The "Village" Approach to Health and Fitness

by Ryan Halvorson on May 18, 2010

Client Success Story

Lance Breger and colleagues work together to improve his client’s quality of life.

Client: Ralph Wittenberg, MD
Personal Trainer: Lance Breger, MS, MINT Fitness
Location: Washington, DC

Accepting the Challenge.When he first came to see IDEA member Lance Breger, MS, a year ago, 73-year-old psychiatrist Ralph Wittenberg, MD, was in poor condition, suffering from heart disease, cancer and muscle wasting; pain from a botched hip surgery; the effects of an overdose of medication given to treat heart failure; and other ailments.

“Ralph was in bad shape—physically, mentally and spiritually,” recalls Breger, head personal trainer at MINT Fitness. “Truthfully, I was concerned and apprehensive.” An educated and competent professional, Breger decided to quash that apprehension and accept the challenge.

Setting Goals. Wittenberg desired improvements in muscle mass, physical function and endurance. “He also wanted to get into and out of his chair and his whirlpool bathtub more easily,” adds Breger. Prior to engaging in movement, Wittenberg completed a battery of questionnaires and evaluations, and he received medical clearance from his cardiologist and primary-care physician.

“The next step was to familiarize Ralph with the gym and determine his level of comfort with different equipment and activities,” says Breger. “I then tested his exercise tolerance for various muscle groups and his ability to balance and to move around.”

Gaining Momentum. Each session begins with myofascial release using breathwork and tools, such as a foam roller, a tennis ball or The Stick, a massage device. Wittenberg then performs agility ladder or cone drills to increase core temperature and enhance balance and coordination. After warming up, Wittenberg gains flexibility through stretching techniques and focuses on activation of core musculature. “The actual workout is a strength training circuit with dumbbells and free motion equipment,” states Breger.

During the first few months of training, Wittenberg focused primarily on stability exercises, then progressed to strength endurance supersets. “After he developed a strong and stable base, we were able to move into hypertrophy and power training to address the muscle mass and daily activity goals,” adds Breger.

Overcoming Setbacks. Despite modest progressions, Breger believed Wittenberg was not achieving his maximum potential. “He would regularly arrive 30 minutes late, and there was a point where his physician believed that Wittenberg’s weight, balance, coordination and hip pain were not improving enough. Arriving late was directly impacting progress toward Ralph’s goals, so this needed to be addressed.”

Breger believes in positive reinforcement, so he worked on developing trust and open communication. After several discussions, Wittenberg began to uncover the root cause of his chronic lateness. “He had a mental block embedded from his past that [made him believe] he should never be good enough or happy enough,” says Breger. Believing that his client would benefit from a well-rounded support system, Breger introduced Wittenberg to other staff members.

Building a Team. MINT Fitness is host to a multitude of professionals who often team up to help individual clients. To address Wittenberg’s physical limitations, Breger worked with MINT’s physical therapist to create a quality corrective exercise regimen. He then suggested that Wittenberg work with various massage therapists to reduce physical—and mental—tensions. Wittenberg sought nutrition guidance from MINT’s registered dietitian and began to use an online nutrition program.

“I also invited Ralph to join me at our club’s Sunday morning gentle yoga class,” says Breger. “He was so struck by how kind and helpful the instructor was that they began private lessons in his home.”

Achieving Success. This multipronged approach worked well for Wittenberg, and he made significant health and fitness breakthroughs. “I am so far past [my original goal] now that I can participate in a 1-hour dance class without stopping,” enthuses Wittenberg. “Every session with [Breger] is different and challenges me to go beyond where I have been and what I think is possible.”

According to Breger, this success would have been impossible without the assistance of his MINT colleagues. “Two, three and five heads are better than one,” states Breger. “Trainers need to let go of the self-identification and possessiveness of ‘my client.’”

Calling All Trainers

Do you have a client who has overcome the odds to achieve new heights in health and fitness? Send your story to and you and your client may be featured in an upcoming issue of IDEA Fitness Journal.

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About the Author

Ryan Halvorson

Ryan Halvorson IDEA Author/Presenter

Ryan Halvorson is the associate editor for IDEA Health & Fitness Association; a personal trainer at the Wave House Athletic Club; and the creator of www.RYAN', an online forum dedicated t...