Cardiovascular Fitness Procedures Manual

Cardiovascular Fitness Procedures Manual January 2005 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF CARDIOVASCULAR FITNESS.......................................... 1-1 1.1 Cardiovascular Fitness in NHANES................................................... 1-1 1.2 Personnel............................................................................................. 1-2 1.3 Integrated Survey Information System (ISIS) .................................... 1-2 2 EQUIPMENT/SUPPLIES/MATERIALS ......................................................... 2-1 2.1 Quinton MedTrack ST65 Treadmill with Hyperdrive ........................ 2-1 2.1.1 Maintenance of the Treadmill ............................................. 2-2 2.1.2 Calibration of the Treadmill................................................ 2-5 2.2 Quinton MedTrack ST Programmable Controller .............................. 2-6 2.2.1 Maintenance of the Programmable Controller .................... 2-8 2.2.2 Calibration of the Programmable Controller....................... 2-8 2.3 Colin STBP-780 Automatic Blood Pressure Monitor ........................ 2-10 2.3.1 Maintenance of the Automatic Blood Pressure Monitor..... 2-11 2.3.2 Calibration of the Automatic Blood Pressure Monitor ....... 2-12 2.3.3 Mercury Manometer (Used for Calibration) ....................... 2-14 2.3.4 Mercury Spills and Leaks.................................................... 2-15 2.4 SECA Floor Scale Model 815 ............................................................ 2-16 2.4.1 Maintenance and Calibration of the Floor Scales ............... 2-17 2.5 SECA Portable Stadiometer Model 222 ............................................. 2-18 2.5.1 Maintenance and Calibration of the Stadiometer................ 2-18 2.6 Description of Supplies....................................................................... 2-19 2.6.1 ECG Electrodes/Alcohol Prep Pads/Abrasive Pads ............ 2-19 2.6.2 Running Shoes .................................................................... 2-19 2.6.3 Mesh Vests.......................................................................... 2-19 2.7 Repair of Equipment........................................................................... 2-20 2.8 Equipment Manuals ............................................................................ 2-20 iii TABLE OF CONTENTS (continued) Chapter Page 2.9 Troubleshooting.................................................................................. 2-21 2.9.1 Quinton MedTrack ST 65 Treadmill and Controller........... 2-21 2.9.2 Colin STBP-780 Blood Pressure Monitor........................... 2-22 3 PROTOCOL ...................................................................................................... 3-1 3.1 Exclusions to the CV Fitness Component .......................................... 3-1 3.1.1 Shared Exclusion Questions................................................ 3-1 3.1.2 Medical History................................................................... 3-2 3.1.3 Medications......................................................................... 3-3 3.1.4 Be All Question................................................................... 3-4 3.1.5 Exclusions Based on Heart Rate and Blood Pressure ......... 3-5 3.2 Introduction to Component................................................................. 3-5 3.3 Measurement of Height and Weight to Determine Body Mass Index ................................................................................................... 3-6 3.3.1 Height.................................................................................. 3-7 3.3.2 Weight................................................................................. 3-7 3.4 Checking SP’s Footwear..................................................................... 3-9 3.5 Determination of Physical Activity Readiness Code.......................... 3-10 3.5.1 Questions to Determine PAR Code: English Version......... 3-10 3.5.2 Questions to Determine PAR Code: Spanish Version ........ 3-13 3.6 Determination of Predicted VO2 Max................................................ 3-14 3.7 Determination of Exercise Protocol.................................................... 3-15 3.8 Preparation for Treadmill Test............................................................ 3-15 3.8.1 Preparation of Skin and Placement of Electrodes ............... 3-16 3.8.2 Selection of Arm for Blood Pressure Monitoring ............... 3-17 3.8.3 Selection of Cuff Size and Placement of Cuff .................... 3-18 3.8.4 Room Temperature.............................................................. 3-18 3.8.5 Mesh Vest ........................................................................... 3-19 3.9 Treadmill Test..................................................................................... 3-19 3.9.1 Setup of Colin STBP Automatic BP Monitor ..................... 3-19 iv TABLE OF CONTENTS (continued) Chapter Page 3.9.2 Setup of Programmable Controller and Treadmill.............. 3-20 3.9.3 Obtaining Pretest Blood Pressure and Heart Rate............... 3-21 3.9.4 Script for Explaining Treadmill Test .................................. 3-22 3.9.5 Demonstrating How to Walk on a Treadmill ...................... 3-23 3.9.6 Warm-up (00:00 - 02:00 Minutes) ...................................... 3-24 3.9.7 RPE Explanation and Assessment....................................... 3-24 3.9.8 Stage 1 (00:00 - 03:00 Minutes).......................................... 3-26 3.9.9 Stage 2 (00:00 - 03:00 Minutes).......................................... 3-27 3.9.10 Recovery Stages 1, 2, & 3 (If Necessary) ........................... 3-29 3.9.11 End of Test .......................................................................... 3-30 3.10 Procedure if Values Exceed Criteria................................................... 3-30 3.10.1 Exception for RPE Greater Than 17 at End of Stage 2....... 3-31 3.11 Procedure if SP is Unable to Adhere to the Protocol.......................... 3-32 3.12 Procedure to Change Predicted Exercise Protocol.............................. 3-32 3.12.1 Increasing the Exercise Protocol......................................... 3-34 3.12.2 Decreasing the Exercise Protocol........................................ 3-35 3.12.3 Changing Exercise Protocol During Warm-up ................... 3-35 3.12.4 Monitoring the Heart Rate During Stage 1 ......................... 3-37 3.12.5 Monitoring the Heart Rate during Stage 2 .......................... 3-38 3.13 Procedure to Stop Treadmill Test Early.............................................. 3-39 3.13.1 Priority 1 Stopping Criteria................................................. 3-39 3.13.2 Priority 2 Stopping Criteria................................................. 3-41 3.14 Procedure to Recover/Restart an Exam .............................................. 3-42 3.15 Recording Problems with Data Acquisition During the Treadmill Test ..................................................................................................... 3-43 3.16 Component Status............................................................................... 3-43 4 INTEGRATED SURVEY INFORMATION SYSTEM (ISIS) DATA ENTRY SCREENS............................................................................................ 4-1 4.1 Shared Exclusion Questions ............................................................... 4-1 4.2 Height and Weight Measurements to Determine BMI ....................... 4-3 4.2.1 Edits on Data Entry for Weight and Height ........................ 4-5 v TABLE OF CONTENTS (continued) Chapter Page 4.3 Questions to Determine Exercise Protocol (PAR Code Questions) ... 4-10 4.3.1 First Level Questions .......................................................... 4-12 4.3.2 Second Level Questions (Little or No Regular Physical Activity) .............................................................................. 4-13 4.3.3 Second Level Questions (Regular Modest Physical Activity) .............................................................................. 4-14 4.3.4 Second Level Questions (Regular Heavy Physical Activity) .............................................................................. 4-16 4.3.5 Required Data Entry for PAR Questions ............................ 4-18 4.4 Pretest Measurements ......................................................................... 4-19 4.4.1 Digital Thermometer for Measuring Room Temperature ... 4-20 4.4.2 Exam Preparation –Arm Used, Cuff Size, Mesh Vest Used 4-21 4.4.3 Capturing Blood Pressure Measurements ........................... 4-27 4.4.4 Demonstrating and Explaining How to Walk on a Treadmill............................................................................. 4-28 4.4.5 Required Data Entry for Arm and Cuff Size....................... 4-29 4.4.6 Required Data Entry for BP Measurements........................ 4-30 4.5 Treadmill Test..................................................................................... 4-31 4.5.1 Function of Treadmill Test Screen...................................... 4-31 4.5.2 Preparing the Treadmill and Controller .............................. 4-34 4.5.3 Getting the SP on the Treadmill.......................................... 4-35 4.5.4 Warm-up ............................................................................. 4-36 4.5.5 Show Data ........................................................................... 4-39 4.5.6 Stage 1................................................................................. 4-40 4.5.7 Stage 2................................................................................. 4-49 4.5.8 Recovery Stages.................................................................. 4-52 4.5.9 Checking Estimated VO2 Max ........................................... 4-53 4.5.10 Component Status for Routine Test .................................... 4-54 4.6 Changing the Exercise Protocol.......................................................... 4-55 4.6.1 Changing the Treadmill Controller ..................................... 4-55 4.6.2 Decreasing the Exercise Protocol........................................ 4-56 4.6.3 Increasing the Exercise Protocol......................................... 4-58 4.6.4 Lowest and Highest Protocol .............................................. 4-60 4.7 Emergency Stop.................................................................................. 4-63 4.8 Priority 1 Stopping Criteria................................................................. 4-64 vi TABLE OF CONTENTS (continued) Chapter Page 4.9 Early Termination of Test – Go to Recovery...................................... 4-67 4.9.1 Data Not Within Acceptable Limits.................................... 4-68 4.10 Priority 2 Stopping Criteria................................................................. 4-77 4.11 Combination of Priority 1 & 2 Stopping Criteria ............................... 4-80 4.12 Problems With Data Acquisition During Treadmill Test ................... 4-81 4.13 Component Status Categories............................................................. 4-84 4.13.1 Complete ............................................................................. 4-84 4.13.2 Partial .................................................................................. 4-85 4.13.3 Not Done ............................................................................. 4-91 5 REFERRALS AND REPORT OF FINDINGS ................................................. 5-1 5.1 Observation Referrals ......................................................................... 5-1 5.2 Report of Findings for CV Fitness...................................................... 5-3 6 QUALITY CONTROL...................................................................................... 6-1 6.1 Overview............................................................................................. 6-1 6.2 Training............................................................................................... 6-1 6.2.1 Initial Training .................................................................... 6-1 6.2.2 Annual Retraining ............................................................... 6-2 6.3 Equipment and Room Set-up Checks ................................................. 6-3 6.3.1 Daily.................................................................................... 6-3 6.3.2 Weekly ................................................................................ 6-4 6.3.3 Stand.................................................................................... 6-5 6.4 Data Entry Screens for QC on Equipment.......................................... 6-6 6.4.1 Quality Control Reminder Message Box ............................ 6-6 6.4.2 Utilities Menu to Select Quality Control............................. 6-7 6.4.3 Quality Control Logon Box ................................................ 6-7 6.4.4 Data Entry Screen for QC Daily Checks............................. 6-8 6.4.5 Data Entry Screen for QC Weekly Checks ......................... 6-12 6.4.6 Data Entry Screen for QC Start of Stand Checks................ 6-16 6.4.7 Incomplete Entry of Quality Control Data.......................... 6-18 vii TABLE OF CONTENTS (continued) Chapter Page 6.5 Observational Visits............................................................................ 6-18 6.5.1 Technician Competency Evaluation Form.......................... 6-19 6.5.2 Quality Control Review of CV Fitness exclusions in Physician's Exam................................................................. 6-24 6.5.3 Site Visit Report Form ........................................................ 6-26 List of Appendixes Appendix A SCRIPTS............................................................................................................ A-1 B EXCLUSIONS BASED ON MEDICAL CONDITIONS ................................. B-1 C EXCLUSIONS BASED ON MEDICATIONS ................................................. C-1 D PHYSICAL ACTIVITY READINESS CODE ................................................. D-1 E REVIEW OF EDIT CRITERIA ........................................................................ E-1 F CALCULATION OF PREDICTED V02 MAX................................................ F-1 G CALCULATION OF ESTIMATED V02 MAX ............................................... G-1 H DETERMINATION OF EXERCISE PROTOCOL .......................................... H-1 I REFERENCE RANGES FOR V02 MAX......................................................... I-1 J SPEED AND GRADE TABLE BY PROTOCOL AND STAGE..................... J-1 K SAMPLE DATA ENTRY SCREENS............................................................... K-1 List of Tables Table 2-1 Troubleshooting problems with the Quinton Med Track ST65 Treadmill and Controller ................................................................................... 2-21 2-2 Troubleshooting problems with the STBP monitor ........................................... 2-22 viii TABLE OF CONTENTS (continued) List of Figures Figure Page 2-1 Quinton MedTrack ST65 Treadmill .................................................................. 2-1 2-2 Treadmill calibration.......................................................................................... 2-4 2-3 Calibration of elevation ..................................................................................... 2-6 2-4 Quinton MedTrack ST Programmable Controller ............................................. 2-7 2-5 Colin STBP-780 Automatic Blood Pressure Monitor........................................ 2-11 3-1 Correct body placement for height measurement .............................................. 3-8 3-2 Site for placement of electrodes (1)................................................................... 3-16 3-3 Site for placement of electrodes (2)................................................................... 3-18 3-4 Treadmill controller - changing the exercise protocol....................................... 3-34 5-1 Menu to select observation referral.................................................................... 5-1 5-2 Pick list of SP’s in current session..................................................................... 5-2 5-3 Observation referral in CV Fitness .................................................................... 5-2 5-4 Observation Referral from CV Fitness in physician’s referral review box ....... 5-3 List of Exhibits Exhibit 3-1 CV Review for Exclusion Medications ............................................................. 3-4 4-1 Shared Exclusions disabled from previous component ..................................... 4-1 4-2 Blood Pressure Section Status from Physician .................................................. 4-2 4-3 Weight and height measurements from body composition................................ 4-3 4-4 Weight and height measurements in CV Fitness room...................................... 4-4 ix TABLE OF CONTENTS (continued) List of Exhibits (continued) Exhibit Page 4-5 Edit message on incorrect data entry for weight................................................ 4-5 4-6 Edit message on incorrect data entry for weight (below edit range).................. 4-6 4-7 Edit message on incorrect data entry for height................................................. 4-7 4-8 Required data entry for height and weight......................................................... 4-8 4-9 Cannot calculate VO2 max ................................................................................ 4-8 4-10 Partial status with comment ‘Other, specify’..................................................... 4-9 4-11 Questions to determine protocol ........................................................................ 4-10 4-12 First level questions to determine exercise protocol.......................................... 4-12 4-13 Little or no regular physical activity (second level questions) .......................... 4-13 4-14 Regular modest physical activity (second level questions) ............................... 4-14 4-15 Second level questions (regular heavy physical activity) .................................. 4-16 4-16 Required data entry for first level activity questions ......................................... 4-18 4-17 Pretest measurements......................................................................................... 4-19 4-18 Unable to obtain room temperature ................................................................... 4-20 4-19 Exam preparation – arm selected....................................................................... 4-21 4-20 SP excluded if neither arm can be used for BP measurement ........................... 4-22 4-21 SP excluded due to physical limitation.............................................................. 4-22 4-22 Partial status with physical limitation if CNO selected for arm......................... 4-23 4-23 Selection of cuff size.......................................................................................... 4-24 4-24 Problem with cuff size ....................................................................................... 4-25 x TABLE OF CONTENTS (continued) List of Exhibits (continued) Exhibit Page 4-25 Mesh vest used................................................................................................... 4-26 4-26 Blood pressure data capture............................................................................... 4-27 4-27 Demonstrate and explain how to walk on a treadmill........................................ 4-28 4-28 Required data entry for arm and cuff used......................................................... 4-29 4-29 Required data entry for blood pressure.............................................................. 4-30 4-30 Treadmill test data entry screen ......................................................................... 4-31 4-31 Preparing the treadmill and controller ............................................................... 4-34 4-32 Starting the timer ............................................................................................... 4-36 4-33 Explaining the rating of perceived exertion (RPE)............................................ 4-37 4-34 Getting RPE for warm-up .................................................................................. 4-38 4-35 Show data window............................................................................................. 4-39 4-36 Show data message ............................................................................................ 4-39 4-37 Treadmill test stage 1 – routine test ................................................................... 4-40 4-38 Get rating of perceived exertion (RPE) ............................................................. 4-41 4-39 Compare heart rate on monitor and screen ........................................................ 4-42 4-40 Example 1 – manually entered heart rate - not necessary.................................. 4-43 4-41 Show data screen for Example 1........................................................................ 4-44 4-42 Example 2 – manually entered heart rate - necessary........................................ 4-44 4-43 Show data window for Example 2..................................................................... 4-45 4-44 Example 3 - manually entered heart rate - incorrect data entry ......................... 4-46 xi