This pilot assessed the acceptability of a 4-floor stair climb as an interruption to sitting during the working day. The experimental group logged 121 floors.week− 1 of the target of 160 floors. The magnitude of this response to the prompt suggests stair climbing is an acceptable interruption to sitting for employees. Participants chose their own pace and each completed ascent and descent interrupted work for about two minutes. There was preliminary evidence that increased stair use by the experimental group improved some biomarkers of lipid health and fasting blood glucose.
For office workers, 24.2 floors.day− 1 proved acceptable, sufficient for the 25 floors.day− 1, and the later recommendation of over 13 floors.day− 1, to improve aerobic fitness in the original studies . Most employees said it was easy or convenient to climb when prompted and, for some, breaks were reported as helpful to work. Sometimes the prompt interrupted their work and stair use did not always fit within their busy schedules. The latter was the reason why one experimental participant dropped out; frequent meetings elsewhere meant that she could not respond to prompts. Stair use interruptions would only be effective for employees who spend most of their time at the same desk and are unconstrained by long meetings elsewhere. Two participants questioned the sustainability of eight daily climbs, a scepticism we do not share. As outlined in the introduction, prompts work for those with prior intentions to be more active [22, 25, 26]. An employee truly seeking to improve their health may be more persistent than the sceptics think. Stair climbing is a plausible physical activity for most of the population because they already do it as part of their daily life . Most participants joined the study for health reasons; the recruited sample was people living with obesity. A prompting intervention might attract employees intending to increase stair climbing for its benefits. Only a longer-term study with an at-risk sample could answer this question about sustainability.
From an organisational perspective, any programme of interrupted sitting would be low-cost. It would need some support from the building management, in particular the IT department, but little else. Computers are ubiquitous for office staff. We were not allowed to recruit employees in finance as the management were concerned that the prompt might introduce errors by interrupting calculations. Employees with frequent meetings out of their office would miss many of the hourly prompts and may also be unsuited for the intervention. On the plus side, it seems likely that interruptions to the working day that total only 16 minutes would be acceptable to employers seeking to facilitate employees who wish to improve their health.
The current study involved eight ascents.day− 1, with a target of 32 floors daily. There were no changes in the control group, consistent with Boreham et al. [33, 34]. For the experimental group in this pilot, there were significant improvements of TC, TC/HDL-C ratio, LDL-C, and non-HDL-C, termed ‘bad cholesterol’. Six ascents.day− 1 targeting 48 floors in Boreham et al. (2000) improved TC, TC/HDL-C ratio and HDL-C whereas five ascents.day− 1 targeting 40 floors in the group’s 2005 paper improved only LDL-C . The improvements in lipoproteins with a 4-floor climb, eight times.day− 1 appear similar to the 8-floor climbs in Boreham and colleagues’ research. In addition, fasting blood glucose was reduced. Participants here descended the stairs after their climb whereas in Boreham’s studies, an available lift adjacent to the stairs would be the likely means of descent after an 8-floor climb (Boreham, personal communication April, 2021). The preliminary data here suggest that more frequent climbs of a lower height have at least comparable effects to 8-floor climbs. This may be important to acceptability; lower climbs entail a shorter interruption during work and should be acceptable to employees and employers. Similar to the data here, a reduction of LDL-C was found in a 12-week intervention of 21 floors.day− 1 . LDL-C is strongly associated with increased risk of coronary heart disease and reductions of LDL-C would reduce risk .
Fasting blood glucose and 2-h OGTT for both groups were within the healthy range, < 5.6 mmol and < 7.8 mmol respectively . Despite this, fasting blood glucose was reduced by walking up and down stairs at work, as it was at home . Acute glycaemic control post-prandially was improved by walking up and down a single floor of stairs in sedentary, middle-aged men  and Type 2 diabetics [41–44]. The descent component of stair use may be important. Descent improved glycaemic control more than ascent when the behaviours were formally compared in women living with obesity [45, 46]. The eccentric nature of exercise when descending may be an important bonus of an alternating ascent and descent protocol for disease risk . Consistent with this, daily stair usage at home decreased MetS risk even after adjustment for age, sex, socioeconomic position, marital status, smoking, self-reported health and sports participation . The preliminary data here suggest improvements in participants with healthy serum glucose. It seems likely that effects would be greater for diabetic and prediabetic individuals. Nonetheless, a recent alternating ascent and descent protocol at home improved the MetS risk factors of glucose, HDL and triglycerides in healthy females . The preliminary data here need confirmation with a larger sample; Michael and co-workers tested 26 ascending and descending participants .
Costs for treating CVD in the EU and the US were estimated at 8% and 17% of total health care expenditure respectively [48, 49]. For diabetes, a major component of MetS risk, costs were estimated at 10% and 14% for the EU and the US respectively [50, 51]. Minimization of health care costs is a pervasive aim of governments. As outlined in the introduction, Stand Up Victoria replaced sitting at work with standing, with modest reductions in MetS risk and fasting glucose. To achieve this, Healy et al., (2017) installed sit-to-stand work stations ($400 each), had a liaison employee who linked with the team, a lecture to the management and brainstorming for the workplace . Employees attended a workshop followed by 30 minute, 1-to-1 interviews with a health coach who subsequently called each individual. This multi-component research intervention revealed what could be achieved with unlimited resources. Employers, however, think the cost of workplace interventions for population health should be funded by other agencies [52, 53]. Minimized cost is an agenda on which business and health care agree. This prompting intervention is low-cost for both. A scheduler, installed in Microsoft outlook, prompts individuals to use a workplace fixture to reduce disease risk. Brief interruptions to sitting are plausible for most, acceptable to employees and may facilitate work. Employers were willing to host low-cost prompting interventions for stair use but sceptical about their value . As shown here, stair use decreases disease risk . This intervention can deliver stair use prompts directly to at-risk employees, i.e. those likely to respond. Improved health for employees, who also report benefits to work wellbeing, from 16 minutes of climbing.day− 1 offers a low-cost option which corporate workplace health might find attractive.
Stair use was not measured directly but instead recorded on a log sheet by the computer. Electronic tagging could remove this uncertainty about the dosage of the intervention. Evidence of reduced disease risk, even in this pilot sample, clearly demonstrates that increased stair use did occur. The amount of stair use needs to be recorded directly in any full-scale trial.
While there were reductions in fasting glucose, there were no improvements in the MetS risk markers of HDL-C or TG in this pilot. Triglycerides were reduced in only one of five previous studies, the one with the largest sample [32, 34, 37, 42, 54]. For HDL-C, the pilot sample was 50% smaller than Boreham et al., (2000) . Nonetheless, lower levels of HDL-C at baseline would have allowed an increase [c.f. Boreham et al., (2000) vs. Table 2]. Lack of effects on HDL-C might reflect variability in lipid concentrations as samples were collected within 24–48 hours of the last stair climbing day; a 72 hour gap would have been preferable . Alternatively, lipoproteins are affected by the meal consumed on the evening prior to the test. Any variation in the evening meals prior to the initial and post-intervention sessions would add noise to the data. In a much larger sample with a standardised evening meal and blood taken at least 72 hours following exercise, large effects on HDL-C and TG were found . We expect the earlier result to replicate in any suitably designed follow-up of this prompting intervention.