. 2023 Nov 1;19(1):136–150. doi: 10.1016/j.jtumed.2023.10.003

Table 2.

Characteristics of the included studies.

Author year	Country	Design	Objective	Population	Intervention	Outcomes	Key findings
Andersen, 2013¹⁶	Denmark	Randomised controlled trial	To explore the effects of email prompts on stair climbing on CVD risk	160 office workers (125 F, aged 42 yrs, 90 % of work hours in sitting)	• randomly assigned (2:1 ratio) for 10 weeks (1) Intervention group: received email prompt-based stair climbing reminders for 10 min every day for 8 weeks (2) control group: pursued usual work	• Aerobic fitness: Increment cycle protocol • BP, BMI • Heart rate monitor at the main stair • Feasibility	• CRF ↑ 1.45 ml/min/kg at 10-week • SBP, DBP ↓ 4.81 mmHg in email group • No significant changes in weight • Low cost email-based encouragements to do daily stair- at work may improves CVD risk among adults in sedentary occupations.
Azmi, 2022¹¹	United Kingdom	Quasi experimental study	To investigate the stair climbing effects on glucose and lipid profiles	• 16 sedentary office workers, (11M, 5F) • Sedentary able to climb regularly	• Four-floors staircase continuously for 8 times a day spread across workdays for 8-week period for 2 min • Every hour prompt from computer • Pedometer measured steps and log-based stair climb • Control group: participants with the buildings less than 4 floors of university	• Venous samples • Fasting and 2hrs post prandial glucose, LDL, VLDL, HDL, triglycerides and total cholesterol • Enzymatic calorimetric assays	• Physiological improvements in LDL-C, TC, TC/HDL-C ratio, non-HDL-C and fasting blood glucose in the experimental group while no change in control group. • Mean change TG (-0.06 mmol/L), TC (−0.6 mmol/L), HDL-C (+0.16 mmol/L), LDL-C (no change), TC/HDL (−0.4) and FG (−0.16 mmol/L) • Behavioral response: no change in the floors climbed (linear, quadratic trends) • ↓in total step counts over the weeks of the study
Boreham, 2005¹⁷	Ireland	Non-randomised controlled trial	To investigate the effects of stair climbing on VO2max, blood lipids, and homocysteine levels among sedentary and healthy young women	• 18 sedentary women in university • No self reported chronic diseases limiting stair climbing	randomly assigned to 8 weeks (1) Intervention group: progressive stair climb. 2 bouts of climb every day, 5 days, increasing one climb every two week (2) control group	• VO2 max: incremental cycle test and metabolic cart • Blood lipids and homocysteine: venous samples (TC, TG, HDL, LDL)	• No significant changes in BMI, TC, HDL-C, TC/HDL-C ratio, TG, or homocysteine. • Compared to controls, the stair climbing group showed a significant ↑in VO2max (+3.5 ml/kg/min) and a ↓ in LDL-C (-0.34 mmoL/l).
Cabral-Santos, 2021¹⁸	Netherlands	Randomized controlled study	to determine whether breaking up prolonged sitting with stair climbing bouts with or without high carb diet alter acute inflammatory response.	40 [10 lean males, 10 overweight/obese (OW) males; 10 lean females. 10 OW females]	Four interventions: control group with 9 h sitting with (1) low carbohydrate or (2) high carbohydrate snack; and stair climbing intervention (15–30 s × 8) with (3) low carbohydrate and (4) high carbohydrate snacks	• At baseline, 3rd and 6th hour assessed • Immune: IL-6, TNF-α and Salivary Immunoglobulin A (SIgA)	• TNF-α levels remained same in both groups • At 540 min mark, Interleukin-6 (IL-6) reduces more in OW with HC snack group • Salivary Immunoglobulin A was always higher in lean and active group but OW adults had elevate levels on both conditions • Stair-climbing post sedentary behaviour reduces acute IL-6 levels in plasma for •When stair-climbing is accompanied by changes in nutrition SIgA level was increased in OW population
Chen, 2017¹⁹	Taiwan	Quasi randomised experimental study	To compare effects on BMD, lipid profile, insulin sensitivity and physical fitness between DSE and ASE individuals.	• 30 obese • sedentary women (60–82 yr) • free from any noncommunicable diseases	• Three interventions: (1) descending stairs (DSE); (2) ascending stairs (ASE); (3) control groups • Twice per weeks, 12 weeks • Stairs of a 10-story building	• upper thigh circumference, muscle soreness, balance and the right calcaneus BMD • functional fitness tests for senior adults consisting of 30-s chair stand, 2-min step, 8-ft up and go, 6-min walk and 6-m tandem walk • Lipid profile, HOMA-IR, HbA1C • MVC of extensors	• HR, BP (−8.6 %) lower in DSE than ASE • No significant changes in MVC-ISO force, plasma CK activity, and VAS of muscle soreness • No significant difference in weight, body fat change between interventions • MVC increase with DSE (34 % VS 19 %) than ASE • The magnitude of increase in balance and insulin sensitivity was higher in DSE than ASE
Cho, 2020²⁰	South Korea	Randomised cross over study design	To explore the acute effects of stair climbing interruptions during prolonged sitting on vascular and metabolic function after a high-fat meal	12 healthy adults (age: 23.5 ± 2.9 years)	Two interventions 1) a 4-h uninterrupted sitting (sitting trial) or 2) a 4-h sitting interrupted with a 5-min stair climbing (66 % of HRR) every hour after a high fat meal	• Metabolic fitness: TG, glucose concentrations, • Popliteal artery blood flow and shear rate • Measured every hour after a high-fat meal, • Brachial artery FMD @ baseline and end of the session	• Plasma TG and glucose ↑ after a high-fat meal and returned to baseline at the end • Brachial artery FMD ↓ (−1.81 %) in the continued sitting, but not with the stair climb interrupted trial (+0.87 %) • Compared with the sitting trial, the interrupted trial improved popliteal blood flow and shear rate
Chow, 2020²¹	China	Randomized controlled study	To examine the effects of stair exercise on cardiometabolic risk in young obese Chinese females	36 inactive female college students with body fat percentage >30 %, no exercise, no chronic diseases	• Three interventions: (1) descending stairs (DSE); (2) ascending stairs (ASE); (3) control groups • Thrice per weeks, 12 weeks • 1st week – 96 steps × 5 reps/session, progress to 27 reps at 12th week	• DEXA (body fat%, whole-body fat mass, trunk fat mass, abdominal, lower limb fat and muscle mass. • fasting blood glucose, insulin, HOMA-IR, IL-6 and TNF-α. • Enzyme linked immunosorbent assay kits • Before and after 12 weeks	• ↑ Insulin sensitivity 3.5-fold in the DSE group compared with ASE group (−33.2 % vs. −9.8 %). • Proinflammatory factors showed significant decreases in TNF-α (−39.9 % vs. −23.2 %). • Significant reduction in body fat mass was observed for the two exercise groups with no significant difference for the mean values
Donath, 2014²²	Switzerland	Non-randomised controlled study	To investigate the effects of two 8-week stair-climbing interventions on balance, gait, strength, and endurance in healthy seniors.	48 enrolled but 39 elderly (22 F) completed Aged 61–83 years, BMI 25.08	• Three interventions: (1) one step strategy; (2) 2-step strategy during stair climb training; (3) control groups –three supervised social sessions (bowling, playing billiards, and darts in 8 weeks • 3 sessions/week, 8 weeks • Supervised – garage, 8 floor climbing	• Static balance (force plate), dynamic balance (beam walk), functional reach • Gait (timing gates), strength (double, single leg press) and submaximal endurance before and after 8 weeks	• Did not change maximal strength and explosive power • HR max increased in 2 steps climb group compared to other while HR rest reduced • Balance improved in 2 steps climb group compared to other • Time effects were seen for functional reach but no between group • stair-climbing interventions did not alter static balance, spatiotemporal gait characteristics, and strength performance in healthy seniors
Gay, 2018²³	United states	Cross-over trial	To determine the effects of 2-min and 4-min bouts of vigorous-intensity stair climbing on glucose levels.	9 overweight/obese adults ranging between ages of 40–64 years with prediabetes and HbA1C levels ranging between 5.7% and 6.4 %	Three interventions: (1) control group; (2) stair-climbing in bouts of 2 min, every hour for 8 h; (3) stair-climbing in bouts of 4 min, followed in every 2 h for 8-h duration.	• Glucose monitored by continuous glucose monitor inserted in abdomen and the finger prick method	• 4 min bout had significant decrease in glucose after 30 min, especially for people with ≥90 mg/dl pre exercise glucose levels • 2 min bout effect was similar to control group. • Population with pre-exercise glucose level <90 mg/dl did not show much change in post exercise glucose levels
Jenkins, 2019²⁴	Canada	Randomised controlled trial	To explore the effect of stair climbing exercise “snacks” on peak oxygen uptake	• Twenty-four young adults • No known CVD	• vigorously ascending a 3-flights (60 steps), • 3 bouts daily • separated by 1–4 h of recovery, 3 days/week for 6 weeks • Supervised	• Peak O2 uptake and power by incremental cycle protocol	• Peak VO2 ↑ in the climbers compared to controls • VO2peak was higher in the training group compared with control (1918 ± 326 ml/min • Wpeak was also higher in the training group compared with control (178 ± 32 W)
Kennedy, 2007²⁵	United Kingdom	Parallel group trial	To investigate the effects of accumulated bouts of stair walking on CRF, BMI and blood lipids in sedentary office workers	• Employees from public sector offices • No known CVD	• Progressive stair climb • Two interventions: (1) stair climb (1 bout/day, 5 days/week, 8 weeks, progressing to 3 climbs gradually; (2) control group • 75 steps/min • Supervised	• Body fat (bioelectrical impedance analysis) • VO2 max (YMCA submaximal cycle test) • Metabolic fitness: TC, TG, HDL, VLDL • Pre and post 8 weeks	• Relative to controls, the stairclimbing group showed a significant increase in predicted VO2max (9.4 %, +2.1 ml/kg/min). • No other significant changes were noted. • modest amounts of stairclimbing may be one of the most time efficient methods of improving and maintaining the health of sedentary individuals.
Lim, 2020¹⁴	Canada	Non-blinded parallel group	To compare the effects of 12 wk of usual and stair climbing– based HIIT program on skeletal muscle phenotype in individuals with CAD.	• 20 CVD (18 M, 2 F), undergone recent treatment for CAD • No pacemakers, <2 months cardiac procedures	Randomised to either usual cardiac rehab (30 min at 60%–80% of peak heart rate) or STAIR (three bouts of one flight (12 steps), 3–6 flights/day for 12 wk. 4 weeks of supervised and 8 weeks of unsupervised	• Muscle biopsies of vastus lateralis before, after 4 weeks and after 12 weeks • Fiber cross-sectional area, satellite cell content, and mitochondrial function through immunohistochemistry and western blot test.	• Participants with CAD had a 52 % lower prevalence of Type I fibres and 1$ higher type 2 fibres • No significant differences in type 1 and II fibres after exercise training • Satellite cells increased at 4th week • No differences in capillarisation or myonuclei • Significant increase in phosphorylation and e-NOS at 4th week while no difference at 12th week • The changes are comparable with short time of stair (5 min) vs traditional exercise training (33 min)
McCulley, 1994²⁶	United states	Non-randomised controlled trial	to determine the efficacy of stair climb compared with walk/run training, for improving CRF and reducing adiposity	• 19 sedentary, middle-aged male volunteers (40–65 years old) • Free from diseases • 12 for walk or stair while 7 chosen as sedentary controls	• Three interventions: (1) STAIR (StairMaster 4000), (2) WALK; (3) SED for 14 weeks, 3–4 day/week, 30–45 min/day • 70–80 % of MHR • The training load was gradually increased to 80–85 % MHR at 14th week • Supervised training	• Body density (underwater weighing) and fat% • VO2 max - Incremental treadmill test	• Absolute VO2max increased by 19.6 %in the stair and 19.4 % in the walk/run group, • Relative VO2max increased by 20.1 % and 20.2 % in the stair and walk/run groups, respectively. • Fat mass decreased by ≈ 2.7 kgs in both intervention groups • Body fat % decreased and equal (−2.5 % body fat) in both groups with training.
Meyer, 2010²⁷	Switzerland	Single group experimental trial	to evaluate impact of a worksite-based promotional campaign of stair use on cardiometabolic risk in apparently healthy adults	• 77 Healthy employees of university hospital • Aged >18 years, <10 stories/day	• Posters motivating the stair climb posted at ‘point of choice’ • Campaigns for stair use • 12 weeks • Hospital building (12 stories, 2 floors per story, 10 steps/flight) • Use during working hours	• Physical activity levels by actigraph GT1M • Maximal aerobic capacity (VO2max): Chester step test • Body composition (Bioelectric impedance) • At 0^th, 3rd and 6th month	• At 12 weeks, VO2max had increased by 9.2 ± 15.1 % (P < 0.001). • BMI (↓ 0.7 ± 2.6 %), fat mass (↓−1.5 ± 8.4 % and waist circumference (↓−1.7 ± 2.9 %) (P < 0.001). • Significant decrease of DBP (−1.8 ± 8.9 %,) and a marginal reduction of systolic pressure (−1.3 ± 7.2 %, P = 0.075). • LDL cholesterol had decreased by 3.0 ± 13.5 % (P = 0.026).
Michael, 2021⁷	Cyprus	Randomized controlled study	To test the effects of walking up and down stairs at home on a range of CVD and MetS risk factors	52 sedentary females (18–45 years) from four different Cyprus companies	• Three interventions: (1) home based stair climb (10 floors of climbing), (2) gym based stair climb (Leekon stair machine – 50 steps/min, 143 steps, 2–5 bouts/day); (3) control • 5 days a week for period of 8 weeks. • progressed till 5 ascents per day in the last two weeks	• Fat percentage: 7 skinfold • VO2 max: 20 m shuttle run • Leg power: counter movement jump • Metabolic fitness: TC, TG, VLDL, Glucose, HDL	• significantly increased aerobic fitness (VO2 max and lactate) in stir climb group • Slight increase of jump height in CMJ in experimental group (p ≤ 0.01) • HDL ↑ and VLDL ↓ • Home-based stair climbing was responsible for lowering fasting blood glucose (p = 0.03)
Mir, 2017²⁸	Malaysia	Non-randomised controlled study	To compare the effectiveness of 4 weeks stair climbing intervention with walking on cardiometabolic outcomes	• 37 young adults (18–25 years) • Healthy with no apparent illness • living a sedentary lifestyle.	• Three interventions: (1) full stair climb (7 floors, 14 flights); (2) half stair climb (3.5 floors, 7 flights) and one-mile treadmill walk • Self-selected speed • Twice day, 5 days a week and 4 weeks	• Physical fitness index from Harvard step test • Absolute VO2 from Astrand Rhyming	• Significant improvement in VO2 max (11.66 ml/kg/min) in full stair climb while no significant difference in other two groups • No statistical difference in the physical fitness index within and between groups • significant reduction (p < 0.005) in time taken to complete the intervention in the all three groups
Ozaki, 2019²⁹	Japan	Experimental study	To explore the additive effects of stair-climb to routine walk program on muscle thickness and strength.	• 15 elderly participants (age >65 years) • free of any overt chronic disease, • not past or current smokers, • not taking any medications	• Two interventions: (1) walking alone; (2) walking + stair climb • 17 weeks progressive walking (self selected speed initially progressing to 65–80 % HRR during final weeks • Walk + stair group had additional incremental step training	• Muscle thickness of right thigh and lower leg– ultrasound scans • MVC knee extensors and flexors – Takei dynamometer • 10 m timed walk test	• Except lower leg, thigh muscle thickness improved within condition • After 6 weeks, knee flexion and extension strength improved • No interaction effects between group x time was noted • Stair climbing did not provide additional training effects
Paschalis, 2013³⁰	Cyprus	Parallel group controlled trial	To compare the effect of two sessions of stair descending versus stair ascending exercise on muscle performance and health-related parameters in young healthy men	• Twenty males • Not taking any medications	• Two interventions: (1) a stair descending group and (2) a stair ascending group • Automatic escalator device • 5 min stair climbing/bout, 5 bouts/day • Speed was set at 60 steps/min	• Creatinine kinase (index of muscle damage) • Isometric knee extensor – isokinetic dynamometer • Blood chemistry: insulin sensitivity, blood lipid profile and redox status • during 1st session and 2nd session interspersed with 3 weeks.	• Significant interaction for ROM, torque and DOMS • Insulin resistance due to muscle damage due to bout 1 • Bout 1 of ascending or descending stair climb causes more muscle damage • Successive stair climbs positively influence insulin sensitivity and lipid profile • stair descending exercise systematically caused greater elevations in insulin sensitivity indices compared to stair ascending exercise.
Rafiei, 2020³¹	Canada	Randomised cross over study	to investigate brief stair climbing exercise “snacks” could lower postprandial insulin, glucose, and free fatty acids responses during prolonged sitting	N = 22 (12 healthy weight, 11 overweight)	completed two interventions: 1) sedentary (9-h sitting) and 2) stair climbing snacks (8 × 15–30 s once per hour).	• Salivary insulin - total insulin area under the curve	Healthy weight • no significant differences between conditions for total (9-h) insulin AUC (P = 0.24, d = 0.4), total glucose AUC (P = 0.17, d = 0.48), total non-esterified fatty acid AUC (P = 0.22, d = 0.4), or total TG AUC (P = 0.72). Overweight • total insulin AUC (−16.5 %, P = 0.036, d = 0.94) and total NEFA AUC (−21 %, P = 0.016, d = 1.2) were significantly lower in SS versus SED. • No differences were found for total glucose and triglyceride AUC (all, P > 0.31)
Takaishi, 2012³²	Japan	Non-randomised cross over study	To explore the effectiveness of stair climb interventions on postprandial glucose in glucose impaired participants	11 healthy participants. Not engaging in regular and strenuous ex.	Two visits: (1) STAIR: stair climbing visit: 80–110 steps/min (moderate intensity corresponding to 60 % HRR and 13 RPE); (2) WALK: self selected walk speed on 650 m course for 2 h for 6 min at 90th min	• Blood glucose, insulin lactate by immunoassay • Energy expenditure by equations	• At 90th min, no diff in glucose levels between WALK and stair • At 105th min, blood glucose levels lower in STAIR compared to WALK • STAIR reduced by 2.5 mmol/dl and WALK reduced by 0.7 mmol/dl • Blood lactate increased after STAIR compared to WALK
Takaishi, 2014¹⁵	Japan	Narrative review	To summarize the studies that have investigated the effects of stair-ascending exercise	Inference • Eight studies (1975–2010). • Work intensity on stairs was found to be similar to that of uphill treadmill walk and loaded bicycle training • Oxygen consumption was estimated for the stair climbing bouts • CRF and metabolic fitness can be improved by accumulating bouts of short-duration exercise with stairs • VO2 for ascending = 33 ml/kg/min while ascending and descending exercise is 19.2 ml/kg/min • 5 min stair climbing exercise reduced the blood glucose concentration by 60 mg/dl (3.3 mmoL/l) • stair climbing improves CVD health and fitness, but should be prescribed for elderly with caution
Takaishi, 2017³³	Japan	Experimental cross over trial	to confirm acute effect of stair exercise on postprandial hyperglycaemia by comparing it cycle exercise performed at the same workload	• 7 T2DM and 7 IGT patients • Not having microvascular complications or antihypertensive medications	Two visits: (1) ST-EX: descending stair (60–65 % HRR, RPE – 13–14), 21 steps, 8–10 reps; STEP RATE – 80–110 (2) Bi-EX: 50–60 reps/minute progressing to predetermined workload	• Finger prick glucose • HbA1C antecubital • Lactate at 90 min • 4th day Douglas bag – gas analysis (RER) • Blood glucose insulin - immunoassay	• blood glucose level ↓ between 90 and 105 min after a meal was significantly greater for ST-EX (−4.0 ± 0.7 mmol/L) than for BI-EX (−2.7 ± 0.9 mmol/L). • Serum insulin levels did not differ between the groups. • VO2 max for ST-EX was ↑ than that for BI-EX, • Lactate level and RER for ST-EX were ↓ than BI-EX.
Whittaker AC, 2021⁸	Netherlands	Secondary analysis study	to explore the association between stair climbing and the metabolic syndrome.	• 782 participants (423F) • Dutch Famine Birth Cohort	Nurses enquired the exposure of “Do you climb stairs daily?’ (yes/no)”	• TG and HDL (enzymatic colorimetric methods) • glucose levels (photometric assay) • waist circumference, BP through sphygmanometer • Composite scores for Metabolic syndrome (MetS)	• who did not climb stairs daily were at greater risk for MetS (OR = 1.90), • the components affected high blood glucose, (OR = 1.73), TG (OR = 1.49) and BP (OR = 1.50).
Yamaji, 2021³⁴	Japan	Cross sectional study	To explore the relation between daily stair climbing activity and vascular function	• 374 patients with hypertension (67–73 years) • Underwent health checkup at university	Three groups based on their daily stair climbing habit: no stairs group, climbing stairs to the 2nd-floor group, and climbing stairs to the ≥3rd-floor group	• Endothelial function (FMD): doppler (brachial artery) • Vascular smooth muscle function was assessed through response to nitro-glycerine	• FMD (3.3 %) ↑ in stair group >3 floors compared to stair <2 floors and no stair group • ↓NID seen in no stairs (7.4 %) group compared to < 2 floors (10.9 %) and >3 floors (11.3 %) • Endothelial function impaired in no stair group

Abbreviations: ASE, ascending stair exercise; AUC, area under curve; BMI, body mass index; BMD, bone mineral density; BP, blood pressure; CK, creatinine kinase; CRF, cardiorespiratory fitness; CVD, cardiovascular disease; DEXA, dual X-ray absorptiometry; DOMS, delayed onset muscle soreness; DSE, descending stair exercise; F, female; FMD, flow mediated dilation; HbA1C, glycated haemoglobin; HDL-C, high density lipoprotein cholesterol; HOMA, IR, insulin resistance; HR, heart rate; IL, interleukin; LDL-C, low density lipoprotein cholesterol; M, male; MVC, maximal voluntary contraction; NEFA, non-esterified fatty acids; NID, nitro-glycerine induced dilation; OR, odds ratio; OW, overweight; ROM, range of motion; TG, triglycerides; TC, total cholesterol; TNF, α, tumor necrosis factor; VAS, visual analogue scale; VO2 max, maximal oxygen consumption.