implementing these interventions?
  • What resource (time and money) constraints prevent or hinder the implementation of these interventions?

Study Characteristics

  • Point-of-decision prompts were evaluated in a range of settings including shopping malls, train and bus stations, airports, an office building, a bank, a healthcare facility, a medical school, a university, and a university library.
  • Studies were conducted in the United States (7 studies), the United Kingdom (2 studies), Scotland (1 study), and Australia (1 study).
  • Signs and banners of varying designs were used as the point-of-decision prompts.
  • Messages addressed health benefits, health promotion, and weight control.
  • Signs (in Spanish and English) used individual and family perspectives to specifically target Hispanic communities.
  • Program duration varied, with a maximum observation period of 12 weeks.
  • All of the included studies used time–series designs and measured stair use in adult populations.
  • While only four studies specified that workers were included among those observed, it is likely that workers were present in all places included in this review.
  • Six studies (13 study arms) measured effectiveness separately among men and women and found that point-of-decision prompts had similar effects for both groups.
  • Four studies (8 eight study arms) measured effectiveness for whites and African Americans and found no difference between racial groups.