ReviewStair-use interventions in worksites and public settings - A systematic review of effectiveness and external validity

•Interventions increased stair climbing in public settings in 3/4 of studies.•In worksites, such effect was observed in 2/3 of studies.•Motivational and directional signs appear to be more effective than motivational signs only.•Performing a second intervention phase maintains over time an increase in stair use.•The elements describing external validity were underreported in included studies.

ObjectiveWe 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.MethodsWe 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.ResultsOf 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.ConclusionThere 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.