Practice questions - Occupational health

Question 1

What is the definition of physical activity?

Answer 1

‘’Any bodily movement produced by contraction of skeletal muscle that results in energy expenditure’’

Question 2

Under what domains are you doing ‘physical activity’?

Answer 2

During:
- Occupational work/education
- Transportation
- Household acitivites
- Leisure time

Question 3

What does ‘intensity’ mean when talking about physical activity?

Answer 3

The intensity says something about the amount of physical power that the body uses when performing an activity. Everything you do when you’re awake counts as physical intensity since you’re busy doing something.

Question 4

What does MET mean?

Answer 4

Metabolic equivalent. It says something about the ratio of your working metabolic rate relative to your resting metabolic rate.

Example:
–> 1 MET is defined as the energy you use when you’re resting or sitting still
– 4 MET means you’re exerting four times the energy than you would if you were sitting still like when you’re biking, or jogging.

Question 5

What are the four physical intensity/activity levels? And what MET-level goes with it?

Answer 5

–> Sedentary movement (≤ 1.5 MET)
–> Light movement (> 1.5 and < 3 MET),
–> Moderature activities (≥ 3 and < 6 MET)
–> Vigorous activities (≥ 6 MET)

Question 6

What activities are health enhancing physical activities?

Answer 6

Moderate and vigorous activities.

Question 7

When are the biggest gains when doing physical activity?

Answer 7

When you just started doing sports or activties (so in the beginning)

Question 8

Would it be better to use questionnaires or an activity tracker?

Answer 8

An activity tracker, because it gives an objective assessmen, while the questionnaires are prone to recall and social desirability bias.

Question 9

There is an obese patient who is diagnosed with type 2 diabetes. You have a motivational interview with her. You decide to first ask her the 1-10 ruler for motivation. You: “If on a scale of 1 to 10, 1 is not at all motivated to change your behaviour and 10 is 100% motivated, what number would you give yourself at the moment?”
Karen: “I think I would be a six”

Which two follow up questions would be best to ask Karen to elicit change talk? (Motivational talk)

Answer 9

1. Why did you choose this number and not 1 (or a lower number)?
2. What would you need to get from this number to a higher number?

Question 10

Stella, an 8-year old girl with slight overweight visits your general practice. She complains that
both during the general physical education class and during recess she is often left out as she
cannot keep up with her (normal weight) friends both regarding endurance as well as strength.
She quickly gets tired during physical activity. Furthermore she sleeps poorly.

What should be adviced considering duration and frequency for the moderate to vigorous physical activity (Aerobic activities)? Use the World Health Organisation physical activity recommendations in your answer.

Answer 10

There should be adviced to do moderate to vigorous physical activity mostly aerobic activities (intensity): for 60
min (duration) per day (frequency)

Question 11

Why is childhood obesity a risk in SCFE?

Answer 11

Is causes abnormal force on a growth plate which has an oblique alignment.

Question 12

In a boy, 10 years old with spastic cerebral palsy, you find shortening of the calf muscles and spasticity. He complains about getting tired easily. He is no longer able to walk to school which
upsets him (previously he could walk for 10 min)

Name two problems on the level of body functions and structures (ICF-model) for this patient.

Answer 12

• Muscle shortening
• Spasticity
• Fatigue

Question 13

What is the difference between sedentary behavior and physical inactivity?

Answer 13

Sedentary behavior: is any waking behavior characterized by an energy expenditure <1.5 MET while in a sitting or recline posture (e.g. prolonged sitting).

Physical inactivity: is insufficient levels of moderate to vigorous intensity physical activity (e.g. not meeting the
(WHO) physical activity recommendations).

Question 14

Loyen et al. (2016) – of which the results are presented in Figure 1 - used questionnaires as the
method to measure sitting time. Give two disadvantages of this method.

Answer 14

Questionnaires are self-reported giving:
- recall bias
- social desirability bias
- questions ask for usual day (not possible to assess differences between weekend and weekdays)

Question 15

You decide to use ActivPAL, Actigraph as an objective measurement method to measure physical activity. Describe 3 details you need to specify in your measurement protocol so other researchers can exactly replicate this procedure.

Answer 15

• Measurement device (name, brand, type (e.g. Actigraph, ActivPAL)
• Initialization frequency (e.g. raw date recorded in 1-minute epoch)
• Wearing day protocol (e.g. minimum number of days worn, 9-day protocol)
• Wearing instructions (e.g. right hip, only during waking hours, removing for water-based
  activities)
• Keeping a diary (date and time information on sleep, work, removal)
• Analysis protocol (e.g. what is considered as non-wear, what is considered a valid day
  (480minutes))
• Outcome measure (e.g. sedentary, light, moderate, vigorous / sedentary, standing,
  stepping)

Question 16

Which framework is the basis for clinical reasoning in rehab medicine?

Answer 16

International classification of functioning, disability and health (ICF-model).

Question 17

Provide 3 principles of Motivational Interviewing, and give for each principle a concrete example how
you would use it in your consultation with a patient.

Answer 17

• Express empathy
  –> Show warmth and communicate respect and understanding, show reflective listening
• Develop discrepancy
  –> This involves exploring pros and cons of the patient their current behavior of changes in a supportive and accepting atmosphere.
• Avoid argumentation
  –> No arguing with the patient. You rather ‘walk’ with the patients, don’t drag them along.
• Roll with resistance
  –> When you encounter resistance, step back, listen and try to understand the patient their perspective
• Support self efficacy
  –> You as motivational counsellor supports self-efficacy by helping patients believe in themselves and become confident in the choices they make.

Question 18

What are the parts of the ICF-model

Answer 18

Top: Health condition

Middle: Body function/structures - activities - participation

Below: personal factors - environmental factors

Question 19

In rehab medicine the ICF model is also used for the functional diagnosis. What is meant by functional diagnosis?

Answer 19

Functional diagnosis is the diagnosis directed at the consequences of a
disorder/disease for functioning in daily life using the ICF frame work.

Question 20

'’Oh, I don’t know. I mean, I think it’s important to be active. I just don’t know how
realistic it is for me to fit it into my daily life. I’m out driving on the road a lot. So it’s not like I can
go to the gym whenever I want. And my job’s not going to change, so I’m still going to be sitting
all that time.’’

You want to show that you understand what your client (Case 2 Simon) is telling you. Give a
two-sided reflection as a reaction to the statement of Simon.

Answer 20

On the one hand, you see the benefits of being more physically active, but on the
other hand you feel like the sedentary nature of your job might cancel out those benefits.

Question 21

Practitioners need to resist the ‘Righting Reflex’, because this often increases client resistance.
Explain what the ‘Righting Reflex’ is.

Answer 21

A natural and instinctive response of trained care providers is to fix the problem, make things
right (to use knowledge acquired from training and experience to help the individual seeking care to overcome their problems).