Researchers at Bayview Medical Center have found that inexpensive signs can encourage stair use, as reported in the September issue of the Annals of Internal Medicine. Signs promoting the health and weight control benefits of stair use were placed beside escalators with adjacent stairs in a Baltimore area shopping mall. Overall findings demonstrated that stair use increased significantly from 4.8 to 6.9 percent with the health sign (Your Heart Needs Exercise, Use the Stairs) and from 4.8 to 7.2 percent with the sign touting the benefits of using the stairs for weight control (Improve Your Waistline, Use the Stairs).

According to Ross Andersen, principal investigator of the study, the U.S. surgeon general recommends that all Americans should accumulate 30 minutes or more of moderate-intensity physical activity on most or all days of the week. "Stair climbing and walking are two of the best and most practical ways for people to become more active," Andersen said.

The study, which took part in three phases, began with an initial baseline assessment of stair vs. escalator use without signs. In the second phase, the heart health benefits sign was placed on an easel beside the escalator/stairs, and in the third phase the weight control sign replaced the health benefits sign. During this three-month study, the habits of 17,901 shoppers were observed.

Researchers examined trends among shoppers of different ages, races, genders and body weights.

Older people (40 years of age and above) responded better to the signs than the younger age group. While older people more than doubled their stair use with the weight control sign (4.1 to 8.7 percent), the younger group only increased from 4.6 to 6.1 percent. Similar patterns emerged with the heart health sign: Older people went from 5.1 to 8.1 percent, and the younger age group's stair use went from 4.6 to 6 percent.

When shoppers were observed by race, researchers discovered that stair use significantly increased among Caucasians for both the heart health sign (5.1 percent to 7.5 percent) and the weight sign (5.0 to 7.8 percent). Signage made no appreciable difference in the African American population; stair-climbing patterns in response to the weight control sign went from 4.1 to 5.1 percent and actually decreased from 4.1 to 3.4 percent with the heart health sign.

A lack of general response to the signs by African Americans was both surprising and a cause for concern. This tendency was especially disturbing given that almost one in two African American women are now overweight. Even more troubling is the prevalence of hypertension and cardiovascular disease among African Americans.

In the future, researchers at Bayview hope to conduct focus groups within the African American community to develop tailored signs or other interventions that would encourage physical activity.

"It's promising to see that inexpensive signs can encourage shoppers to use the stairs instead of taking the escalator," Andersen said. "Our next challenge is to determine what will motivate a greater percentage of the population."