Cardiovascular Fitness Procedures Manual

256 Pages·2005·8.14 MB·English

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