Health Examination Questionnaire and Pro Forma

International Project on Cardiovascular Disease in Russia

2015-2018

Published version 2.0 July 2018

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system.

The International Project on Cardiovascular Disease in Russia (IPCDR) project was funded in part by a Wellcome Trust Strategic Award [100217]. The project was also funded by the Arctic University of Norway, UiT in Tromsø; Norwegian Institute of Public Health; the Norwegian Ministry of Health and Social Affairs.

Development of the questionnaire was led by the London School of Hygiene & Tropical Medicine in collaboration with the Northern State Medical University, Arkhangelsk, Novosibirsk State Medical University, the Research Institute of Internal and Preventive Medicine - Branch of IC&G SB RAS, Novosibirsk and colleagues from other institutions.

This is a paper version of the questionnaire and proforma used for data collection although all data were collected electronically using data capture created using SURVANT (NETELIXIS IT SOLUTIONS 2015. SURVANT survey authoring and data collection software: version 1.0. http://www.survant.net.)

Further details about the study are available here: Cook S, Malyutina S, Kudryavtsev AV et al. Know Your Heart: Rationale, design and conduct of a cross-sectional study of cardiovascular structure, function and risk factors in 4500 men and women aged 35-69 years from two Russian cities, 2015-18 Wellcome Open Res 2018, 3:67 (doi: 10.12688/wellcomeopenres.14619.1)

Content

Module J. Registration/Last meal	4

Module K. Blood pressure measurement	5

Module R. Blood sample collection.	7

Module A. Cardiology history	9

Module B. Angina.	11

Module C. Medications.	14

Module D. General health	18

Module E. Respiratory	19

Module F. Other diseases	22

Module G. Questions for women	24

Module H. Alcohol consumption	27

Module I. Smoking	30

Module L. Anthropometry and body composition	31

Module O. ECG and Vicoder	33

Module O3. Actiheart	36

Module P4. Actiheart collection	38

Module M. Physical functioning tests	39

Module P. ECHO and vascular ultrasound	42

Module S. Spirometry	44

Module J	REGISTRATION/LAST MEAL

J1. J2.	When was the last time that you ate or drank, apart from water? «____»___________20___y (DATE) Record time of last meal. Please use 24 hour clock _______:_______
J3.	What did you eat?
Snack 1 A full meal 2 Only drink 3
Difficult to answer 97
Refuse to answer 98

Stress the importance of accuracy to the participant. Now I will ask you some questions about your food and drink today. This can affect the results of some tests so it is important to be as accurate as possible.

J4.	Did you drink anything during the previous 4 hours?
Yes	1
No	2	Go to J6
Difficult to answer	97	Go to J6
Refuse to answer	98	Go to J6
J5.	What did you drink? (Please indicate all that apply)
Any alcoholic drinks	1
Coffee, black tea, coca-cola, pepsi-cola,any drinks containing caffeine	2
Other	3
Have not been drinking during the previous 4 hours	4
Difficult to answer	97
Refuse to answer	98
J6.	Have you consumed alcohol drinks within the last 24 hours before the medical examination?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
Module K	BLOOD PRESSURE MEASUREMENT

I am now going to measure your blood pressure. Stress the importance of accuracy to the participant

K1.	Room temperature (to nearest 0.1ºC)
,	ºС
No measurement could be obtained	98
Blood Pressure Measurements Instructions. 1. Plug cable a into laptop 2. Start Blood Pressure software 3. Make three measurements leaving 2 minutes between each measurement. 4. Export measurement (to CSV)
K5.	File collection for Blood Pressure measurement Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.
K5a.	Interviewer-Blood Pressure Measurement successful, data exported and collected?
Yes	1
No	2 Go to K5b
K2.	Record which arm was used for measuring Blood Pressure. The arm for measuring blood pressure was…
Right	1
Left	2
K3.	Arm circumference (to nearest 0.1 cm)*
,	сm
No measurement could be obtained	98
K4.
Blood pressure cuff used
Small	1
Medium	2
Large	3
K5b.	Why Blood Pressure measurement was not successful? Participant refused Not applicable to participant Couldn't export data Couldn't collect data Other Go to K5c
K5c.	Please explain the reason why Blood Pressure measurement wasn’t successful____
K5d.	Please enter any comments you wish to enter on blood pressure section (for example if blood pressure was very high and needed to postpone the examination).
K14.	Oxygen saturation	%

Module R	BLOOD SAMPLE COLLECTION
T2_a.	Room temperature (to nearest 0.1ºC)
,	ºС
No measurement could be obtained	98

R1.	What was the blood sample body drawing site?
From right arm	1	Go to R3
From left arm	2	Go to R3
blood has not been drawn	3	Go to R3
blood was drawn from the other body site	4
R2.	Please, specify the blood sample body drawing site.
R3.	Was SST vacutainer 1 (8,5 ml) filled (with gold top)?
Yes, completely	1
Yes, partially	2
No	3
R4.	Was SST vacutainer 2 (8,5 ml) filled (with gold top)?
Yes, completely	1
Yes, partially	2
No	3
R5.	Was SST vacutainer 3 (8,5 ml) filled (with gold top)?
Yes, completely	1
Yes, partially	2
No	3
R6.	Was SST vacutainer 4 (8,5 ml) filled (with gold top)?
Yes, completely	1
Yes, partially	2
No	3
R7.	Was vacutainer (10 ml) with EDTA 1 filled (purple top)
Yes, completely	1
Yes, partially	2
No	3
R8.	Was vacutainer (6 ml) with EDTA 2 filled (purple top)
Yes, completely	1
Yes, partially	2
No	3
R9.	Real time start: _______:_______:_______

Module A	CARDIOLOGY HISTORY

A1.	Have you ever had your blood pressure measured by a doctor or other medical professional?
Yes	1
No	2 Go to A5
Difficult to answer	97
Refuse to answer	98
A2.	Have you ever been told by a doctor or nurse that you have high blood pressure?
Yes	1
No	2 Go to A5
Difficult to answer	97
Refuse to answer	98
A3.	Has a doctor prescribed drugs to control your blood pressure?
Yes	1
No	2 Go to A5
Difficult to answer	97
Refuse to answer	98
A4.	Do you take these drugs?
Every day	1
Only sometimes such as when I feel unwell	2
Never	3
Difficult to answer	97
Refuse to answer	98
A5.	Have you ever been told by a doctor or nurse that you have diabetes mellitus?
No	1 Go to A8
Yes, and I use insulin	2
Yes, and I control it with drugs	3
Yes, and I control it with diet only	4
Difficult to answer	97 Go to A8
refuse to answer	98 Go to A8
A6.	What type of diabetes did the doctor say you had?
Type 1 diabetes	1
Type 2 diabetes	2
Difficult to answer	97
Refuse to answer	98
A7.	At what age were you diagnosed with diabetes?________ Years
Difficult to answer	97 Re
Refuse to answer	98
A8.	Have you ever been told by a doctor that you have high cholesterol?
Yes	1
No	2
Difficult to answer	97 Re
Refuse to answer	98

Module B	ANGINA
B1.	Have you ever had any pain or discomfort in your chest?
Yes	1
No	2 Go to B11
Difficult to answer	97
Refuse to answer	98
B2.	Do you get this pain or discomfort in your chest when you walk uphill or hurry?
Yes	1
No	2 Go to B8
Never walk uphill or in a hurry	3
Difficult to answer	97
Refuse to answer	98
B3.	Do you get this pain or discomfort when you walk at an ordinary pace on the level?
Yes	1
No	2
Never walk at an ordinary pace on ground level	3
Difficult to answer	97
Refuse to answer	98
B4.	When you get any pain or discomfort in your chest, what do you do?
Stop	1
Slow down	2
Continue at the same pace	3
Difficult to answer	97
Refuse to answer	98
B5.	Does pain or discomfort in the chest go away when you stand still?
Yes	1
No	2 Go to B7
Difficult to answer	97 Go to B7
Refuse to answer	98 Go to B7
B6.	How soon does pain or discomfort in the chest go away?
10 minutes or less	1
More than 10 minutes	2
Difficult to answer	97
Refuse to answer	98
B7	Where do you get this pain or discomfort?
B8.	Have you ever had a severe pain across the front of your chest lasting for half an hour or more?
Yes	1
No	2	Go to B11
Difficult to answer	97	Go to B11
Refuse to answer	98	Go to B11
B9.	Did you see a doctor because of this pain?
Yes	1
No	2	Go to B11
Difficult to answer	97	Go to B11
Refuse to answer	98	Go to B11
B10.	What did he or she say it was?
Angina (ischemic heart disease)	1
Myocardial infarction	2
Something else	3
Did not say	4
Difficult to answer	97
Refuse to answer	98
B11.	Have you ever been told by a doctor that you have/had or been diagnosed with following diseases:
B11_1. Myocardial infarction/heart attack
Yes (and I was hospitalised)	1
Yes (but I was not hospitalised)	2
No	3
Difficult to answer	97
Refuse to answer	98
B11_2. Angina/ Ischemic Heart Disease
Yes (and I was hospitalised)	1
Yes (but I was not hospitalised)	2
No	3
Difficult to answer	97
Refuse to answer	98
B11_3. Cerebral stroke
Yes (and I was hospitalised)	1
Yes (but I was not hospitalised)	2
No	3
Difficult to answer	97
Refuse to answer	98
B11_4. Operations/interventions on the heart
Yes (and I was hospitalised)	1 Go to B11_4_4a
Yes (but I was not hospitalised)	2 Go to B11_4_4a
No	3 Go to B11_5
Difficult to answer	97
Refuse to answer	98
B11_4_4a. What operation did you have (choose all that apply)
Coronary artery bypass graft	1
Valve replacement	2
Implantation of stent in coronary arteries	3
Other	4
Difficult to answer	97
Refuse to answer	98
B11_5. Chronic Kidney Disease
Yes (and I was hospitalised)	1
Yes (but I was not hospitalised)	2
No	3
Difficult to answer	97
Refuse to answer	98
B11_6. Chronic disease of bronchi and lungs
Yes (and I was hospitalised)	1
Yes (but I was not hospitalised)	2
No	3
Difficult to answer	97
Refuse to answer	98
Module C	MEDICATIONS USE
C1.	Do you currently use any medications including inhalers?
Yes	1
No	2	Go to D1

Please, show the packaging of used medications. If there is no package, what are the names of used medications? What are the doses and frequency of used medications? Please include any inhalers. Interviewer! Please, register up to 7 used medications. Dose of medication refers to strength of medication e.g. mg per tablet. Don’t register ointments, creams, herbal infusions and food supplements.

Name of the medication	Dose (e.g. mg	Reason for taking	Number of units of medication used during one take	Frequency of use of medication
tablets / capsules/inhalers	Codes for frequency of use of medications: 01 daily 3 times a day 02 daily 2 times a day 03 daily once a day 04 3 times a week 05 2 times a week 06 once a week 07 fewer than once a week 08 not regularly, only when needed 97 difficult to answer 98 Refuse to answer
C2.	ml - injections
insulin units
drops
tablets / capsules/inhalers
C3.	ml - injections
insulin units
drops
tablets / capsules/inhalers
C4.	ml - injections
insulin units
drops
Name of the medication	Dose (e.g. mg	Reason for taking	Number of units of medication used during one take	Frequency of use of medication
tablets / capsules/inhalers	Codes for frequency of use of medications: 01 daily 3 times a day 02 daily 2 times a day 03 daily once a day 04 3 times a week 05 2 times a week 06 once a week 07 fewer than once a week 08 not regularly, only when needed 97 difficult to answer 98 Refuse to answer
C5.	ml - injections
insulin units
drops
tablets / capsules/inhalers
C6.	ml - injections
insulin units
drops
tablets / capsules/inhalers
C7.	ml - injections
insulin units
drops

C9.	Record whether medications were seen
Medications seen	1
Medications not seen, self-report only	2

C10. Please enter any comments you want to record on the cardiology questionnaire (for example participant had difficulty hearing and needed to see the screen).

Module D	GENERAL HEALTH

D1.	How do you rate your own health in general?
Very good	1
Good	2
Neither good, poor or bad	3
Poor	4
Very poor	5
Difficult to answer	97
Refuse to answer	98

Мodule E	RESPIRATORY
I now want to ask you some questions about your breathing
E1.	Do you usually cough first thing in the morning in winter? Stress the word “usually” to the participant.
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E2.	Do you usually cough during the day or at night in winter? Stress the word “usually” to the participant.
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E3.	If participant answered NO to E1 AND E2 do not ask this question Do you cough like this on most days for as much as three months each year?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E4.	Do you usually bring up phlegm from your chest first thing in the morning in winter? Stress the word “usually” to the participant.
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E5.	Do you usually bring up any phlegm from your chest during the day- or at night – in winter? Stress the word “usually” to the participant
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E6.	If participant answered NO to E4 AND E5 do not ask this question Do you bring up phlegm like this on most days for as much as three months each year?
Yes	1
No	2
Difficult to answer	97 98
Refuse to answer	98
E7.	Are you troubled by shortness of breath when hurrying on level ground or walking up a slight hill?
Yes	1
No	2	Go to E12
Difficult to answer	97
Refuse to answer	98
E8.	Do you get short of breath walking with people of your own age group on level ground?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E9.	Do you have to stop for breath when walking at your own pace on level ground?
Yes	1
No	2	Go to E12
Never walks at own pace on level ground	3
Difficult to answer	97
Refuse to answer	98
E10.	Do you have to stop for breath when walking about 100m or for a few minutes on level ground?
Yes	1
No	2	Go to E12
Never walks 100m	3
Difficult to answer	97
Refuse to answer	98
E11.	Do you get breathless while undressing or feel too breathless to leave your house?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E12.	Have you had attacks of wheezing or whistling in your chest at any time in the last 12 months?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
E13.	Have you at any time in the past 12 months been woken at night by an attack of shortness of breath?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98

Мodule F	OTHER DISEASES
I now want to ask you about problems with other body systems.
F1.	Do you have any diseases of the liver diagnosed by a physician?
Yes	1
No	2	Go to F 4
Difficult to answer	97	Go to F 4
Refuse to answer	98	Go to F 4
F2.	What are these diseases of liver? Please select all that apply.
Interviewer – if participant reports jaundice but no diagnosis code as “other”.
Hepatitis	1
Fatty liver disease	2
Cirrhosis	3
Liver cancer	4
Other	5
Difficult to answer	97
Refuse to answer	98
F3.	What did the physician tell you had caused your liver disease? Please select all that apply.
Alcohol	1
Being overweight	2
Virus	3
Other	4
Difficult to answer	97
Refuse to answer	98
F4.	Have you ever been diagnosed with cancer?
Yes	1
No	2	Go to F6
Difficult to answer	97	Go to F6
Refuse to answer	98	Go to F6

F5.	Please type in what part of the body was affected________________
Difficult to answer	97
Refuse to answer	98
F6.	During the past 12 months, have you ever gone to a doctor with any traumas / injuries? Interviewer! Here only physical, but not psychological traumas are assumed.
Yes	1
No	2	Go to section G for women or to section H for men
Difficult to answer	97	Go to section G for women or to section H for men
Refuse to answer	98	Go to section G for women or to section H for men
F7.	What were these traumas / injuries? Please select all that apply.
Fracture/broken bone	1
Bruising, sprain, dislocation	2
Cut/Open wound/ Bite	3
Concussion	4
Other	5
Difficult to answer	97
Refuse to answer	98

Мodule G	QUESTIONS ONLY FOR WOMEN

Please establish the gender of the participant as it will determine which questions will be asked next (the section following is for female participants only and will be skipped for male participants). If participant is male go to Section H.

G1.	Have you ever been pregnant?
Yes	1
No	2 Go to G6
Difficult to answer	97
Refuse to answer	98
G2.	How many pregnancies did you have? Enter number of times pregnant.
Difficult to answer	97
Refuse to answer	98
G3.	In total during your life, how many of the following have you had?
Live births
Still births (28 weeks+)
Miscarriages (less than 14 weeks)
Miscarriages (14-27 weeks)
Difficult to answer	97
Refuse to answer	98
G4.	Are you currently pregnant, or think you may be pregnant?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
G5a.	During any of your past pregnancies or your current pregnancy, have you ever been told by a doctor you had/have high blood pressure in pregnancy (Hypertension in pregnancy)?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
G5b.	During any of your past pregnancies or your current pregnancy, have you ever been told by a doctor you had/have Gestational Diabetes revealed during pregnancy?
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
G5c.	During any of your past pregnancies or your current pregnancy, have you ever been told by a doctor you had/have Pre-eclampsia? Pre-eclampsia - a complication during pregnancy, the patient shows a significant increase in blood pressure, swelling and appearance of seizures with loss of consciousness.
Yes	1
No	2
Difficult to answer	97
Refuse to answer	98
G6.	About how old were you when you had your first menstrual period?
Years
Difficult to answer	97
Refuse to answer	98
G7.	In the past 12 months have you had a period or menstrual bleeding?
Yes	1 Go to G9
No	2
Difficult to answer	97
Refuse to answer	98
G8.	If you have not had a period in the last 12 months were your periods stopped by:
Surgery	1
Chemotherapy or radiation therapy	2
Pregnancy or breastfeeding	3
Natural stop/ menopause	4
Other	5
Difficult to answer	97
Refuse to answer	98
G9.	When was your last period?
Year Month
Difficult to answer	97
Refuse to answer	98
G9a.	If you cannot remember the month and year please give your age at the time. ______Years.
Difficult to answer	97
Refuse to answer	98
G10.	Have you ever taken Hormone Replacement Therapy (HRT)?
Interviewer – this question does not refer to hormones used for contraception. You should clarify this for participants if they ask
Yes	1
No	2 Go to Section H
Difficult to answer	97
Refuse to answer	98
G11.	When did you first start HRT (hormone replacement therapy)?
Year Month
Difficult to answer	97
Refuse to answer	98
G11a.	Years Years If you cannot remember the month and year please give your age at the time. Please enter age in years.
Difficult to answer	97
Refuse to answer	98
G12.	Are you currently on HRT (hormone replacement therapy)?
Yes	1 Go to Section H
No	2
Difficult to answer	97
Refuse to answer	98
G13.	When did you stop taking HRT (hormone replacement therapy)?
Year Month
Difficult to answer	97
Refuse to answer	98
G13a.	Years If you cannot remember the month and year please give your age at the time. Please enter age in years.
Difficult to answer	97
Refuse to answer	98
Мodule H	ALCOHOL CONSUMPTION

Now I am going to ask you some questions about your use of alcoholic beverages in the past year. Because alcohol use can affect many areas of health (and may interfere with certain medications), it is important for us that you will be as accurate as you can be.

In this section we ask about drinks or ‘portions’. One drink/portion of alcohol is 10 g ethanol and is equal to: SHOW FLASH CARD

-250 ml non-strong beer (4-6% ABV)

-150 ml strong beer (7-9% ABV)

-100 ml normal/table wine

- 60 ml fortified wine

-30 ml vodka or other strong spirit

H1.	How often do you have a drink containing alcohol?
Never	1 Go to H9
Monthly or less	2
2-4 times per month	3
2-3 times per week	4
4 or more times per week	5
Difficult to answer	97
Refuse to answer	98
H2.	How many drinks (portions) containing alcohol do you have on a typical day when you are drinking?
1 or 2	1
3 or 4	2
5 or 6	3
7, 8 or 9	4
10 or more	5
Difficult to answer	97
Refuse to answer	98
H3.	How often do you have six or more drinks on one occasion? Interviewer - Remind participant 6 portions is equal to approximately 3 x 500ml cans of beer, 3 large (200ml) glasses of wine or 180ml of vodka (3.5 x 50ml glasses).
Never	1
Less than monthly	2
Monthly	3
Weekly	4
Daily or almost daily	5
Difficult to answer	97
Refuse to answer	98
H4.	How often during the last year have you found that you were not able to stop drinking once you had started?
Never	1
Less than monthly	2
Monthly	3
Weekly	4
Daily or almost daily	5
Difficult to answer	97
Refuse to answer	98
H5.	How often during the last year have you failed to do what was normally expected of you because of drinking?
Never	1
Less than monthly	2
Monthly	3
Weekly	4
Daily or almost daily	5
Difficult to answer	97
Refuse to answer	98
H6.	How often during the last year have you needed a drink first thing in the morning to get yourself going after a heavy drinking session?
Never	1
Less than monthly	2
Monthly	3
Weekly	4
Daily or almost daily	5
Difficult to answer	97
Refuse to answer	98
H7.	How often during the last year have you had a feeling of guilt or remorse as a result of your drinking?
Never	1
Less than monthly	2
Monthly	3
Weekly	4
Daily or almost daily	5
Difficult to answer	97
Refuse to answer	98
H8.	How often during the last year have you been unable to remember what happened the night before because of your drinking?
Never	1
Less than monthly	2
Monthly	3
Weekly	4
Daily or almost daily	5
Difficult to answer	97
Refuse to answer	98
H9.	Have you or someone else been injured because of your drinking?
No	1
Yes, but not in the last year	2
Yes, during the last year	3
Difficult to answer	97
Refuse to answer	98
H10.	Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
No	1
Yes, but not in the last year	2
Yes, during the last year	3
Difficult to answer	97
Refuse to answer	98

Мodule I	SMOKING

Now I ask you some questions about smoking.

I1.	Are you a current smoker?
Never smoked	1	Go to J1
No, ex-smoker	2
Yes, a regular smoker	3	Go to I3
Yes, I smoke but less that 1 cigarette per day	4	Go to I3
Difficult to answer	97	Go to I3
Refuse to answer	98	Go to J1
I2.	How many years ago did you stop smoking regularly? Please choose one answer.
Up to one year ago	1
More than 1, up to 5 years ago	2
More than 5, up to 10 years ago	3
More than 10 years ago	4
Difficult to answer	97
Refuse to answer	98	Go to J1
I3.	What do you smoke most often? Please choose one answer.
Cigarettes (papirosy)	1
Filtered cigarattes	2
Unfiltered cigarattes	3
Other (please specify)	4	____________
Difficult to answer	97
Refuse to answer	98
I4.	When you smoke/smoked, how many per day is/was usual?
Up to 10	1
More than 10, up to 20	2
More than 20	3
Not a regular smoker (<1 cigarette per day)	4	Go to J1
Difficult to answer	97
Refuse to answer	98
I5.	How old were you when you started smoking regularly? Years_______
Difficult to answer	97
Refuse to answer	98

I6. Please enter any comments you want to record on the questionnaire (for example, participant had difficulty hearing and needed to see the screen)__________

Мodule L	ANTHROPOMETRY AND BODY COMPOSITION
L1. Waist 1 (in cm to nearest mm)
,	cm
If measurement is not taken please insert zero (0) in the text field.
L2. Hip 1 (in cm to nearest mm)
,	cm
If measurement is not tken please insert zero (0) in the text field.
L3. Waist 2 (in cm to nearest mm)
,	cm
If measurement is not taken please insert zero (0) in the text field.
L4. Hip 2 (in cm to nearest mm)
,	cm
If measurement is not taken please insert zero (0) in the text field.
L5. Height 1 (in cm to nearest mm)
,	cm
If measurement is not taken please insert zero (0) in the text field.
L6. Height 2 (in cm to nearest mm)
If measurement is not taken please insert zero (0) in the text field.

L7.	Body composition measured. I am now going to use the Tanita Body Analyser. Tell the participant that the contradictions for body composition analysis are having a pacemaker and pregnancy. In the absence of contraindications and consent of the participants use the Tanita body composition analyser in standard mode. If there are contraindications or the participant refuses body composition analysis put the analyser in weight only mode and record weight. Please tell the participant that there are no risks for pregnant women or people with pacemakers when weight only mode on Tanita device is used.
Body composition analysis measured	1
Body composition analysis not carried out (pacemaker)	2
Body composition analysis not carried out (pregnant)	3
Body composition analysis not carried out (other reason)	4
If measurement is not taken please insert zero (0) in the text field. Collect data from Tanita in next question if answer is 1.
Collect the data file for the participant for the Tanita body analyzer. Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.
L7c.	Interviewer - was the measurement successfully taken, data exported and collected? Answer yes only if the data collection in the previous screen has been successful!
Yes	1
No	2	Go to L7d
L7d.	If no why was Tanita measurement not successful?
Participant refused	1
Not applicable to participant	2
Couldn’t export data	3
Couldn’t collect data	4
Other	5	Go to L7e
L7e.	Please explain reason why Tanita measurement wasn’t successful_______
L7b.	Weight 1 (to nearest 0.1 kg). If L7= 2,3,4
.	kg

Module О	ECG AND VICODER

T1.	Room Temperature (to nearest 0.1˚C).
,	ºС

I am now going to measure your heart activity with the Cardiax device.

Explain details to the participant if required. Proceed with setting up the equipment as required and proceed when ready.

Cardiax Measurement Instructions.

Plug cable a into laptop.

Start Cardiax software.

Place electrode on participant.

Take measurement.

Export measurement (to CSV).

Save electrocardiogram as PDF.

M1. Collect the data file(s) for the participant for the Cardiax measurement. Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.

M1_2. Collect the PDF file(s) for the participant for the Cardiax measurement.

O1a.	Was the measurement successfully taken, data exported and collected? Answer yes only if the data collection in the previous screen has been successful!
Yes	1
No	2 Go to O1b
M1ab.	Please give a brief explanation of the results from the Cardiax measurement.
O1b.	If no why Cardiax measurement was not successful?
Participant refused	1
Not applicable to participant	2
Couldn’t export data	3
Couldn’t collect data	4
Other	5 Go to O1c
O1c. Please explain reason why cardiax measurement wasn’t successful?______

Vicoder

T4.	Room Temperature (to nearest 0.1˚C)
,	ºС

I am now going to use the Vicorder Machine.

Explain details to the participant if required. Proceed with setting up the equipment as required and proceed when ready. Record three measurements of pulse wave velocity, 1 measure of blood pressure and three measures of pulse wave analysis.

O2e. Did the participant smoke in the past 3 hours?

Yes

No

O2f. Record the distance from the supra-sternal notch to the bottom of the neck cuff in cm to the nearest mm. Distance from supra-sternal notch to TOP of thigh cuff to be entered directly into Vicorder software.

cm

O2g. Record distance from shoulder at level of sternal notch to top of thigh cuff (only to be entered if participant has a protruding stomach) in cm to the nearest mm.

Distance from supra-sternal notch to TOP of thigh cuff to be entered directly into Vicorder software.

. cm

O2. Collect the data file for the participant for the Vicorder measurement. Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.

O2_1. Collect the data file for the participant for the Vicorder measurement. Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.

O2h. Was the femoral or carotid cuff repositioned at any point during vicorder examination?

Yes Go to O2_i

No Go to O2_b

O2i. If the cuff were repositioned please enter the new distance measured between the supra- sternal notch and the top of the thigh cuff.

cm

O2j. If the cuff were repositioned please enter the new distance measured between the supra- sternal notch and the bottom of the carotid cuff.

. cm

O2b.	Interviewer - Was the vicorder measurement successfully taken, data exported and collected? Answer yes only if the data collection in the previous screen has been successful!
Yes	1
No	2 Go to O2c
O2c.	Record reason vicorder measurement was not successful?
Participant refused	1
Not applicable to participant	2
Couldn’t export data	3
Couldn’t collect data	4
Other	5 Go to O2d
O2d.	Record reason why Vicorder measurement wasn’t successful.
O2k.	Please enter any comments you want to record on the vicorder examination.

Мodule О3	ACTIHEART
P5a.	Would you like to have an Actiheart device fitted and calibrated to measure your Physical activity?
Yes	1
No	2
Explain details to the participant if required. Proceed with setting up the equipment as required and proceed when ready. 200m self-paced walk test: Ensure participant is standing quiet and still at least 1min prior to walk test.
I am now going to set up the Actiheart Machine.
O4.	Real time start:	_______:_______
O5.	Duration of the test:	_______:_______
O6. Total number of completed laps:
O6a.	Distance on final lap in meters (In-complete laps only):
O7.	Was any walking aid used?
Yes	1
No	2 Go to O8
O7a.	What type (e.g frame/stick), specify ________
O8.	Comments:_______
I am now going to collect the Actiheart measurement Explain details to the participant if required. Proceed with setting up the equipment as required and proceed when ready. Collect the data file(s) for the participant for the Actiheart measurement. Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.
P5b.	Was the actiheart exercise measurement successfully taken, data exported and collected? Answer yes only if the data collection in the previous screen has been successful!
Yes	1 Go to P5e
No	2 Go to P5c
P5c.	Reason Actiheart measurement not successful:
Participant refused	1
Not applicable to participant	2
Couldn’t export data	3
Couldn’t collect data	4
Other	5 Go to P5d
P5d.	Why was the Actiheart exercise data collection not successful?
P5e.	Interviewer - Was the Actiheart successfully fitted and calibrated?
Yes	1
No	2 Go to P5f
P5f.	Reason Actiheart set up not successful?
Participant refused	1
Not applicable to participant	2
Calibration failed	3
Other	4
P5g.	Please explain the reason why the Actiheart set up wasn’t successful?

Мodule P4	ACTIHEART COLLECTION

I am now going to collect the Actiheart measurement.

Explain details to the participant if required. Proceed with setting up the equipment as required and proceed when ready.

P4.	Collect the data file(s) for the participant for the Actiheart measurement. Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.
P4a.	Interviewer - Was the measurement successfully taken, data exported and collected? Answer yes only if the data collection in the previous screen has been successful!
Yes	1 Go to P4d
No	2
P4b.	Why was the Actiheart data collection not successful?
Participant refused	1
Not applicable to participant	2
Couldn’t export data	3
Couldn’t collect data	4
Other	5 Go to P4c
P4c.	Please explain the reason why the Actiheart data collection wasn’t successful?
P4d.	When did participant stop wearing the Actiheart device according to their diary? (Date)
«____»___________20___г
P4e.	When did participant stop wearing the Actiheart device according to their diary? (Time)
_______:_______

Мodule M	PHYSICAL FUNCTIONING TESTS

We are now going to perform a Grip Strength Test.

Grip Strength.

Grip strength should be measured with participant sitting down in chair with arm support. VERY IMPORTANT: Adjust the lever of the Hand Dynamometer so it suits the hand. It should rest on middle piece of the four fingers.

M1a.	Was participant willing to do this test?
Yes	1
No	2
Unable for health reasons	3
Unable for other reason (e.g. equipment not available)	4
M1b.	Please record the reason why the test was not carried out.
LEFT HAND	RIGHT HAND
М2.	1st measurement (to nearest 0,1 kg) , kg No measurement could be obtained 98	М3.	1st measurement (to nearest 0,1 kg) , kg No measurement could be obtained 98
М4.	2nd measurement (to nearest 0,1 kg) , kg No measurement could be obtained 98	М5.	2nd measurement (to nearest 0,1 kg) , kg No measurement could be obtained 98
М6.	3rd measurement (to nearest 0,1 кг) , kg No measurement could be obtained 98	М7.	3rd measurement (to nearest 0,1 kg) , kg No measurement could be obtained 98

M8.	Hand Dominance	Right-Handed	1
Left-Handed	2
Ambidexterous (can write equally well with both hands)	3

Balance test (one leg)

We are now going to perform a Balance Test.

M9a.	Was participant willing to do this test?
Yes	1
No	2
Unable for health reasons	3
Unable for other reason (e.g. equipment not available)	4
M9b.	If participant is unwilling or unable to do test please record the reason why___
M10.	Balance test 1st measurement. Eyes open. Time balance held (eyes open) to the nearest 0.1 second.
.	Seconds
If Participant unable to stand unsupported please press “Refuse to answer”.
M11.	Balance test 2nd measurement. Eyes closed. Time balance held (eyes closed) to the nearest 0.1 second.
.	Seconds
If Participant unable to stand unsupported please press “Refuse to answer”.

Chair stands

We are now going to perform a Chair Stands Test.

M12a.	Was participant willing to do this test?
Yes	1
No	2
Unable for health reasons	3
Unable for other reason (e.g. equipment not available)	4
M12b.	If participant is unwilling or unable to do test please record the reason why._____
M13.	Time taken for chair stands (nearest 0.1 second).
.
If Participant unable to stand unsupported please press "Refuse to answer"
M14.	Number of chair stands completed (maximum 10).
If Participant unable to stand unsupported please press "Refuse to answer"
M15.	If less than 10 chair stands completed what was the reason for doing less.
Participant unable to stand unsupported	1
Participant became breathless	2
Participant stopped and unable to continue	3
You or participant felt the test was unsafe	4
Test took longer than 2 minutes	5
Other reason	6
M15a. Other reason (specify)__________

Мodule P	ECHO and VASCULAR ULTRASOUND

T5.	Room Temperature (to nearest 0.1˚C).
,	ºС

P1.	Was the Vascular Ultrasound successfully completed?
Yes	1
No, participant refused	2
No, other reason	3	Go to P1a
Please make sure that the files are collected and stored using the Participant ID in the EchoPac Computer.
P1b.	Please explain reason why vacular ultrasound measurement wasn’t successful?____
P1_1. P1_2	Time vascular ultrasound examination began _______:_______ Time vascular ultrasound examination ended _______:_______
P3.	ECHO completed.
Yes	1
No, participant refused	2
No, other reason	3	Go to P3a
Please make sure that the files are collected and stored using the Participant ID in the EchoPac Computer.
P3a.	Please explain the reason why the ECHO measurement wasn’t successful?
P2_1.	Time ECHO began _______:_______
P2_2.	Time ECHO ended_______:_______

Questions P1c and P1d only for Novosibirsk Please make sure that the files are collected and stored using the Participant ID in the EchoPac Computer.
P1c.	Was the abdominal ultrasound measurement successfully completed?
Yes	1
No, participant refused	2
No, other reason	3	Go to P1d
P1d.	Please explain the reason why Abdominal Ultrasound measurement wasn’t successful?_______

Мodule S	SPIROMETRY

T6.	Room Temperature(to nearest 0.1˚C)
. ˚C

I am now going to use the Spirometer Machine.

Explain details to the participant and ask if they want to participate. Proceed with setting up the equipment as required and proceed when ready. Contraindications for spirometry are chest infection in the last month, history of detached retina, myocardial infarction in past month, surgery to eyes, chest or abdomen in past 3 months, pregnancy 1st or 3rd trimester, currently on medication for tuberculosis.

S1b.	Spirometry completed (for subset of participants)
Yes	1
No, participant refused	2
No, participant not asked to do spirometry	3
No, contraindication	4 Go to S2
No, other reason (please specify)	5 Go to S1d
S1.	Collect the data file for the participant for the Spirometry measurement. Before continuing make sure the measurement has been taken successfully and participant data has been exported. Once ready, press Next to proceed and collect the data into the system.
S1d.	Other reason. Please specify why Spirometry was not successful.
S2.	Contraindications for spirometry.
Chest infection in the past month	1
History of detached retina	2
Myocardial infarction in past month	3
Surgery to eyes, chest or abdomen in past 3 months	4
Pregnancy 1st or 3rd trimester	5
Currently on medication for tuberculosis	6
S1c.	In the past hour did the participant
Have a drink containing caffeine	1
Use an inhaler	2
Smoke	3
None of the above	4