APPENDIX B
SHARED/SAFETY EXCLUSION QUESTIONS
Shared Exclusion Questions
English Spanish
Do you have any amputations of your legs and feet
other than toes?
¿Tiene alguna amputación de las piernas y pies que
no sean los dedos de los pies?
Where is the amputation? ¿Se refiere a la cadera derecha, izquierda o las dos
caderas?
How much do you weigh without clothes or shoes? ¿Cuánto pesa sin ropa o zapatos?
Do you have a pacemaker or automatic
defibrillator?
¿Tiene un marcapaso o desfibrilador automático?Are you currently pregnant? ¿Está usted actualmente embarazada?
How many weeks? ¿Cuántas semanas?
Safety Exclusion Questions (Asked in Household Interview, if Yes, then confirmed by Physician)
English Spanish
CVQ030. Has a doctor ever said you have a heart
condition and that you should only do physical
activity recommended by a doctor?
CVQ040. Do you feel pain in your chest when you
do physical activity?
CVQ050. In the past month, have you had chest
pain when you were not doing any physical
activity?
CVQ060. Do you lose your balance because of
dizziness?
CVQ070. Do you ever lose consciousness?
CVQ080. Do you have a bone or joint problem that
could be made worse by walking?
CVQ165. Do you know of any other reason why
you should not walk on a treadmill?
BeAll Question (asked in Physician’s Exam or CV Fitness)
English Spanish
Since you were interviewed in your home on
{Household Interview Date} have there been any
changes in your health or medications that would
prevent you from walking on a treadmill for the
fitness test?