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Point-of-decision prompts for physical activity

Health Factors: Diet & Exercise
Decision Makers: Educators Employers & Businesses Local Government State Government Healthcare Professionals & Advocates Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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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

Increased physical activity

Evidence of Effectiveness

There is strong evidence that point-of-decision prompts increase stair use and physical activity levels (CG-Physical activityBrownson 2006Soler 2010Sax-Bellew 2008Nocon 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). 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 (ALR-Fulton 2015).

Point-of-decision prompts increase stair use in escalator settings, 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).


United States

Several states support the placement of point-of-decision prompts in workplaces and public venues. The CDC StairWELL to Better Health program in Atlanta, Georgia (CDC-StairWELL) is an example of a point-of-decision prompt and stairwell enhancement initiative; it has been the basis for many similar initiatives to increase stair use across the country, as in Maine (MMC-5210 StairWELL) and Texas (ASTHO-Texas POD prompts 2013). The Indiana Healthy Weight Initiative and Indiana’s Communities Putting Prevention to Work grant projects also use point-of-decision prompts to increase stair use in worksites (NBCH-CPPW Indiana, IHWI-Worksites).  

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

ALBD - Active Living by Design (ALBD). Increasing physical activity and healthy eating through community design. Accessed on May 17, 2018
CDC-StairWELL - Centers for Disease Control and Prevention (CDC). Physical activity: StairWELL to better health. Accessed on March 1, 2018
ESMM NC-MM Workbook - Eat Smart, Move More North Carolina (ESMM NC). Move more workbook. Accessed on December 15, 2015
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. Accessed on October 29, 2018
Montclair DHHS-Take the stairs toolkit - Montclair Department of Health & Human Services (DHHS), Partners for Health. Take the stairs: A worksite wellness activity toolkit. Accessed on April 6, 2016
NDC-Play 60 last season - National Dairy Council (NDC), National Football League (NFL). Fuel up to play 60: Last season's playbook. Accessed on March 7, 2016
PI-ENACT stair use - Prevention Institute (PI), Strategic Alliance for Healthy Food and Activity Environments. Workplace food and activity environment ENACT strategy: Encourage stair use. Accessed on March 4, 2016
Re:Th!nk - Re:Th!nk Winnebago. Point of decision prompts. Accessed on February 5, 2016

Citations - Description

CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity. Accessed on October 5, 2018

Citations - Evidence

ALR-Fulton 2015 - Fulton J. Point-of-decision prompts increase walking in a large metropolitan airport: The Walk to Fly study. 2015 Active Living Research (ALR) Annual Conference. 2015. Accessed on March 4, 2016
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. Accessed on March 4, 2016
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. Accessed on November 9, 2017
CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity. Accessed on October 5, 2018
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. Accessed on March 4, 2016
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. Accessed on March 4, 2016
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. Accessed on March 1, 2016
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. Accessed on May 20, 2016
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. Accessed on December 22, 2015
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. Accessed on May 24, 2016

Citations - Implementation

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. Accessed on January 8, 2016
CDC-StairWELL - Centers for Disease Control and Prevention (CDC). Physical activity: StairWELL to better health. Accessed on March 1, 2018
CFAD-Stair prompts - Center for Active Design (CFAD), New York City Department of Health and Mental Hygiene. Stair prompt signage. Accessed on March 4, 2016
IHWI-Worksites - Indiana Healthy Weight Initiative (IHWI). Worksite resources: Indiana healthy worksites toolkit for small businesses. Accessed on March 4, 2016
MMC-5210 StairWELL - Maine Medical Center (MMC), Healthy Maine Partnerships (HMP). 5-2-1-0 Let's go! StairWELL initiative. Accessed on March 4, 2016
NBCH-CPPW Indiana - National Business Coalition on Health (NBCH). Communities Putting Prevention to Work (CPPW) by state with NBCH member business coalition; 2010. Accessed on January 25, 2016

Page Last Updated

August 6, 2015

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