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Letters   |    
Effects of Point-of-Choice Prompts on Stair Usage in a Psychiatric Setting
Paul F. Gorczynski, Ph.D., M.A.; Guy E. Faulkner, Ph.D., M.Sc.; Tony A. Cohn, M.B.Ch.B., M.Sc.; Gary J. Remington, M.D., Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.004582012
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The authors are affiliated with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Faulkner is also with the Faculty of Kinesiology and Physical Education, and Dr. Cohn and Dr. Remington are also with the Department of Psychiatry, all at the University of Toronto, Ontario, Canada.

Copyright © 2013 by the American Psychiatric Association

To the Editor: Psychiatric settings and services have been described as potentially obesogenic because they provide opportunities for increased calorie intake and reduced energy expenditure (1). To supplement traditional weight-loss interventions that mainly target individual behavioral change and to address the higher prevalence of obesity among psychiatric inpatients, ecologically framed interventions are required. For example, in one uncontrolled study, changing how meals were served in a psychiatric ward led to significant weight loss (2).

In terms of physical activity, persons with serious mental illness constitute a large population of adults who are not active enough to experience health benefits (3). A potential strategy to increase overall physical activity among sedentary individuals is to modify the physical and sociocultural environments to facilitate engagement in more incidental physical activity (4). Stair use is an environmental modification that has been studied for its impact on increasing physical activity and improving health. Stair use interventions mainly rely on point-of-choice signs, such as posters, to promote stair use over escalator or elevator use. A recent review of studies of point-of-choice prompts found that most led to a significant increase in stair climbing (5).

We decided to assess the effectiveness of point-of-choice prompts in increasing stair use between two floors of a five-floor building at the Centre for Addiction and Mental Health in Toronto, Canada. The purpose of this “proof-of-principle” study was to examine whether environmental modifications to increase incidental physical activity are feasible in a psychiatric setting.

Our six-week study, conducted in the summer of 2010, used a quasi-experimental, interrupted time-series research design. Individuals who lived and worked on the unit were participants. Stair use was measured by an infrared motion sensor and by systematic behavioral observations during three study phases—before, during, and after the installation of point-of-choice prompts. Elevator use was measured only by observation. No significant change in the overall number of stair users was noted over the three phases. Logistic regression analysis of observational data did not find an effect of sex or hospital status (whether participants lived or worked at the hospital) on stair or elevator use. Although patients did not change their stair use behavior, male employees and male volunteers significantly increased stair use over the study period (N=133, χ2=13.4, df=2, p=.001).

Overall, this study showed that a simple environmental intervention is feasible in a psychiatric setting and that it can have an effect on certain demographic groups. Individuals with schizophrenia face many physical and mental health challenges; inclusive and accessible strategies must be created to encourage them to become active. As this study found, such efforts may have a secondary effect of increasing activity levels of staff. In addition to stair use, other environmental strategies should focus on increasing low-intensity or incidental physical activity, because individuals with schizophrenia are largely inactive and any increase in the level of physical activity would be beneficial (3).

Although more research is necessary, environmental interventions can play a role in increasing levels of physical activity and help address the obesogenic environment that faces individuals living in psychiatric settings.

This research was supported by a Seed Grant Award and a Student Award from the Centre for Urban Health Initiatives.

Dr. Cohn has received speaker fees from or participated on an advisory panel for Pfizer, Inc., and Boehringer Ingelheim. Dr. Remington has received research support or consultant or speaker fees from or participated on an advisory panel for Laboratorios Farmacéuticos Rovi, S.A., Medicure, Neurocrine Biosciences, Novartis, Pfizer, Inc., and Roche. The other authors report no competing interests.

Faulkner  GE;  Gorczynski  PF;  Cohn  TA:  Psychiatric illness and obesity: recognizing the “obesogenic” nature of an inpatient psychiatric setting.  Psychiatric Services 60:538–541, 2009
[CrossRef] | [PubMed]
 
Cohn  TA;  Grant  S;  Faulkner  GE:  Schizophrenia and obesity: addressing obesogenic environments in mental health settings.  Schizophrenia Research 121:277–278, 2010
[CrossRef] | [PubMed]
 
Lindamer  LA;  McKibbin  C;  Norman  GJ  et al:  Assessment of physical activity in middle-aged and older adults with schizophrenia.  Schizophrenia Research 104:294–301, 2008
[CrossRef] | [PubMed]
 
Sallis  JF;  Owen  N:  Ecological models of health behavior; in  Health Behavior and Health Education: Theory, Research, and Practice . Edited by Glanz  K;  Rimer  BK;  Lewis  FM.  San Francisco,  Jossey-Bass, 2002
 
Nocon  M;  Müller-Riemenschneider  F;  Nitzschke  K  et al:  Increasing physical activity with point-of-choice prompts: a systematic review.  Scandinavian Journal of Public Health 38:633–638, 2010
[CrossRef] | [PubMed]
 
References Container
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References

Faulkner  GE;  Gorczynski  PF;  Cohn  TA:  Psychiatric illness and obesity: recognizing the “obesogenic” nature of an inpatient psychiatric setting.  Psychiatric Services 60:538–541, 2009
[CrossRef] | [PubMed]
 
Cohn  TA;  Grant  S;  Faulkner  GE:  Schizophrenia and obesity: addressing obesogenic environments in mental health settings.  Schizophrenia Research 121:277–278, 2010
[CrossRef] | [PubMed]
 
Lindamer  LA;  McKibbin  C;  Norman  GJ  et al:  Assessment of physical activity in middle-aged and older adults with schizophrenia.  Schizophrenia Research 104:294–301, 2008
[CrossRef] | [PubMed]
 
Sallis  JF;  Owen  N:  Ecological models of health behavior; in  Health Behavior and Health Education: Theory, Research, and Practice . Edited by Glanz  K;  Rimer  BK;  Lewis  FM.  San Francisco,  Jossey-Bass, 2002
 
Nocon  M;  Müller-Riemenschneider  F;  Nitzschke  K  et al:  Increasing physical activity with point-of-choice prompts: a systematic review.  Scandinavian Journal of Public Health 38:633–638, 2010
[CrossRef] | [PubMed]
 
References Container
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