A multistage controlled intervention to increase stair climbing at work: effectiveness and process evaluation.

BACKGROUND: Stair climbing helps to accumulate short bouts of physical activity throughout the day as a strategy for attaining recommended physical activity levels. There exists a need for effective long-term stair-climbing interventions that can be transferred to various worksite settings. The aims of this study were: 1) to evaluate short- and long-term effectiveness of a worksite stair-climbing intervention using an objective measurement of stair climbing and a controlled design; and 2) to perform a process evaluation of the intervention. METHODS: We performed a controlled before-and-after study. The study was conducted in two corporate buildings of the same company located in Paris (France), between September, 2013 and September, 2014. The status of either "intervention site" or "control site" was assigned by the investigators. Participants were on-site employees (intervention site: n = 783; control site: n = 545 at baseline). Two one-month intervention phases using signs (intervention phase 1) and enhancement of stairwell aesthetics (intervention phase 2) were performed. The main outcome was the change in stair climbing, measured with automatic counters and expressed in absolute counts/day/100 employees and percent change compared to baseline. Qualitative outcomes were used to describe the intervention process. RESULTS: Stair climbing significantly increased at the intervention site (+18.7%) but decreased at the control site (-13.3%) during the second intervention phase (difference between sites: +4.6 counts/day/100 employees, p < 0.001). After the intervention and over the long term, stair climbing returned to baseline levels at the intervention site, but a significant difference between sites was found (intervention site vs. control site: +2.9 counts/day/100 employees, p < 0.05). Some important facets of the intervention were implemented as intended but other aspects had to be adapted. The main difficulty reported by the company's staff members lay in matching the internal communications rules with critical intervention criteria. The program was maintained at the setting level after the end of the study. CONCLUSIONS: This study shows a successful stair-climbing intervention at the worksite. The main barriers to adoption and implementation were related to location and visibility of posters. Process evaluation was useful in identifying these barriers throughout the study, and in finding appropriate solutions.

Stair-use interventions in worksites and public settings - a systematic review of effectiveness and external validity.

OBJECTIVE: We performed a literature review with the main aims to propose an updated overview of the effectiveness of stair-use interventions and to determine the most effective type of intervention. METHODS: We systematically searched stair-use interventions performed in worksites or public settings, published up to mid 2013. We used a harvest plot approach to visualize the findings in addition to a quantitative synthesis. We also assessed external validity using the Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS: Of 8571 articles identified, 50 were included. In worksites (25 studies) and public settings (35 studies), an increase in stair climbing was found during the intervention period in 64% and 76% of studies, respectively. Combining motivational and directional signs in worksites or conducting a second intervention phase in public settings increased stair climbing in 83% and 86% of studies, respectively. Elements of external validity were overall largely under-reported. CONCLUSION: There is evidence that stair-use interventions are effective to increase stair climbing in public settings, but evidence of such effect is limited in worksites. Issues regarding the best sequencing of interventions or the potential importance of environmental interventions should be addressed in future studies. Process evaluation should be an integral part of interventions.

Early excess weight gain of children in the Pima Indian population.

OBJECTIVE: To determine the period of childhood in which weight relative to height increases in Pima Indian children and young adults in comparison with the general US population. METHODS: Heights and weights of children in the Pima Indian population were derived from either clinical examinations conducted by the Department of Public Health Nursing (from 1-48 months of age), or from examinations in the National Institutes of Health longitudinal survey of health in the Pima population (for birth and ages 5-20 years), and compared with standards for the US population recently published by the National Center for Health Statistics. RESULTS: Weight relative to height (weight-for-length in children aged <24 months, body mass index at ages > or =2 years) was significantly higher in Pima children at all ages examined after the first month of life. Compared with reference values, the most dramatic increases in weight relative to height occurred in 2 stages of childhood: mean z scores of weight-for-length increased between 1 month (mean +/- SEM: males: -0.2 +/- 0.19; females: -0.02 +/- 0.14) and 6 months (males: 0.8 +/- 0.04; females: 0.7 +/- 0.04) of age; mean z scores for body mass index increased gradually between 2 years (males: 0.4 +/- 0.06; females: 0.4 +/- 0.08) and 11 years (males: 1.4 +/- 0.08; females: 1.4 +/- 0.08) and remained stable thereafter. CONCLUSION: Excessive weight gain occurs early in the Pima population with changes relative to reference values most marked in the first 6 months of life and between 2 and 11 years. Interventions toward primary prevention of obesity may need to be targeted at children rather than adults in this population.