Stair Use: A workplace intervention to promote physical activity

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Stair Use A workplace intervention to promote
physical activity Dr Holly Blake
Lecturer/Chartered Health Psychologist School of
Nursing, University of Nottingham On behalf of
the Q-Active Project Team
A Q-Active Study
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Overview

• The Q-Active Team
• What is Q-Active?
• How does the stair use study fit in?
• How will this initiative be scientifically
  evaluated?

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The Q-Active Team

• An alliance between QMC, Sport England and the
  University of Nottingham
• Dr Sandra Lee, Active Workforce Project Manager,
  QMC
• Prof Mark Batt, Centre for Sports Medicine, QMC
• Mrs Pauline Hodgson, Human Resources, QMC
• Ms Isobel Schofield, Finance Department, QMC
• Mrs Ilana Freestone, Sport England
• Dr Holly Blake, School of Nursing, University of
  Nottingham

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The Q-Active Project

• Primary aim
• To change the health culture of QMC to encourage
  increased physical activity and healthy
  behaviours amongst staff
• Secondary aims
• To produce a cost-saving to QMC in terms of
• reduced lost days due to sickness absences
• Increased productivity
• To improve staff physical health, psychological
  wellbeing and job satisfaction
• To improve the perception of the organisation in
  the local community and amongst staff

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How will we achieve this?

• To improve current staff physical activity
  facilities
• and provide more opportunities to be physically
  active at work
• To significantly increase physical activity
  levels of QMC staff
• To improve the nutrition facilities for QMC staff
  
• To significantly improve nutritional intake of
  staff whilst at work
• To provide facilities for staff to unwind,
  socially interact, take breaks and to enhance
  their psychological wellbeing at work
• To reduce stress/improve wellbeing in QMC staff
• To develop Trust health policies
• To affect the health culture of QMC management

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Providing opportunities to be physically active

• Stair Use A workplace intervention to promote
  physical activity
• The goal of this intervention is
• to make taking the stairs the norm and not the
  exception by presenting stair climbing in a new
  way
• To meet the objectives of the Q-Active project in
  providing an ecological environmental
  intervention to increase physical activity and
  change the health culture of staff at QMC

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Why be more physically active?

• Physiological benefits of exercise
• can favourably alter important cardiovascular
  risk factors in previously sedentary individuals
• (Boreham et al, 2005)
• increases in daily energy requirements
• (Bunyard et al., 1998)
• reductions in body fat
• (Bunyard et al., 1998 Cox et al., 2001)
• decreased resting heart rate
• (Cox et al., 2001 Kobayashi et al, 2001)
• increased flexibility
• (Adams, 2001)
• reduced blood pressure
• (Cox et al., 2001 Moreau et al., 2001).
• helps to control changes associated with midlife
  and menopause
• including depression, weight gain, loss of muscle
  mass and bone density and risk of heart disease
• (McAuley Rudolph, 1995 Shangold Sherman,
  1998).

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Why be more physically active?

• Psychosocial benefits of exercise
• increased self-efficacy towards exercise
• (Adams, 2001 McAuley et al, 1995)
• reduced physique anxiety
• (McAuley et al., 1995 Sorensen et al, 1997)
• decreased symptoms of depression
• (Moore et al., 1999)
• positively influence quality of life
• (Shepherd, 1995)
• Improved social well-being
• (Biddle and Mutrie, 2001).

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Why the stairs?

• BENEFITS TO EMPLOYEES
• Activities like stair climbing can significantly
  contribute to the 30 minutes of physical activity
  we all need everyday, plus
• Stair climbing is easy to do in most workplaces
• Moderate intensity lifestyle activities like
  taking the stairs may be more successfully
  promoted than structured vigorous intensity
  exercise

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More benefits to employees

• Cardiovascular disease and death lower amongst
  regular stair users
• Two flights of stairs climbed per day can lead to
  2.7 kg weight loss over one year and using the
  stairs burns twice as many calories as walking
• Taking the stairs is often the quickest way to a
  destination especially at peak times

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Benefits to the EmployerQMC NHS Trust

• People spend more than one-half of their waking
  lives at work.
• In order to stay healthy we need to find ways to
  incorporate physical activity into our workday
• Active employees are healthier and more
  productive employees
• Physical activities like stair climbing are a
  great way for employee to cope with job-related
  stress.

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More benefits to the employer

• Economically viable
• Stair climbing is less costly and more accessible
  than other employee wellness programs
• Effective
• Stair climbing interventions typically result in
  a 6-15 increase in stair use
• Results
• Workplaces which implement stairway physical
  activity programs report improved employee
  relations, camaraderie and teamwork.

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Furthermore

• No health inequalities
• Using the stairs requires no special skill,
  equipment or clothing
• Good for the environment!
• Stair climbing is a 'green' activity, the only
  energy source used is what is stored in our
  bodies.... good for you and the environment!

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Stair use as incidental activity

• focus is now upon the accumulation of physical
  activity during the course of a day
• (Jakicic and Wing, 1995).
• Accumulating activity in this way may result in
  attaining the adequate level of energy
  expenditure across the course of a day
• (Dunn et al, 1998).
• focusing on incidental activities may help to
  target less active individuals.
• Incidental activities such as stair climbing and
  walking are easy ways to increase activity levels
  by accumulating activity throughout the day

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Research Design Scientific Evaluation

• a mixed-methods study incorporating
• an observational study with a time-series design
• a questionnaire study of self-reported stair use
• a qualitative study using staff focus groups
• Data will be collected at baseline, intervention
  and follow-up

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Setting

• Queens Medical Centre NHS Trust (QMC)
• Participants all QMC Trust employees
• Observational data will be collected on staff and
  members of the general public (incl.
  patients/visitors) during each phase of the
  study.
• Self-report questionnaire data will be collected
  from staff working on floors C-F of the Queens
  Medical Centre building.
• Focus groups will be run with a representative
  group of staff working on various floors at QMC
  from various occupational backgrounds

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Intervention

• The environmental intervention will consist of
  appropriately placed signs (point of decision
  prompts) conveying health messages
• eg step up to better health
• possible Q-Active button at lifts

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Phases of study

• Following a two-week set-up period, data
  collection will occur in phases as below
• Baseline (weeks 3-4) Two weeks
• Intervention 1st phase (weeks 5-6) Two weeks
• No intervention control phase one (weeks 7-8)
  Two weeks
• Intervention 2nd phase (weeks 9-10) Two weeks
• No intervention control phase two (weeks 11-12)
  Two weeks

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Procedures

• Observational Measures
• Counts of stair use during a 24-hr period on each
  day during each phase of the study
• Using thermal camera proximity sensors which will
  assess direction of stair walking in a
  non-obtrusive and accurate way
• Questionnaire data
• Self-report questionnaire about stair use will be
  sent to staff working on floors C-F at baseline
  (week 3) and following first phase intervention
  (week 6)
• This data will allow us to further determine
  stair use amongst staff (as QMC is a public
  building and so observation will include many
  non-staff individuals).

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Procedures

• Focus Groups
• Staff focus groups will be run at baseline
  (during week 3-4) to explore existing staff
  attitudes towards physical activity and stair
  climbing as a method of increasing physical
  activity.
• We can determine from this
• How active are staff at QMC already?
• Do they most frequently use stairs or lifts?
• At the second phase of focus groups (during week
  13-14) we will be able to determine
• How active are staff at QMC following
  intervention?
• Do they now most frequently use stairs or lifts?
• How effective/influential did they find the
  prompts?

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A great plan! And scientifically valid

• The proposed study is one of a number of
  evaluations that are planned for Q-Active
• It will be the first mixed-methods study of its
  kind with the potential for long term follow-up
• It is vital that this important study is
  scientifically evaluated in order to provide firm
  evidence to influence policy and practice
• Results will contribute to Trust policy on
  physical activity and health

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Summary

• We need to increase physical activity in the
  population for a variety of health reasons
• The workplace is a good setting to target large
  numbers
• Healthcare settings need to set the example for
  workplace interventions for health
• By increasing stair use at QMC (added to other
  Q-Active interventions) we aim to do this
• We need immediate funding! Any ideas?