Point-of-decision prompts for physical activity

Point-of-decision prompts are motivational signs placed on or near stairwells, elevators, and escalators to encourage individuals to use stairs. Point-of-decision prompts can be implemented in workplaces or in public venues such as train, subway, and bus stations, airports, shopping malls, banks, and libraries. Point-of-decision prompts can be implemented alone or in combination with stairwell enhancements such as music, art, signs, carpet, paint, or lighting upgrades (CG-Physical activity).

Expected Beneficial Outcomes (Rated)

  • Increased physical activity

Evidence of Effectiveness

There is strong evidence that point-of-decision prompts increase stair use and physical activity levels (CG-Physical activity, Brownson 2006*, Soler 2010, Sax-Bellew 2008, Nocon 2010*), especially when implemented in public venues (Bellicha 2015*).

Point-of-decision prompts are effective in a range of settings among a variety of population subgroups (CG-Physical activity); the largest effects have been shown for individuals who are obese (Brownson 2006*). Point-of-decision prompts have greater effects on stair climbing in worksites when motivational signs are supplemented with directional signs (Bellicha 2015*). For example, one worksite study suggests directional footprints may be more effective at increasing stair use than posters in part because employees find footprints more noticeable (Van der Meiden 2019*). Several workplace supports including stair prompts and signs or maps of nearby walking routes are significantly associated with employees’ meeting CDC recommendations for physical activity while performing work-related tasks and during work travel (Hipp 2017a). Point-of-decision prompts in airports that include information about the distance and time needed to walk between concourses can increase the number of passengers who choose to walk instead of ride trains (Fulton 2017).

Point-of-decision prompts increase stair use in escalator settings (Bellettiere 2019; Nocon 2010*), but may be less effective in elevator settings (Nocon 2010*). Customizing prompts to appeal to specific populations or to describe specific benefits may increase their effectiveness (CG-Physical activity). In a worksite-based study, point-of-decision signs with specific messages (e.g., “Walking up stairs burns almost 5 times more calories than riding an elevator”) had greater effects on stair use than signs with more general messages (e.g., “Burn calories. Get healthy.”) (Eckhardt 2015*). Improving the aesthetics of existing stairwells or the visibility and accessibility of stairwells in new buildings along with point-of-decision prompts can also increase physical activity (Nicoll 2009).

Oral point-of-decision prompts during conference proceedings can also increase the number of participants choosing to stand rather than sit through presentations (Lang 2015*).

Impact on Disparities

No impact on disparities likely

Implementation Examples

States can support the placement of point-of-decision prompts in workplaces and public venues. For example, in Texas, a collaboration between state agencies and partners supports a point-of-decision prompt and stairwell enhancement initiative, based on the former CDC StairWELL to Better Health program in Atlanta, Georgia (ASTHO-Texas POD prompts 2013).

In New York City, the Department of Health and Mental Hygiene supported point-of-decision prompt efforts around the city, printing and distributing approximately 30,000 point-of-decision signs to encourage stair use (CFAD-Stair prompts).

Implementation Resources

HPBD - Healthy Places by Design (HPBD). Advances community-led action and proven, place-based strategies to ensure health and wellbeing for all.

NDC-Play 60 signs - National Dairy Council (NDC), National Football League (NFL). Fuel up to play 60: Last season's playbook.

CDC-Prompts for physical activity - Centers for Disease Control and Prevention (CDC). Physical activity: StairWELL to better health.

Montclair DHHS-Take the stairs toolkit - Montclair Department of Health & Human Services (DHHS), Partners for Health. Take the stairs: A worksite wellness activity toolkit.

HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs.

Citations - Evidence

* Journal subscription may be required for access.

CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.

Brownson 2006* - Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health. 2006;27:341–70.

Soler 2010 - Soler RE, Leeks KD, Buchanan LR, Brownson RC, Heath GW, Hopkins DH. Point-of-decision prompts to increase stair use: A systematic review update. American Journal of Preventive Medicine. 2010; 38(2 Suppl):S292-300.

Sax-Bellew 2008 - Bellew B. Primary prevention of chronic disease in Australia through interventions in the workplace setting: A rapid review. Haymarket, NSW: The Sax Institute; 2008.

Nocon 2010* - Nocon M, Muller-Riemenschneider F, Nitzschke K, Willich SN. Increasing physical activity with point-of-choice prompts: A systematic review. Scandinavian Journal of Public Health. 2010;38(6):633-8.

Bellicha 2015* - Bellicha A, Kieusseian A, Fontvieille AM, et al. Stair-use interventions in worksites and public settings: A systematic review of effectiveness and external validity. Preventive Medicine. 2015;70:3-13.

Van der Meiden 2019* - Van der Meiden I, Kok H, Van der Velde G. Nudging physical activity in offices. Journal of Facilities Management. 2019;17(4):317-330.

Hipp 2017a - Hipp JA, Dodson EA, Lee JA, et al. Mixed methods analysis of eighteen worksite policies, programs, and environments for physical activity. International Journal of Behavioral Nutrition and Physical Activity. 2017;14(79):1-10.

Fulton 2017 - Fulton JE, Frederick GM, Paul P, et al. Increasing walking in the Hartsfield-Jackson Atlanta International Airport: The walk to fly study. American Journal of Public Health. 2017;107(7):1143-1149.

Bellettiere 2019 - Bellettiere J, Liles S, Benporat Y, et al. And she’s buying a stairway to health: Signs and participant factors influencing stair ascent at a public airport. Journal of Primary Prevention. 2018;38(6):597-611.

Eckhardt 2015* - Eckhardt MR, Kerr J, Taylor WC. Point-of-decision signs and stair use in a university worksite setting: General versus specific messages. American Journal of Health Promotion. 2015;29(5):291-293.

Nicoll 2009 - Nicoll G, Zimring C. Effect of innovative building design on physical activity. Journal of Public Health Policy. 2009;30(Suppl 1):S111-23.

Lang 2015* - Lang JJ, McNeil J, Tremblay MS, Saunders TJ. Sit less, stand more: A randomized point-of-decision prompt intervention to reduce sedentary time. Preventive Medicine. 2015;73:67-69.

Citations - Implementation Examples

* Journal subscription may be required for access.

ASTHO-Texas POD prompts 2013 - Association of State and Territorial Health Officials (ASTHO). Evidence based public health case study: Texas implements point-of-decision (POD) stairwell prompts to increase employee physical activity. 2013.

CFAD-Stair prompts - Center for Active Design (CFAD), New York City Department of Health and Mental Hygiene. Stair prompt signage.

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