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Background: Physical inactivity negatively affects health and is associated with type 2 diabetes, cardiovascular disease, cognitive dysfunction and shorter life span. Despite the growing body of evidence for detrimental effects, the population is increasingly sedentary and currently sitting nine to ten hours per day

the pattern is seen across all age groups. This harmful development must be mitigated to combat the increasing epidemic of lifestyle-related diseases in society. Stair walking has the potential to incentivize people to be more physically active seamlessly integrated into everyday life. Objectives: To investigate whether six months of daily stair walking (200 stair steps daily) in addition to walking on level ground (75 minutes per week) versus only walking on level ground (150 minutes per week) - in a time-effective manner - confers greater blood pressure reduction as well as greater improvement in aerobic fitness, strength, cardiovascular risk factor control and self-assessed health parameters. Work plan: Study subjects will be screened for inclusion through an online screening tool. Participants are both men and women 40-70 years old with increased cardiometabolic risk defined by hypertension, abdominal obesity and sedentary lifestyle (less than 4000 steps per day). Study subjects (n=400) will be randomized into two groups: 1) daily stair walking plus half the weekly recommended walking on level ground and 2) recommended weekly walking on level ground alone. Activity levels will be monitored regularly. Subjects will be followed for six months. Measured outcomes are blood pressure, aerobic fitness, strength, cardiovascular risk factor control and self-assessed health parameters. Significance: If stair walking is a feasible and time-effective physical activity it could improve individual health through a simplistic training alternative that can be seamlessly integrated into everyday life. It could inform infrastructure planning by ensuring that stairs are readily available and promoted for pedestrians. Healthcare costs could be decreased by keeping vulnerable groups more physically active thus reducing the growing burden of lifestyle-related diseases. Positive findings have population-level scalability and could corroborate the European Society of Cardiology s guidelines on both individual prevention and strong policy suggestions on physical activity when planning/building new landscaping.