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PDF Editor FAQ

What are signs that a person is going to die in the next 40 days?

You're looking for the Palliative Prognostic Index. The article on its establishment can be found here: The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. It is, to the best of my knowledge, the most accurate method of clinically determining if someone's survival is less than 6 weeks (or 42 days). That said, it does look like some people are examining more objective physiologic methods suggestive of imminent death (Predicting 7-Day Survival Using Heart Rate Variability in Hospice Patients with Non-Lung Cancers).The Palliative Prognostic Index basically finds that 76% of people with a score of >4 die within 6 weeks (positive predictive value). How do you calculate the PPI score? I can't find a clean online worksheet for it but:If you're bed bound, you get 2.5 points.If you're bed bound and have stopped eating, you get 4 points.If you're delirious, you get 4 points.If you're short of breath, you get 3.5 points.If you have a swollen body, you get 1 point.If you have reduced appetite, you get 1 point.If you have less than mouthfuls of food, you get 2.5 points.There are some limitations to the index. It's validated only in patients with known, incurable cancer. There may also be some variability in how the scores are rated based on who is doing the rating. But if someone has a score > 4 points, they are more likely to die in the next 40 days.TL;DR: as people get more ill, they become bed bound and eventually lose their appetite; in fact, eating can become quite uncomfortable. Once these happen, you've got about a month left.

What is your favorite anti-stress activity?

I usually go towards mindfulness. There are so many mindful techniques which can help to relieve stress. I think anyone could find something that is a good fit for them.Out of all of them, my favorite way to relieve stress is deep breathing.I instantly feel the result and I get calmer after few repetitions.Even for breathing techniques, there are more options and they can take only a few seconds.The techniques themselves are simple. The only thing you have to do is breathe and be aware of it. There are various ways of applying this throughout your day. You can find a free worksheet and planner to help you with that, here.Here are some of the benefits of deep breathing:1. Clear mindYour mind cannot focus on more than one thing at a time. Imagine you feel overwhelmed and your mind is all over the place. By practicing any breathing technique, you will only focus on breathing. It will act like a PAUSE button for all your thoughts.2. Relaxed bodyWhile practicing deep breathing, on the exhalation your muscles will relax.This applies especially to the first technique – light like a feather. After practicing that, you’ll feel like you dropped down a 10-kilo backpack.3. Slow down your heart rateStudies have shown that meditation and deep breathing have the power to slow down your heart rate.When you’re anxious and stressed, you feel an inner agitation and tense muscles. These symptoms show an increased heart rate. When you manage to calm down and relax, your heart rate will also go down.And the best thing about breathing techniques?You can practice some of them anywhere, at any time of the day.To learn even more, you can read detailed descriptions for 7 types of breathing techniques here: 7 breathing techniques that will improve your mood

How do you customize a weight loss and exercise plan for yourself?

I'm going to preface this answer by saying, that I've spent the better part of decade learning how to customize weight loss and exercise plans for other people. And I'm still learning new stuff all the time!The biggest mistakes people make is thinking that a routine is static, once you’ve developed it you don’t have to do anything new or different, right?Wrong…Both need to be constantly tweaked as you get better or worse at certain things. That’s the hard part.If you don’t track progress then you don’t know how to tweak things, so do yourself a favour and track your progress (load progressions and weight/girth at a minimum).For me to put to paper what I've spent all those years learning in a Quora answer is impossible, maybe a book, if I'm lucky. The key thing that most people simply cannot do effectively by themselves, is assess themselves.Even seasoned fitness professionals do a poor job of self-assessment, and we know what to look for. Nothing beats an external set of eyes, even if that external set of eyes isn't all that talented as a coach.Put a kid in a gym and give him a basketball and he'll eventually figure out how to play basketball on his own. Put a kid with a basketball, on basketball court with 11 other kids, and the worst basketball coach ever and you've still just accelerated that kid's progress ten fold.Likewise, put someone in a gym and they will wander around a bit. Observe what other people are doing in the gym, mimic them (or copy them), and look a little lost. They'll eventually figure out some stuff to do that may or may not be all that effective. Give the same person a coach for 3-6 months, and they should get better a lot more quickly. It can be a relatively short-term investment (<2 years).This question comes down to the fact that coaching works, even bad coaching. Better than trying to do it all by yourself because you get feedback, and feedback is incredibly important for progress. Honestly, people don't understand just how huge and impactful coaching is and can be until they've experienced it.I would never have gone as far in sports, school or my career, without the special coaches I've been lucky enough to have in my life. They all offered a great external point of view. Some I've paid for, others I've worked with or for and many were paid or volunteered their time.That being said there are some important things to keep in mind and I'll do my best to give you some pointers.The reason there is no perfect plan that I can just write out for you, is because the human body is a biological machine. Not a machine. There are some principles you have to adhere to, like progressive overload, but a everything else is up for debate.Perfection, when it comes to training, and biological systems, doesn't really exist. You do the best you can and your outcome might be very different from someone else following the exact same program under the exact same circumstances.Have you ever met a farmer that could make every single one of his apples grow perfectly to the exact same colour, shape, size? I doubt it, because biological systems just don't work like that, no matter how good a farmer you are.What trainers, coaches and fitness enthusiasts really mean by this is that training programs need to account for individual variance to some degree.What they don't mean by this is that your program has to be completely different from everybody else's.A lot of 'individual' needs are prevalent in a lot of other people too. Programs are still more similar than they are dissimilar. When you pay attention, you see patterns emerge. This is why I can design one program, several people can use it, and most will still get some benefit from it.The ideal situation however is that this program is modified correctly for the individual based on their unique predisposition. This might mean changing a lot of the exercises or it could be just a slight tweak of one or two exercises. Maybe your body responds best to a certain rep range, or maybe it responds best to regular changes in rep ranges.The fundamentals are the same, but there are slight modifications to consider to make it ‘custom.’For example, everybody in a Crossfit gym does the same WOD and I would argue most get results (provided they don't get injured or drop out). However, in a good box, all the coaches are taught how to scale the workouts appropriately, so even though the workout is the 'same on paper' it is not the same workout.Walk around and you’ll see some people using bands on their chin-ups, others pushups from the knees or with bands to assist, that person over there is using 65 lbs on the squat, that person is 135 over there and the other person has 195 on the far side of the gym. This is catering the workout to the individual and it's hard to argue that Crossfit isn't effective for what it is (I'd argue there are better ways of doing the same thing so as to minimize risk - but that's another answer to a different question).Tip #1: Learn Progressions and Regressions for all the key exercises.This is the easiest way to individualize a program to an individual, though some coaches are more skilled at it than others and it may require a lot of time to learn.In essence, we (and our coaches) all like to believe that we are a pretty and unique snowflake (and we might be) but when it's snowing out can you tell the difference between them? Sure you get some fat snow, some fast snow, some icy snow, etc...but on the broad scale snowflakes are a lot less unique than they are on the crystalline scale.You're exactly the same. Everybody has a unique shoulder on the cellular level, but there are only 3 or 4 types of acromion processes on the broad scale. 2 of these make for bad overhead pressing ability (these people will have to fight their shoulder structure and will probably never have awesome overhead pressing ability on the relative scale), people with one will probably never have a shoulder issue in their lives and the last one can go either way depending on environment and their training.Can you clear a shoulder test? If not, then you shouldn't have much if any overhead pressing in your program (I've seen a lot of people who do anyway, and then wonder why they have chronic shoulder pain...).Likewise here are some other basic classifications and generalizations you could make about most people:4 Different types of pelvic structuresDifference in the depth of ball and socket jointsFlexibility vs Stability (Mobility)Muscle Tone (Hyper vs Hypo, or High vs Low)Long Spine vs Short SpineLong Limbs vs Short LimbsRetroversion vs Anteversion (fancy way of saying how your shoulder and/or hip joints are structurally rotated)Posture (both static and dynamic)History of InjuryNeuromuscular Disorder (CP, etc...) vs HealthyTraining HistoryDesired ObjectivesSome coaches are anal retentive about the whole customization thing. I know of many who refuse to publish or put out programs they've designed because it doesn't agree with their 'values' on the issue of programming.Other coaches are super lax about it (in my opinion falsely) and use the same stuff over and over again with the same people, or worse just make stuff up on the fly without any concept of progression and regression. I generally fall in the middle, so here is my take.Tip #2The more advanced you get, the more 'specific' your desired outcomes, the more 'custom' approach you need. The more important coaching becomes. Most people are not that advanced until they have a few years of smart training under their belt.Tip #3About 90% of the population doesn't need anything overly custom, just catered to their needs. A landmine press instead of an overhead press for instance. They train the same muscles, but the former will be better for someone with shoulder issues 9 times out of 10.Tip #4Most people just need to start where they are at. I estimate that more than 70% of the population starts a fitness, weight loss or nutrition/exercise plan with a program that is too difficult for them or too easy for them.Tip #5The majority of reasons why someone can't or shouldn't do a particular program has to do with a lack of appropriate mobility, body structure, or strength to do specific exercises within that program (meaning most of any given decent program is fundamentally sound for nearly everyone, it's only a few exercises that need to be changed, reordered, etc...).Most people aren't qualified enough to figure this out for themselves. If it hurts, don't do it. Overhead pressing and bad bench press technique are probably the two biggest issues I see in this regard. I have worked with a lot of people who I don't think should press overhead until their mobility significantly improves. A fixed barbell is tough on the shoulders relative to other options like kettlebells or dumbbells that permit more rotation.It doesn't mean these are bad or 'dangerous' exercises though, it just means they are not applied well given the situation.Don’t get locked into dogma when it comes to fitness tools. Like a good tradesman, pick the right tools for the job.Tip #6When you look at the overwhelming majority of good programs, they are all more similar than they are different. Focus on the the similarities, rather than the differences.Tip #7You can start with a basic template and learn to swap in appropriate exercises. I call these Frameworks; Much in the same way Rails makes programming with Ruby a lot easier to do.Building frameworks for my training allows me to more quickly and more easily cater workouts to various individuals and myself.Tip #8Program adherence is actually more important that the program itself. Even if your custom program is a little 'off' but you follow it diligently, it's a lot better than the 'perfect program' you don't adhere to.Tip #9Most of common gym wisdom is nonsense. 'You have to squat to thighs parallel' no, you have to squat with as much range as you physically can, and then work to improve your range during your mobility work. Its contextual. Nothing is 100% necessary, don’t let sports like powerlifting or olympic lifting totally guide your resistance training approach (or conditioning for that matter). They are both very specific sports.A lot of people get hurt at the gym every year trying to follow 'conventional advice' even if it's poorly suited to their needs. Start from ‘needs’ first.Common Problems I See:People way stronger pushing than pulling, leading to a really funky static posture. You need more pulling in your program.People who are way stronger squatting and deadlifting proportionately to single leg movements like lunging, single leg squatting and single leg deadlifts. You need more single leg stuff in your program.People who just don't understand core training at all and do way too many crunches and crunch variations. They end up with really flexible/loose spines, which is not a good thing (more women than men, but still men often). You need more chops, lifts and rotational stability work, in addition to hip flexion training (weak or restricted psoas) with a neutral spine, along with anti-flexion and anti-extension training. You need more multi-directional core stability.People with poor glute control, strength and power. Usually a result of really tight hip flexors, but sometimes hamstring dominance.People with really tight hip flexors from sitting all day (stretch more and strengthen the opposing glute muscles).People with really tight ankle complexes (stretch more)People with really tight Thoracic Rotation (stretch more) and Extension (mostly from sitting)People with really poor shoulder function and mobility (limit overhead pressing, stretch deliberately and increase shoulder stability often) - learn what proper retraction, protraction, depression and elevation look like.People with really poor pelvic control, have a hard time controlling their pelvis while squatting, deadlifting, nearly anything that involves the pelvis. Hint: it ties in really heavily with the 'core' and most people don't realize this.People who are way stronger in their upper body than their lower body. If you routinely bench more than you squat or deadlift and you're not a ranked powerlifter, you need to train legs more.People with really tight, really weak non-dominant side (if you're a righty your left leg) adductors and really weak on their strong side abductors (stretch the groin more and strengthen the hip external rotators). Typically righties will have a right internally rotated hip and a left externally rotated hip, training should address this a little.Disproportionate amounts of power, endurance or strength in certain areas. A lot more specific, and difficult to address on your own.A lack of explosive training for 'fear' or previous injury.A lack of variance because they get habituated to a routine and don't leave it, which often means they are doing something like circuit training, or the same rep/set schemes for ages and then wondering why they aren't seeing progress. Everything works for a little while, until it doesn't. I've said it many times on Quora, eventual Change is the more important thing to consider in any program.Inadequate progression/regressions - often people are doing an exercise for too long that is either too easy, or too hard for them to actually be doing. They don't get a training adaptation because they are doing the exercise wrong, or they simply aren't creating enough stimulus.Inadequate intensity (or too much at the expense of technique). Many people I've worked with simply don't challenge themselves enough. Its hard to learn where that sweet spot is, between too much and not enough, and it's a time investment.A lack of understanding how their training should support their objectives. For instance the weekend warrior that is strong but not particularly explosive or elastic, should do more of the latter if performance is the objective. You can't just do strength work if you have a fat loss goal. You probably shouldn't do too much cardio if you have a muscle mass goal. People are often training competing demands to their desired objectives, without really knowing it.Things Every Program Should Contain(At Some Point in the Macrocycle/6-12 Month Period or less):A Squat Variation (or Knee Dominant Movement)A Lunge Variation (or single leg squat, or Single Leg Knee Dominant Movement)A Deadlift Variation (or Hip Dominant Movement)A Single Leg Hip Hinge (or Single Leg Hip Dominant Movement)A multi-planar movement (step and chop, jefferson deadlift, single arm DB press, Turkish Get-Up, etc...)A vertical press and pull (if you aren't cleared overhead, go with an incline press variation - ideally you do single arm and double arm variations, I like to alternate between the two with horizontal press and pull)A horizontal press and pull (I tend to consider closed chain and open chain movements but that's complicated for most people - just don't always do bench or always do push-ups for each and every phase, that's not smart)A loaded Carry, Walk or Sled DrillA Crawl VariationA Hip Flexion DrillAn Anti-Extension Drill (think front plank or rollouts and variations)An Anti-Lateral Flexion Drill (think side plank and variations)An Anti-Flexion Drill (usually covered by the hip hinge listed above, a deadlift falls into both categories)An Anti-Rotation Drill (Chops, Lifts, Pallof Presses) and/or Controlled Rotational DrillsA breathing drill (could be for relaxation purposes even if your breathing patterns are already good)A Grip Training Drill (could be the carries, could be a plate pinch, could be a fat bar on something else above...)A dedicated warmup and mobility routine that addresses where you lack stability, and where you lack adequate flexibility.Some jumping, hopping, skipping, sprinting, or other form of plyometric activity (even if your goals aren't increased speed/strength) at an appropriate levelSomething that stresses the heart mildly (particularly if your resting heart rate isn't about 60 BPM upon waking) to intensely 1-2 times a week.Every now and then train a lot of the movements above explosively, train with med balls, use kettlebells, bodyweight or use bands.Every now and then train a lot of the movements above with high reps, pushed to technical fatigue.Every now and then train a lot of the movement above with high intensity low reps (3-6 reps) provided technique requirements are metTrain mostly in a 6-12 rep range, unless your objectives dictate otherwise, particularly for any isolation movements you want to add.Place emphasis on lagging components aboveTrain additional isolation exercises with a function-down approach. Meaning train the shoulder stabilizers and hip stabilizers above aesthetic objectives.Train aesthetic isolation exercises arm curls, leg curls, leg extensions, deltoid work, etc..., only after the above is done (unless you're a ranked bodybuilder).Tip #9 still applies, but I’m confident you can find variations of those things that work for you and your goals.The proportions of the above, the tools you use, and the specifics are what are really catered to the individual. Perhaps even more specifically, cater to the desired outcome. If you have knee pain for instance, squats and lunges may need to be modified to eliminate the painful movements.Most of good programming is making people better at what they suck at. The problem is most people hate doing what they suck at and just want to do more of what they are good at, which just leads to worse problems down the road.Do enough of the things you like and learn to like more of the things you are not as fond of. Another problem is that most people are conditioned to think the following:If it feels harder it's betterIf I sweat a lot it's a good training sessionI only want to get my heart rate up because that's the only thing that matters (there is more to fitness than heart rate)If it doesn't fit the above criteria, I'm wasting my time (something will always be better than nothing -- so if you can't do all of the above, start with just one thing).People get into established routines/expectations as to what a good workout should be. Habitually doing the same stuff over and over again though, leads to overuse injury. If you avoid mobility training, you're setting yourself up for problems. If you avoid getting stronger, you're joints won't be able to handle all that bouncing and running you do. If you avoid doing any conditioning or cardiovascular work, you'll get winded easily playing with your kids. These is just reality, you need balance in any routine.If you need help, here are a few basic frameworks I developed and are freely available on my website (given in order of time committment required and level of experience):A Better Scientific Seven Minute WorkoutThe 2x2 Training FrameworkThe X Split RoutineUpdate:I just realized that I didn't really address the issue of building your own 'weight loss' program so much as 'exercise program'. However, the exercise component being a definite part of that, the above still applies to weight loss (or performance, or weight gain even, you just make a few slight modifications for each).I think everybody needs to develop a foundation of good exercise and nutrition habits (which in my experience eliminate about 90% of the problems most people have at some point in the process) and the above is definitely a good foundation from which to train off of, no matter what your objectives.Technically most people mean 'fat loss' but let's forget about semantics for a little while.Weight gain (fat accumulation) is almost always a result of:An accumulation of bad habits (less exercise, more bad foods, less cooking, etc...) which lead to more universal unsupportive behaviors (energy excess).The lack of appreciable and necessary skills.The biggest problem is that habits are unconscious, most people aren't even aware of them (again, hence why having an external pair of eyes is the most helpful) and it's really hard to know what skills you should learn/develop that make sticking to those habits a lot easier.I gave (I think) a practical, flexible, and fairly useful answer here:What is a realistic plan for losing 20% of my body weight? I’m a 52 year old male, 6'2″, 270.1 lbs.Really the biggest mistake I continually see (and I'll say this till I'm blue in the face) is that people try to take on way too much change at once. They get a meal plan that spells out every meal they should eat for the next 3 months to the teaspoon, but they don't know how to cook/prep most of the meals.They buy a book with a workout plan, or worse, grab one for free off the internet and soon one skipped workout (because they can't do 6 days a week of training yet) equals 3 skipped workouts, equals 'the hell with working out, I can't do all these exercises anyway!'People cause more frustration for themselves when they try to overhaul their exercise routine, or they overhaul their diet with all these rules, do nots, or 'permitted' foods. They fail to account for the adherence factor - that the execution of any weight loss program or exercise program or plan is at least 50% of the equation (and I'd argue it's more like 75%) for success. They fail to realize that success with this is mostly driven by the mind and not the nutrition or exercise plan.Here are the criteria that I think people should aim to meet with any nutrition plan, but a weight loss plan should follow the same criteria.What is a good diet? What does science say? I rarely eat sugar, I only drink water, tea and coffee. In general I eat healthy.It should:Address any nutrient deficiencies (or potential ones),Be mindful of your environment (working from home is different from working an hour commute away)Help control energy intake and appetiteMake it easy to adhere to the plan (or slowly developing the skills you need to adhere to it),Emphasize the highest quality of ingredients that suits your personal situation (If you can afford cage free eggs, do it, if you can't, don't worry about it, just get the regular eggs. Don't jump on the organic everything if it's beyond your means, you can still be healthy without that stuff.)Take into account your unique situation (financially, occupationally, socially, etc...)Have an exercise component somewhere that supports your objectives.The specifics of any diet (like a certain macronutrient ratio) are less important than your ability to adhere to the plan.Really weight loss is about finding the impactful limiting factors and removing those barriers. If you have a 3 coke a day habit, that might be a significant factor to address. If you eat crappy pizza every day for lunch, that might be a significant factor to address. If you have an issue with gluten, removing it could make a significant difference. If you have an issue with lactose, removing it could make a significant difference. If you drink a lot of alcohol, that might be a factor to address. Smoking could be a factor to address, and so on and so forth.I like to start with the limiting factor that seems the easiest to change and yet remains the most impactful.Here is a worksheet I use with my clients on how to figure that out for themselves. It’s designed to make them more aware of the factors going on in their lives that may be contradicting their desired outcome:Limiting Factor Commitment ChartHere is one I've pre-made identifying some of the most impactful habits I think people can adopt:The Habit Commitment ChartThey are free for you to use, if you're using them on your own though, you may need a little trial and error. Also these are a few years old now (I'll get around to re-doing them I'm sure), so I'm not sure how I feel about some of these habits so much anymore (like eating every 3-4 hours, isn't a high priority for me any more these days, though sometimes that may still work for you). There may even be a few I'd add to the list now but most of them are still solid.For more practical content like this, check out my new Quora Space: Skill Based Fitness. Hope to see you there…

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