The Association of Stair Climbing Behaviors With Hazard of All-Cause Mortality in Adults With or At Risk of Knee Osteoarthritis

OBJECTIVE

To investigate the association of stair climbing difficulty and stair climbing frequency with the risk of all-cause mortality over 13 years in adults with or at high risk for knee OA.

METHODS

We used data from the Osteoarthritis Initiative (OAI), a prospective cohort study of community-dwelling adults with or at high risk for symptomatic knee OA. The exposures were stair climbing difficulty and frequency, assessed at baseline using self-report questionnaires. The outcome was all-cause mortality, assessed from baseline through 13 years of follow-up. Kaplan-Meier survival curves and Cox proportional hazards regression were used to investigate the association between stair climbing exposures and all-cause mortality.

RESULTS

Three hundred seven (6.81%) and 310 (6.84%) participants in the difficulty and frequency samples, respectively, died during 13 years of follow-up. Those who were limited in any capacity in terms of their stair climbing ability had 54% to 84% greater hazard of all-cause mortality, and those who climbed at least 7 flights of stairs per week had 38% lower hazard of all-cause mortality.

CONCLUSION

Adults with or at high risk for knee OA who report difficulty with climbing stairs or who infrequently use stairs are at greater hazard of all-cause mortality. Stair climbing difficulty and frequency are simple to collect and changes may occur early in OA progression, allowing for early intervention. Brief questions about stair climbing behaviors can serve as a functional vital sign within the clinician's toolbox.

Minimal power required to ascend a flight of stairs versus actual power measured with body-fixed sensors in adults aged 19-85 years

A good stair-climbing (SC) ability is crucial for independent living in older adults. A simple formula that estimates the mean power needed to ascend a flight of stairs in a predetermined time (i.e., total ascent duration) is easy to implement in practice, but lacks information on actual power values generated per step. The latter is possible with body-fixed sensors. This study aimed at comparing both methodologies and investigating their sensitivity to detect age-related differences. 318 participants (162 ♀; age 19-85 years) were tested on a 6-step staircase and two methodologies were used to estimate mean SC power: (1) a body-fixed sensor with automated detection of power production per step, and (2) a mathematic equation based on timed ascent duration, body mass and stair height. SC power was 210.4 W lower with formula compared to sensor, lower in women versus men and in older versus young adults (p < 0.001). The difference in SC power between sensor and formula was greater in individuals with better performance (i.e., men and young adults) (p < 0.001), indicating a ceiling effect of the formula in well-functioning and younger individuals. Likewise, ICC's between both methodologies showed poor reliability in people aged <65 years (0.087-0.363) and moderate to good reliability in people aged ≥65 years (0.453-0.780). To conclude, participants with better SC performance are able to largely overshoot the minimal power required to ascend the stairs in a certain duration. This makes the sensor more sensitive to identify early age-related differences compared to the formula.

Children with bilateral cerebral palsy use their hip joint to complete a step-up task

Performance in stair-climbing is largely associated with disruptions to mobility and community participation in children with cerebral palsy (CP). It is important to understand the nature of motor impairments responsible for making stairs a challenge in children with bilateral CP to clarify underlying causes of impaired mobility. In pediatric clinical populations, sensitive measurements of movement quality can be captured during the initial step of stair ascent. Thus, the purpose of this study was to quantify the lower limb joint moments of children with bilateral CP during the stance phases of a step-up task. Participants performed multiple stepping trials in a university gait laboratory. Outcome measures included extensor support moments (the sum of hip, knee, and ankle sagittal plane moments), hip abduction moments, and their timing. We recruited seven participants per group. We found that peak support and hip abduction moments were similar in the bilateral CP group compared to the typical development (TD) group. We also found that children with bilateral CP timed their peak moments closer together and increasingly depended on the hip joint to complete the task, especially in their more affected (MA) lower limb. Our investigation highlights some underlying causes that may make stair climbing a challenge for the CP population, including a loss of selective voluntary motor control (SVMC), and provides a possible treatment approach to strengthen lower limb muscles.

Exercise in the workplace: examining the receptivity of practical and time-efficient stair-climbing "exercise snacks"

In the workplace, people are often sedentary for prolonged time and do not regularly engage in physical activity-two factors independently linked to premature morbidity and mortality. This study aimed to determine the receptivity of incorporating practical stair-climbing "exercise snacks" (Snacks; three isolated bouts of ascending 53-60 stairs performed sporadically throughout the day) into workplace settings compared to more traditional high-intensity interval training (HIIT; performed as three bouts of 53-60 stairs within a structured HIIT workout) and to explore if these exercise strategies could influence sedentary and physical activity behaviour. Fourteen participants (12 women; Mage = 38.9 ± 10.2 years) completed two supervised exercise trials (Snacks and HIIT) followed by 1 week participating in either form of exercise in their workplace. Ratings of perceived exertion (RPE), affective valence, enjoyment, and self-efficacy were measured at the supervised exercise sessions. During the follow-up period, sedentary behaviour and physical activity were measured with an accelerometer. Affective valence was more positive (p = 0.03; η2 p = 0.21) and there was a lower rise in RPE (p = 0.01; η2 p = 0.29) during Snacks than HIIT. Post-exercise enjoyment of, and self-efficacy towards, Snacks and HIIT were high and similar (ps > 0.05). After the supervised trials, 10/14 of the participants preferred Snacks and 4/14 preferred HIIT (p = 0.18). On days when participants chose to perform either exercise modality, the average number of sit-to-stands in a 24 h period was increased (48.3 ± 8.7 to 52.8 ± 7.8; p = 0.03; Hedge's g = 0.73) and moderate-to-vigorous physical activity tended to increase (21.9 ± 18.2 to 38.1 ± 22.1 min; p = 0.06; Hedge's g = 0.60) compared to days when they chose not to exercise. Stair-climbing exercise snacks may be an attractive approach to implement in the workplace setting and has potential to positively impact sedentary behaviour and physical activity metrics.

Stair Climbing Ability and Identification of the Nine Stairs Ascent and Descent Test Cut-Off Points in Hip Osteoarthritis Patients: A Retrospective Study

Objectives As the prevalence and incidence of hip osteoarthritis (hip OA) continue to rise, measuring the impact of hip OA severity on a patient's functionality is essential. Stair walking is a particularly relevant task to assess hip OA patients, as difficulty with stair ascent is one of the driving factors in deciding to undergo a total hip arthroplasty. Although stairs tests often arise in post-arthroplasty measures, there is a lack of reported stairs performance time in hip OA patients. Therefore, this retrospective study aimed to report the stair performance time of hip OA patients categorized by disease severity and determine cut-off points that differentiate between severity grades. Materials and methods The patient selection was based on the review of de-identified data from our research laboratory database. 254 hip OA patients (aged ≥ 50 years) were divided according to the Kellgren-Lawrence classification system into three groups: Grade 2 (n=68), Grade 3 (n=109), and Grade 4 (n= 68). The stair-walking ability was evaluated using the 9S-A/D test. The time taken to ascend and descend the stairs was measured separately, and the total time (9S-A/D) was also recorded. The one-way ANOVA model, Welch test, Games-Howell posthoc test, Chi-Square tests, and Two-Way ANOVA model were used for the statistical analysis of the data. The cut-off points were obtained by receiver operating curve (ROC) analysis. The statistical significance was set at p<0.05. Results Homogeneity was found between the three groups regarding demographic and clinical characteristics, except age and gender (p<0.001). The comparison of the variables (9S-ascent, 9S-descent, and 9S-A/D) between groups, adjusted for gender and age, showed significant differences: Grade 2 individuals had shorter performance times compared to those in Grade 3 and Grade 4 (p<0.005). Simultaneously, patients with Grade 3 hip OA have a shorter performance time than those with Grade 4 hip OA (p<0.005). Regarding ROC analysis of Grade 2 versus Grade 3: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.742 (95%CI 0.67-0.81), 0.734 (95%CI 0.66-0.81), and 0.745 (95%CI 0.54-0.90), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 8.7 s (sensitivity 56%, specificity 88%), 7.1 s (sensitivity 58%, specificity 80%), and 16.25 s (sensitivity 54%, specificity 90%), respectively. Concerning ROC analysis of Grade 3 versus Grade 4: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.702 (95%CI 0.62-0.78), 0.711 (95%CI 0.63-0.79), and 0.715 (95%CI 0.64-0.80), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 11.5 s (sensitivity 66%, specificity 65%), 8.3 s (sensitivity 71%, specificity 62%), and 19.05 s (sensitivity 71%, specificity 61%), respectively. Conclusions The study provides evidence that the progression of hip OA affected stair walking; the performance time of 9S-ascent, 9S-ascent, and 9S-A/D tests was significantly longer as the severity of hip OA worsened. ROC analysis results show tests' ability to distinguish the cut-off point between different hip OA grades. However, further research is required for the reporting and classification of stair performance time values in hip OA patients and to further investigate the ability of 9S-ascent, 9S-descent, and 9S-A/D tests to predict the grade of hip OA.

Effect of robot-assisted stair climbing training as part of a rehabilitation program to improve pulmonary function, gait performance, balance, and exercise capacity in a patient after severe coronavirus disease 2019: a case report

BACKGROUND

Severe coronavirus disease 2019 (COVID-19) infection may decrease respiratory and physical functions.

OBJECTIVE

To evaluate whether robot-assisted stair climbing training (RASCT) would improve pulmonary and physical functions in a patient post-severe COVID-19 infection.

CASE DESCRIPTION

A 48-year-old woman who had experienced severe COVID-19 underwent a 6-week inpatient rehabilitation. She persistently exhibited impaired pulmonary and physical functions, including walking and balance impairment. We provided a 30-min outpatient RASCT biweekly for 6 weeks.

OUTCOMES

After training, maximal inspiratory and maximal expiratory pressures improved from 81 and 74 cmH2O to 104 and 81 cmH2O, respectively. The walking speed improved from 1.15 to 1.21 m/s. In balance ability, physical performance battery score and timed up-and-go test improved from 8 to 11 s and 10.89 to 9.95 s, respectively. Regarding exercise capacity, the 6-min walk test distance improved from 453 to 482 m, and the number of 1-min sit-to-stand test improved from 20 to 23, with improved pulse rate and saturation level. The physical and psychological domain scores of the World Health Organization Quality-of-Life Scale-BREF improved from 44 to 63 and 69 to 81, respectively; Falls Efficacy Scale-International scores improved from 38 to 21.

CONCLUSION

RASCT, as part of a rehabilitation plan, was feasible and effective for this patient after severe COVID-19 infection.

A longitudinal controlled signage intervention to increase stair use at university buildings: Process and impact evaluation using RE-AIM framework

Introduction

Stair climbing intervention could be suggested to address low occupational physical activity amongst university students and employees. Strong evidence showed the effectiveness of signage intervention in increasing stair use in public areas. However, evidence in worksite settings, including university settings, was inconclusive. This study aimed to evaluate the process and impact of a signage intervention to increase stair use at a university building using the RE-AIM framework.

Method

We conducted a non-randomised controlled pretest-posttest study to examine the effect of signage intervention placed in university buildings in Yogyakarta (Indonesia) between September 2019 and March 2020. The process of designing the signage involved the employees in the intervention building. The main outcome was the change in the proportion of stair use to elevator use measured by manual observations of video recordings from closed-circuit television. A linear mixed model examined the intervention effect by controlling the total visitor count as a confounder. RE-AIM framework was used in the process and impact evaluation.

Results

The change in the proportion of stair climbing from baseline to the 6th-month phase at the intervention building (+0.067 (95% CI = 0.014-0.120)) was significantly higher than that of the control building. However, the signs did not change the proportion of the stair descending at the intervention building. The signs were potentially viewed 15,077-18,868 times/week by visitors.

Conclusion

Signage intervention using portable posters could easily be adopted, implemented, and maintained in similar settings. A co-produced low-cost signage intervention was found to have a good reach, effectiveness, adoption, implementation, and maintenance dimension.

Interrupting Pedestrians in Indonesia; Effect of Climate on Perceived Steepness and Stair Climbing Behaviour

Increased activity during daily life is one public health initiative to reduce population inactivity. Increasing temperature and humidity influence walking for transport by reducing the blood supply available to exercising muscles. This study investigated effects of temperature and humidity on a perceptual cue, estimated stair slant, that can influence behaviour, and on subsequent speed of climbing. Participants (402 males, 423 females) estimated the slant of a 20.4° staircase at a university in Indonesia. Subsequently, the participants were timed covertly while climbing. As temperature and humidity increased, estimated stair slant became more exaggerated. Females estimated stair slant as steeper than males. For stair climbing, speed was reduced as temperature increased, and females climbed slower than males. Estimates of stair slant were not associated with speed of the subsequent climb. Climate influences estimates of stair slant that precede stair climbing and subsequent speed of the ascent. In this study, perception was unrelated to behaviour.

Identification of Early Knee Osteoarthritis Based on Knee Joint Trajectory during Stair Climbing

Patients with knee osteoarthritis show low stair climbing ability, but a diagnosis of stair performance time is not enough to identify the early stages of knee osteoarthritis. Therefore, we developed an indicator named range of the knee joint trajectory (RKJT) as a kinematic parameter to express more detailed characteristics than stair performance time. To achieve this, we used our developed "IR-Locomotion", a markerless measurement system that can track the knee joint trajectory when climbing stairs. This study aimed to test whether the RKJT effectively identifies patients with early knee osteoarthritis even after controlling stair performance time. Forty-seven adults with moderate to severe knee pain (mean age 59.2 years; 68.1% women) underwent the radiographic examination (Kellgren and Lawrence grade) of both knees and a stair climbing test on 11 stairs. The RKJT during the stair climbing test was calculated by "IR-Locomotion". A generalized linear mixed model was used to evaluate the discriminative capability of RKJT on early knee osteoarthritis (i.e., Kellgren and Lawrence grade of 1). As expected, patients with early knee osteoarthritis showed larger RKJT than non-radiographic controls (95% confidence interval: 1.007, 1.076). Notably, this finding was consistent even after adjusting stair performance time.

Desk based prompts to replace workplace sitting with stair climbing; a pilot study of acceptability, effects on behaviour and disease risk factors

Background

Prolonged sitting is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Occupational sitting accounts for up to 50 h/week for employees. This pilot study assessed the acceptability of stair climbing as an interruption to sitting throughout working hours, and provided preliminary data of the effects on glucose and lipid profiles.

Methods

A quasi-experimental design was conducted involving 16 sedentary office workers (five females and 11 males) for intervention (n = 8) and control groups (n = 8) with mean age of 36.38 (5.58). For the eight-week intervention, a continuous four-floor stair climb and descent was performed eight times/day spread evenly over the working day. A prompt to climb was presented on the participant’s computer eight times/day. Participants in the experimental group recorded daily floors climbed and steps (measured using pedometers) in a weekly log sheet. Blood samples were collected pre and post intervention to test effects on fasting glucose and 2 h plasma glucose, triglycerides, and total (TC), LDL and HDL cholesterol. Experimental participants were interviewed at the end of the study. The Wilcoxon signed rank test was used to compare the median changes (pre-post) of the dependent variables.

Results

On average, the experimental group climbed 121 floors/week when prompted. There were significant reductions in fasting blood glucose, TC and LDL, as well as the derived measures of ‘bad’ cholesterol and the TC/HDL ratio in the experimental group. Post-experimental interviews indicated that the interruption to sitting was well tolerated.

Conclusion

Prompted stair climbing activity had impacts on health outcomes and was found acceptable to employees at work.

Trial registration

Ethics for this study was approved by Science, Technology, Engineering and Mathematics Ethical Review Committee, University of Birmingham with ethics reference number ERN_15_0491.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14393-1.

Submaximal Testing to Estimate Aerobic Capacity Using a Matrix C5x Stepmill

The primary purpose of this study was to determine if the Matrix C5x stepmill’s preprogrammed submaximal test is able to accurately predict maximal oxygen uptake. Sixteen participants completed a maximal treadmill test and a preprogrammed submaximal test on a Matrix C5x stepmill. Oxygen uptake was measured using a Cosmed K5 during both tests. Maximal oxygen uptake (VO_2max) was calculated from submaximal data using a multi-stage calculation and compared against measured VO_2max from the maximal test and estimated VO_2max from the submaximal stepmill test. METs were also measured during the submaximal test and compared to the METs estimated by the stepmill and METs calculated using submaximal stepping equations. Measured VO_2max (39.18 α 6.6 ml^.kg^-1.min^-1) was significantly higher (p < 0.001) than estimated VO_2max (28.06 α 3.2 ml^.kg^-1.min^-1) and calculated VO_2max (35.58 α 8.0 ml^.kg^-1.min^-1). Measured METs were significantly (p = 0.04) higher than estimated METs in all stages, and higher than calculated METs in stage 1 of the submaximal test. The C5x did not provide accurate estimations of METs or maximal oxygen uptake. Calculating maximal oxygen uptake from submaximal stepmill data may provide an alternative, although development of a new equation may be warranted.

Cardiovascular responses to high-intensity stair climbing in individuals with coronary artery disease

Exercise‐based cardiac rehabilitation leads to improvements in cardiovascular function in individuals with coronary artery disease. The cardiac effects of coronary artery disease (CAD) can be quantified using clinical echocardiographic measures, such as ejection fraction (EF). Measures of cardiovascular function typically only used in research settings can provide additional information and maybe more sensitive indices to assess changes after exercise‐based cardiac rehabilitation. These additional measures include endothelial function (measured by flow‐mediated dilation), left ventricular twist, myocardial performance index, and global longitudinal strain. To investigate the cardiovascular response to 12 week of either traditional moderate‐intensity (TRAD) or stair climbing‐based high‐intensity interval (STAIR) exercise‐based cardiac rehabilitation using both clinical and additional measures of cardiovascular function in individuals with CAD. Measurements were made at baseline (BL) and after supervised (4wk) and unsupervised (12 week) of training. This study was registered as a clinical trial at clinicaltrials.gov (NCT03235674). Participants were randomized into either TRAD (n = 9, 8M/1F) and STAIR (n = 9, 8M/1F). There was a training‐associated increase in one component of left ventricular twist: Cardiac apical rotation (TRAD: BL: 5.6 ± 3.3º, 4 week: 8.0 ± 3.9º, 12 week: 6.2 ± 5.1º and STAIR: BL: 5.1 ± 3.6º, 4 week: 7.4 ± 3.9º, 12 week: 7.8 ± 2.8º, p (time) = 0.03, η² = 0.20; main effect) and post‐hoc analysis revealed a difference between BL and 4 week (p = 0.02). There were no changes in any other clinical or additional measures of cardiovascular function. The small increase in cardiac apical rotation observed after 4 weeks of training may indicate an early change in cardiac function. A larger overall training stimulus may be needed to elicit other cardiovascular function changes.

Evaluation of the power deficit of elderly people during stair negotiation: Which joints should be assisted at least by an exoskeleton and with what amount?

Climbing stairs can become a daily obstacle for elderly people, and an exoskeleton can assist here. However, the exoskeletons that are designed to assist stair climbing are actuated in different ways. To find a minimal actuation configuration, we identify the assist phases by evaluating the power deficit of 11 healthy but weak elderly people (72.4 ± 2.1 years; 69-76 years; 1.67 ± 0.10 m; 74.88 ± 14.54 kg) compared to 13 younger people (24.0 ± 1.8 years; 22-28 years; 1.74 ± 0.10 m; 70.85 ± 11.91 kg) in a biomechanical study and discuss moment characteristics. Three-dimensional kinematics and ground reaction forces were collected, and kinematics, kinetics, and power characteristics of each subject for ascent and descent were calculated using inverse dynamics. Significant differences for power between both groups were assessed with statistical parametric mapping method using dynamic time warping. During ascent, the largest significant power deficit of the elderly subjects occurs in the single stance phase (SSP) during pull-up in the knee joint. During descent, significant mean power deficits of 0.2 and 0.8 W/kg for the highest deficit occur in the ankle joint in the beginning of the SSP and also in the knee joint in the same phase. Therefore, an exoskeleton should address the power deficit for knee extension (ascent: 1.0 ± 0.9 W/kg; descent: 0.3 ± 0.2 W/kg) and could assist the ankle during ascent and descent by an additional plantar flexion moment of 0.2 Nm/kg each.

Influence of COVID-19 Building Restrictions on Physical Activity Promotion Through Increased Stair Use and Limited Elevator Access: A Quasi-Experimental Study-Sport and Physical Activity Group Active Campus Project

BACKGROUND

The aim of this study was to determine the effectiveness of UK government COVID-19 safe offices policy to increase stair use in a higher education setting during the COVID-19 pandemic.

METHODS

Automated counts at 3 ground floor staircases and the elevator entrances were used to estimate stair to elevator use ratio for ascent and descent from/to the ground floor of a university building at baseline (January to March 2020), first and second intervention months (October 2020, November 2020, respectively). Stair promoting signage and a 1-way system was implemented, in line with government policy.

RESULTS

At baseline, stair to elevator use ratio for ascent from and descent to the ground floor was 1.36 (0.02) and 1.88 (0.02) people, respectively. The ratio significantly increased in the first intervention month to 2.64 (0.09) and 3.96 (0.22) people for ascent and descent, respectively. However, the ratio decreased between the first and second intervention months to 1.63 (0.06) and 3.05 (0.52) people for ascent and descent, respectively.

CONCLUSION

The UK government COVID-19 policy was effective at increasing stair use in a higher education setting.

Home-Based Stair Climbing as an Intervention for Disease Risk in Adult Females; A Controlled Study

Cardiovascular disease and the metabolic syndrome are major contributors to health care expenditure. Increased physical activity reduces disease risk. The study compared effects of walking up and down stairs at home with continuous, gym-based stair climbing on the disease risk factors of aerobic fitness, serum lipids, body composition, fasting blood glucose, and resting cardiovascular variables. Sedentary women (31.7 ± 1.4 years) were randomly assigned to home-based (n = 26) or gym-based (n = 24) climbing for five days.week⁻¹ over an eight-week period. Each ascent required a 32.8-m climb, with home-based climbing matching the vertical displacement in the gym. Participants progressed from two ascents.day⁻¹ to five ascents.day⁻¹ in weeks 7 and 8. Relative to controls, stair climbing improved aerobic fitness (V˙O₂max +1.63 mL.min⁻¹.kg⁻¹, 95% CI = 1.21–2.05), body composition (weight −0.99 kg, 95% CI = 1.38–0.60), and serum lipids (LDL cholesterol −0.20 mmol.L⁻¹, 95% CI = 0.09–0.31; triglycerides −0.21 mmol.L⁻¹, 95% CI = 0.15–0.27), with similar risk reductions for home and gym-based groups. Only the home-based protocol reduced fasting blood glucose. Discussion focuses on stair climbing bouts as time-efficient exercise and the potential benefits of a home-based intervention. Stair use at home offers a low-cost intervention for disease risk reduction to public health.

Prefrontal Cortex Involvement during Dual-Task Stair Climbing in Healthy Older Adults: An fNIRS Study

Executive function and motor control deficits adversely affect gait performance with age, but the neural correlates underlying this interaction during stair climbing remains unclear. Twenty older adults (72.7 ± 6.9 years) completed single tasks: standing and responding to a response time task (SC), ascending or descending stairs (SM_up, SM_down); and a dual-task: responding while ascending or descending stairs (DT_up, DT_down). Prefrontal hemodynamic response changes (∆HbO2, ∆HbR) were examined using functional near-infrared spectroscopy (fNIRS), gait speed was measured using in-shoe smart insoles, and vocal response time and accuracy were recorded. Findings revealed increased ∆HbO2 (p = 0.020) and slower response times (p < 0.001) during dual- versus single tasks. ∆HbR (p = 0.549), accuracy (p = 0.135) and gait speed (p = 0.475) were not significantly different between tasks or stair climbing conditions. ∆HbO2 and response time findings suggest that executive processes are less efficient during dual-tasks. These findings, in addition to gait speed and accuracy maintenance, may provide insights into the neural changes that precede performance declines. To capture the subtle differences between stair ascent and descent and extend our understanding of the neural correlates of stair climbing in older adults, future studies should examine more difficult cognitive tasks.

Motivational signage increases stair usage on a Hispanic serving institution

Objective: Stair climbing is considered a good physical activity. Motivational signage has been successful in promoting stair usage in various settings. This study was to investigate the effects of motivational signage on stair usage in a Hispanic serving institution. Participants: A total of 31,067 pedestrians were observed from February to March 2013. Methods: Stair usage was monitored for 9 h per day each week at phase 1 (baseline), 2 (intervention), and 3 (post-intervention). Results: Overall, participants' stair usage was higher during phase 2 (49.0%) and phase 3 (48.0%), compared with phase 1 (39.7%). The participants during phase 2 and 3 were more likely to use the stairs compared to participants during phase 1, regardless of floor level (3-story or 4-story building), status (student or staff/faculty), and time of day (7:30-10:29, 10:30-13:29, or 13:30-16:30) (p < .001). Conclusion: Motivational signage can effectively encourage more stair usage, and hence promote healthy behavior in a predominantly Hispanic-serving institution.

Effects of Progressive Walking and Stair-Climbing Training Program on Muscle Size and Strength of the Lower Body in Untrained Older Adults

The purpose of the present study was to investigate the effect of the progressive walking program on lower limb muscle size and strength and evaluated whether the stair-climbing exercise provided additional training effects when combined with the walking program. Fifteen elderly subjects (age 69 ± 1 years, height 1.63 ± 0.02 m, body weight 64.5 ± 2.0 kg) were randomly assigned to a walking group or a walking and stair-climbing group. The progressive walking program comprised continuous (week 1-8) and interval (week 9-17) exercises. The walking and stair-climbing group also performed stair climbing. Muscle thickness, strength, and walking performance were evaluated before and 8 and 17 weeks after the start of the program. The muscle thickness of the anterior and posterior parts of the thigh significantly (p < 0.05) increased in both groups. There was also a significant (p < 0.01) main effect of time in isometric maximal strength and the values expressed relative to body mass for both knee extension and flexion. However, no group × time interactions were noted. Furthermore, the percentage change of knee flexion strength after the training period was significantly (p < 0.01) correlated with the pre-intervention value. Seventeen weeks of the progressive walking program can increase thigh muscle size and strength for older adults; however, an added stair-climbing exercise may not provide additional training effects. Furthermore, the magnitude of improvement in knee flexion strength would depend on the pre-intervention value.

Effects of a Brief Stair-Climbing Intervention on Cognitive Performance and Mood States in Healthy Young Adults

OBJECTIVE

Previous studies focused on the benefits of acute exercise on cognition and mood have mostly used specialized laboratory-based equipment, thus little is known about how such protocols generalize to naturalistic settings. Stair climbing is a simple and readily accessible means of exercise that can be performed in naturalistic settings (e.g., at home or at the workplace). In the present study we examined the effects of stair-climbing intervals on subsequent cognitive performance and mood in healthy young adults.

METHOD

Thirty-two undergraduate students (M age = 19.4 years, SD = 1.3; 21 females) completed a controlled randomized crossover trial with session order counterbalanced across participants. Participants visited the lab on two occasions, one week apart, and completed one control session (no exercise) and one stair-climbing session (3 × 1 min stair-climbing intervals) with cognitive performance and mood assessed at the end of each session.

RESULTS

Repeated measures ANCOVA revealed that males (Hedges' g av = 0.45) showed better switching performance following the stair climbing but females (Hedges' g av < 0.03) did not. Participants felt more energetic (Hedges' g av = 1.05), less tense (Hedges' g av = 0.61), and less tired (Hedges' g av = 0.43) following the stair climbing. In addition, higher exercise intensity during the stair climbing predicted better subsequent switching performance and higher energetic ratings.

CONCLUSION

These findings indicate that short bouts of stair climbing in a naturalistic setting can induce cognitive benefits for more challenging tasks, albeit only in males, indicating a sex-specific effect. Short bouts of stair climbing can be a practical approach to increase feelings of energy in daily life.

Signage Interventions for Stair Climbing at Work: More than 700,000 Reasons for Caution

Increased stair climbing reduces cardiovascular disease risk. While signage interventions for workplace stair climbing offer a low-cost tool to improve population health, inconsistent effects of intervention occur. Pedestrian movement within the built environment has major effects on stair use, independent of any health initiative. This paper used pooled data from UK and Spanish workplaces to test the effects of signage interventions when pedestrian movement was controlled for in analyses. Automated counters measured stair and elevator usage at the ground floor throughout the working day. Signage interventions employed previously successful campaigns. In the UK, minute-by-minute stair/elevator choices measured effects of momentary pedestrian traffic at the choice-point (n = 426,605). In Spain, aggregated pedestrian traffic every 30 min measured effects for ‘busyness’ of the building (n = 293,300). Intervention effects on stair descent (3 of 4 analyses) were more frequent than effects on stair climbing, the behavior with proven health benefits (1 of 4 analyses). Any intervention effects were of small magnitude relative to the influence of pedestrian movement. Failure to control for pedestrian movement compromises any estimate for signage effectiveness. These pooled data provide limited evidence that signage interventions for stair climbing at work will enhance population health.

Anterior Tibial Post Impingement During Stair Climbing: A Kinematic Analysis and Clinical Outcomes

BACKGROUND

Anterior tibial post impingement during gait and stair ambulation was reported in knees with posterior-stabilized prostheses. However, the link between anterior post impingement and knee kinematics and between anterior post impingement and the clinical outcome has not been well investigated. Therefore, the purpose of this study was to assess the anterior impingement to clarify the relevant kinematics and clinical results including patient-reported outcomes.

METHODS

We analyzed 40 well-functioning knees in 20 patients with a posterior-stabilized prosthesis due to osteoarthritis and who were followed up for 2 years or more. Dynamic lateral radiographs during stair-climbing activity were analyzed using a shape-matching technique, and anterior post impingement and the clinical outcome were assessed.

RESULTS

Anterior impingement of the tibial post was observed in 13 knees (33%) during the latter half of the stance phase and at the beginning of the swing phase with the average implant flexion angle of -2.4°. Implant flexion was significantly smaller, while the femoral component was located more posterior in the impingement knees. The posterior tibial slope was significantly greater in the impingement group (6.7° ± 2.0°, 5.3° ± 1.9°, respectively; P = .041); however, no significant differences were demonstrated in anteroposterior laxity and patient-derived assessments.

CONCLUSION

To avoid anterior post impingement, the posterior tibial slope should be made at 5° or less. Femoral notch-anterior post articulation should be designed to have good congruency in order to act as an anterior stabilizer in the case of impingement at knee extension.

Modular Neural Mechanisms for Gait Phase Tracking, Prediction, and Selection in Personalizable Knee-Ankle-Foot-Orthoses

Orthoses for the lower limbs support patients to perform movements that they could not perform on their own. In traditional devices, generic gait models for a limited set of supported movements restrict the patients mobility and device acceptance. To overcome such limitations, we propose a modular neural control approach with user feedback for personalizable Knee-Ankle-Foot-Orthoses (KAFO). The modular controller consists of two main neural components: neural orthosis control for gait phase tracking and neural internal models for gait prediction and selection. A user interface providing online feedback allows the user to shape the control output that adjusts the knee damping parameter of a KAFO. The accuracy and robustness of the control approach were investigated in different conditions including walking on flat ground and descending stairs as well as stair climbing. We show that the controller accurately tracks and predicts the user's movements and generates corresponding gaits. Furthermore, based on the modular control architecture, the controller can be extended to support various distinguishable gaits depending on differences in sensory feedback.

Occupational Physical Activity Habits of UK Office Workers: Cross-Sectional Data from the Active Buildings Study

Habitual behaviours are learned responses that are triggered automatically by associated environmental cues. The unvarying nature of most workplace settings makes workplace physical activity a prime candidate for a habitual behaviour, yet the role of habit strength in occupational physical activity has not been investigated. Aims of the present study were to: (i) document occupational physical activity habit strength; and (ii) investigate associations between occupational activity habit strength and occupational physical activity levels. A sample of UK office-based workers (n = 116; 53% female, median age 40 years, SD 10.52) was fitted with activPAL accelerometers worn for 24 h on five consecutive days, providing an objective measure of occupational step counts, stepping time, sitting time, standing time and sit-to-stand transitions. A self-report index measured the automaticity of two occupational physical activities (“being active” (e.g., walking to printers and coffee machines) and “stair climbing”). Adjusted linear regression models investigated the association between occupational activity habit strength and objectively-measured occupational step counts, stepping time, sitting time, standing time and sit-to-stand transitions. Eighty-one per cent of the sample reported habits for “being active”, and 62% reported habits for “stair climbing”. In adjusted models, reported habit strength for “being active” were positively associated with average occupational sit-to-stand transitions per hour (B = 0.340, 95% CI: 0.053 to 0.627, p = 0.021). “Stair climbing” habit strength was unexpectedly negatively associated with average hourly stepping time (B = −0.01, 95% CI: −0.01 to −0.00, p = 0.006) and average hourly occupational step count (B = −38.34, 95% CI: −72.81 to −3.88, p = 0.030), which may reflect that people with stronger stair-climbing habits compensate by walking fewer steps overall. Results suggest that stair-climbing and office-based occupational activity can be habitual. Interventions might fruitfully promote habitual workplace activity, although, in light of potential compensation effects, such interventions should perhaps focus on promoting moderate-intensity activity.

Restoring physical function after knee replacement: a cross sectional comparison of progressive strengthening vs standard physical therapy

Objective: The purpose of this study is to compare the functional status of patients 12 months after total knee arthroplasty (TKA) who underwent progressive strengthening or standard of care rehabilitation to older adults without knee joint pain. Methods: This cross-sectional design study included 165 participants in the progressive strengthening group, 40 participants in the standard of care group, and 88 older adults (control group). The Knee Outcome Survey - Activity of Daily Living, knee active range of motion (ROM), quadriceps strength, and performance tests were compared between groups using a one-way ANOVA. The proportions of participants in both TKA groups who achieved the lower bound of the 95% confidence interval of the control group were compared using a Fisher's exact test. Results: Significant between-group effects were found for all variables (p < 0.001). The control group had better outcomes than both the progressive strengthening and standard of care groups (p < 0.001). Compared to the standard of care group, a higher proportion of participants in the progressive strengthening group achieved the lower bound cutoff for active knee extension ROM (p = 0.042), quadriceps strength (p = 0.032), and stair climbing time (p = 0.029). Conclusion: More participants in the progressive strengthening group had physical function that was similar to the healthy control group, when compared to the standard of care group. Progressive strengthening rehabilitation may be more effective in restoring normative levels of function after TKA than standard of care.

Markerless Knee Joint Position Measurement Using Depth Data during Stair Walking

Climbing and descending stairs are demanding daily activities, and the monitoring of them may reveal the presence of musculoskeletal diseases at an early stage. A markerless system is needed to monitor such stair walking activity without mentally or physically disturbing the subject. Microsoft Kinect v2 has been used for gait monitoring, as it provides a markerless skeleton tracking function. However, few studies have used this device for stair walking monitoring, and the accuracy of its skeleton tracking function during stair walking has not been evaluated. Moreover, skeleton tracking is not likely to be suitable for estimating body joints during stair walking, as the form of the body is different from what it is when it walks on level surfaces. In this study, a new method of estimating the 3D position of the knee joint was devised that uses the depth data of Kinect v2. The accuracy of this method was compared with that of the skeleton tracking function of Kinect v2 by simultaneously measuring subjects with a 3D motion capture system. The depth data method was found to be more accurate than skeleton tracking. The mean error of the 3D Euclidian distance of the depth data method was 43.2 ± 27.5 mm, while that of the skeleton tracking was 50.4 ± 23.9 mm. This method indicates the possibility of stair walking monitoring for the early discovery of musculoskeletal diseases.

[Kinetic mechanism of electroacupuncture for stair climbing in knee osteoarthritis patients]

OBJECTIVE

To observe the kinetic change that reflects joint loading in different planes during stair climbing in knee osteoarthritis (KOA) after electroacupuncture (EA) by three-dimensional motion analysis, so as to provide reference for its biomechanical mechanism treated with acupuncture.

METHODS

Forty KOA patients, in accordance with the random number table, were assigned into an observation group and a control group, 20 cases in each one and finally 18 cases completed. Acupoints in the observation group were Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34), Yinlingquan (SP 9), Xuehai (SP 10), Liangqiu (ST 34) and Zusanli (ST 36); points in the control groups were located about 2 cm next to the above acupoints with shallow acupuncture. EA was connected at Neixiyan (EX-LE 4) and Yinlingquan (SP 9), Liangqiu (ST 34) and Yanglingquan (GB 34). The frequency was 2 Hz with continuous wave in the observation group and there was no current in the control group for the corresponding points. All the treatment was given for 3 weeks, totally 11 times. Climbing stairs gait was measured before and after treatment. Velocities and kinetic parameters during ascending and descending stairs were analyzed, including flexion and extension peak torques of hip, knee, ankle on the vertical plane, external knee adduction moment on the coronal plane.

RESULTS

After treatment in the observation group, velocities during ascending and descending stairs significantly increased (P<0.05, P<0.01); maximal ankle plantar flexor moments during ascending and descending stairs and the second peak external knee adduction moment (PEKAM2) during ascending stairs significantly increased (P<0.05, P<0.01). After treatment in the control group, the first peak external knee adduction moment (PEKAM1) and PEKAM2 during descending stairs were less than those before treatment (P<0.05, P<0.01). In the observation group, the difference value (DV) of velocity before and after treatment was positively correlated to DV in the torque of ankle plantar flexors during ascending stairs in the observation group (r=0.598，P<0.01). Excluding the impact of velocity, the DV of the maximal torque of ankle plantar flexors during ascending stairs didn't show difference in the observation group (P>0.05).

CONCLUSION

EA can increase the velocities of ascending and descending stairs of KOA patients. It improves the loading capacity of knee joint on both sagittal and coronary planes. But its effect during ascending may be correlated with the increase of velocity. The mechanism of different effects between EA and minimal acupuncture on joint moments is still unclear and warrants further study.

Step by step: a microgenetic study of the development of strategy choice in infancy

To examine patterns of strategy choice and discovery during problem-solving of a novel locomotor task, 13.5- and 18-month-old infants were placed at the top of a staircase and encouraged to descend. Spontaneous stair descent strategy choices were documented step by step and trial by trial to provide a microgenetic account of problem-solving in action. Younger infants tended to begin each trial walking, were more likely to choose walking with each successive step, and were more likely to lose their balance and have to be rescued by an experimenter. Conversely, older infants tended to begin each trial scooting, were more likely to choose scooting with each successive step, and were more likely to use a handrail to augment balance on stairs. Documenting problem-solving microgenetically across age groups revealed striking similarities between younger infants' strategy development and older children's behaviour on more traditionally cognitive tasks, including using alternative strategies, mapping prior experiences with strategies to a novel task, and strengthening new strategies. As cognitive resources are taxed during a challenging task, resources available for weighing alternatives or inhibiting a well-used strategy are reduced. With increased motor experience, infants can more easily consider alternative strategies and maintain those solutions over the course of the trial.

Benefits of a worksite or home-based bench stepping intervention for sedentary middle-aged adults - a pilot study

The aim of this study was to investigate the benefits of a low-volume, vigorous intensity bench stepping programme in sedentary middle-aged adults. Thirty-one healthy but sedentary adults (12 men; 55-64 years) took part in the study. Participants accumulated up to 9 min per day of stepping exercise on three days per week over the 4-week experimental period. Parameters of cardiorespiratory fitness, body composition and lower limb muscle strength were measured on three occasions: TS1 (baseline test), TS2 (following a 4-week control period) and TS3 (following the 4-week intervention). Data were analysed using a repeated-measures ANOVA. Adherence to the programme was excellent (96%). Relative to the insignificant changes following the control period, parameters of cardiorespiratory fitness were significantly improved following training. No alterations in body composition or lower limb muscle strength were detected. These results show that less than 30 min per week of bench step exercise, accumulated in short bouts throughout the day, can improve parameters of cardiorespiratory fitness after only 4 weeks in previously sedentary middle-aged adults. Due to its low-cost, time-efficient and discrete aspects, stepping exercise may have important implications for public health initiatives that promote physical activity in a population who commonly report 'lack of time' as a barrier to physical activity.