Intended for healthcare professionals


Health promotion by encouraged use of stairs

BMJ 1995; 311 doi: (Published 29 July 1995) Cite this as: BMJ 1995;311:289
  1. Avril Blamey, health promotion officera,
  2. Nanette Mutrie, senior lecturerb,
  3. Aitchison Tom, senior lecturerc
  1. aGreater Glasgow Health Board, Glasgow G2 4JT
  2. b Institute of Biomedical and Life Sciences, University of Glasgow
  3. cDepartment of Statistics, University of Glasgow
  1. Correspondence to: Ms Blamey
  • Accepted 13 May 1995

The national fitness survey for England concluded: “the high prevalence of physical inactivity suggests that it may be even more important for public health than attention to cholesterol, arterial blood pressure or smoking.”1 The prevalence and risk of inactivity in the United States led the American College of Sports Medicine to issue guidelines suggesting that sedentary adults should have at least 30 minutes of accumulated moderate physical activity on most days of the week.2 To achieve this target the members of the public should be encouraged to add activity into their daily routine at every opportunity.

This study investigated whether Scottish commuters or shoppers would respond to an intervention consisting of motivational signs encouraging them to walk up stairs rather than take an escalator.

Subjects, methods, and results

Signs saying “Stay Healthy, Save Time, Use the Stairs” were placed in a city centre underground station where stairs (two flights of 15 steps) and escalators were adjacent. Observers recorded the number of men and women using the escalators and stairs on Mondays, Wednesdays, and Fridays between 8.30 am and 10 am over a period of 16 weeks. Subjects carrying luggage or with pushchairs were excluded. Observations were made over one week before the signs were put up (baseline), over three weeks when the sign was present, over two weeks immediately after the sign was removed, and during the fourth and 12th week after the posters were removed. Subjects faced a binomial choice—that is, whether or not to use the stairs. A stepwise logistic regression was fitted with this choice as a response variable and the sex of the subject, the week of the study, and their interactions as potential explanatory factors.3 Simultaneous 95% confidence intervals were calculated to compare the percentage stair use at baseline with that during each of the seven subsequent observation weeks. This was achieved using a Bonferroni multiple comparisons procedure for men and women separately.3


Pattern of stair use among men and women during study. Values are weekly sample percentages with 95% confidence intervals

A total of 22275 observations were made. Overall stair use at baseline was around 8%. This increased to the order of 15%-17% during the three weeks when the sign was present. The figure shows that pattern of stair use for men and women during the campaign. Stair use by both men and women remained significantly higher than baseline values during the three intervention weeks. The motivational sign signficantly increased the percentage of men using the stairs from 12% at baseline to 21% throughout the duration of the intervention. The corresponding figures for women were 5% to 12%. Stair use decreased during the two weeks after the sign was removed. Twelve weeks after removal of the posters stair use remained significantly (P=0.01) higher than at baseline. There was, however, a downward trend suggesting a possible eventual return to baseline values.

The stepwise logistic regression showed a main effect for sex (F=224 v F (1,(infinity)); P<0.0001), as well as week of study (F=22 v (F (7,(infinity)); P<0.0001). Women were more likely to use escalators than men at all times. The interaction between sex and week of study (F=2.5 v F (7,(infinity)); P=0.015) and the day of the week (F=3.2 v F (2,(infinity)); P=0.04) were also significant.


The motivational sign positively influenced stair use in a safe and well lit venue. The improvement in stair use was slightly greater than that found in a similar American study.4 Use of stairs can make an important contribution to an accumulated daily activity programme and is specifically mentioned in the guidelines of the American College of Sports Medicine.2 Further study is required to establish whether sedentary people or those who are already active respond to these cues.

The Health Education Board for Scotland has distributed motivational stair walking posters throughout Scottish workplaces.

We thank Strathclyde Passenger Transport Executive and its staff for accommodating the study. We thank Ian Brown, who coordinated the observer's work, and Roy Leckie, who completed additional analysis, both as part of their undergraduate projects. We also thank the observers.


  • Funding Health Education Board for Scotland.

  • Conflict of interest None.


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