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Although the studies have a positive message, there are still some unanswered questions.
  • Dose for health effects: There is some lingering doubt on whether climbing a flight of stairs provides enough activity for health benefits. A letter to the editor by Reisman and Gross, (1999) questioned the assumption that climbing a flight of stairs is enough to provide health benefits.This has been addressed by several authors. Regular climbers would appear to benefit, and even infrequent users, as in a shopping mall, may be adding a useful segment to a daily dose.
  • Population-level prevalence and potential: Another gap is the population-level potential of stair-use interventions. We do not know how many people are in situations where they could benefit from use of the interventions. Research is needed to map out how many people find themselves in settings with a stair-elevator choice and how often the choice is posed.
  • There is no data yet about possible effects on employee morale or productivity that would add appeal for workplace interventions. It seems plausible that the effort by employers to spend money making stairwells more pleasant (evident concern for the employees health and well-being), would improve morale. This needs documentation.
  • There is a need to test more potential messages. Different types of health messages should be studied. The ecological message of saving energy through not using elevators does not appear to have been tested. Combined environmental-health messages seem to have potential.
  • There is little published documentation of costs of different options. More work on costs, and cost-effectiveness, needs to be done
  • There is nothing in the published literature so far on the best means of packaging the intervention to make it easier for many more organizations to adopt. Some research on diffusion of the innovation is warranted given the apparent effectiveness and the recommendation by the US Independent Task Force on Community Preventative Services.
Overall Conclusions
  • Signs and messages encouraging stair use appear to be an effective intervention. They consistently seem to encourage substantial short- and medium-term behavioural change.
  • Although cost-effectiveness studies do not yet exist, messages to promote stair choice appear to be a cost-effective intervention. Costs would seem to be reasonable, although the initial capital costs of modifying stairwells may be substantial
  • Research is still needed on several topics and the results would probably encourage the implementation of this useful intervention
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