HEALTH PROMOTION

centage of subjects using the stairs from baseline to intervention phase by a minimum of 7% up to a maximum of 8.3%. Our inter- vention module ‘stairs instead of lifts’ was performed in four offices of the Swiss federal administration. It included action days where health professionals interacted directly with employees as well as written information about recent physical activity recom- mendations to achieve health benefits. Most of the action days consisted of implementing attractive or ‘pull’ techniques in con- trast to forceful push incentives ie.shutting down the lift. ● Apples or other fruit were offered on the stairs ● Competitions were organised to find the department which could first accumulate enough metres equivalent to the altitude of the Chasseral, a well known mountain in the surroundings of Bern which is 1600m above sea level

● A game of chance in the form of a lucky dip was performed for stair users, prizes from the lucky dip included free meals and drinks with every third ticket being a winner

● A jigsaw puzzle was transported from one floor to another piece by piece

● During one day the lift was symbolically closed which was the only dissuasive or ‘nasty’ intervention

The study shows that it was possible to increase the use of stairs between 2.8% to 13.2%. Furthermore, it indicates that the attrac- tiveness of the stairwell influences people to use the stairs.

Reproduced with kind permission from the Greater Glasgow Health Board

decision to change is a process and not a sudden event. This process entails frequent movements towards change and then back again towards indulging in the old pattern of behaviour. Therefore concrete behaviour change is not necessarily the only worthwhile goal to pursue in a consultation. Helping someone to think about change could lead to success at a later point (3).

Why stairs? In Switzerland, a group of exercise professionals and scientists developed an intervention project called “Office in Motion” and the goal was to increase physical activity among white collar workers with a particular focus on those daily life activities which required little expense or inconvenience.

Encouraged by some studies in Britain and America (4,5), an intervention module ‘stairs instead of lifts’ was created. Though most people do not spend a vast amount of time on stairs, the use of stairs can be a contribution to an accumulated daily activity programme. To start climbing stairs does not take an enormous amount of time, requires no special skills or financial expense and can be performed regularly. Climbing stairs is often regarded as a key pattern, indicative of changes in general physical activity behaviour. Based on this assumption it is the change of behaviour that counts and not just the energy expenditure.

The notion of the two studies from Blamey (see p25) and Brownell was to influence people’s behaviour with a cognitive behaviour intervention saying respectively ‘Stay Healthy, Save Time, Use the Stairs’ and ‘Your Heart Needs Exercise, Here’s Your Chance’. The analysis revealed that the motivational signs increased the per-

24 SportEX

At baseline, the proportion of stair use was higher at worksites with bright stairwells and low floors than at worksites with dark and inaccessible stairwells. This finding supports the concept of health promotion which relates individual behaviour to structural and environmental factors. It is not easy to include both these factors but for practical reasons they must be part of the inter- vention programme.

Obese and fit Imagine that you are obese, not fit and you want to start exer- cising. Do you know where to go? For obese people it can really be difficult to join an appropriate exercise programme. Being aware of this problem the Women’s Health Centre in our city (Graz, Austria) together with the Institute of Sport Sciences worked out an exercise programme for obese women. Lessons were given once a week and lasted two hours with the aim of the project being to offer a joyful health orientated exercise programme which met the wants and needs of the obese women and influenced their adher- ence to their exercise routines positively.

Decrease in weight was not an objective and was not evaluated. The reason for this decision was that a decrease in weight was unlikely to happen in such a short time and therefore could not be used as a reward or an incentive. Data from a longitudinal study (6) indicates that not the degree of obesity but a bad fit- ness level is the main cause of premature death. ● The core part of the programme involved different games with a soft ball. It was assumed that the distraction of a ball game would support exercising without the people feeling exhausted or bored - especially at the beginning of the programme. Additionally, during the game participants were allowed to walk briskly but not to run. It turned out that those games with a soft ball then became joyful endurance training sessions, and were fully accepted by the women.