Talking Shop with Ralph La Forge

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Ralph La Forge, M.S., is a physiologist at Duke University Medical Center who teaches physicians and medical groups around the country how to integrate mindful practices like yoga with conventional allopathic treatments.

Yoga Journal: What yoga research are you involved with now?

Ralph La Forge:Hatha yoga-based therapy for chronic disease—not just any hatha yoga-based therapy for any disease. My interest is in therapeutic yoga that truly couples the mentation aspects with asanas. We’ve seen much success with low-level hatha yoga posture sequences applied to chronic disorders, specifically coronary disease, and especially heart failure. Up until six or eight years ago, these patients were sent home to wait for a new heart or put on drugs and left to their fate. Many of them manifest significant depressive symptoms primarily because of their low physical function level and relatively poor clinical prognosis. In many cases, they’re still sent home, but not to do nothing—they’re performing low-level aerobic exercise and restorative yoga sequences.

YJ: What do you mean by “mentation?”

RLF: Mentation is the most important component. We help patients to cognitively focus on their breath sounds, for example, rather than the disease process itself.

YJ: How did you come to be particularly interested in the scientific foundations of hatha yoga?

RLF: I’ve had a longstanding interest in the fact that the mind controls about 80 percent of the disease process. Yogic breathing practices have helped not only my athletic endeavors but also my mental stamina at the workplace. I’ve experienced the personal benefits of enhanced physical performance, incorporating yogic breathing strategies during peak energy expenditure during a competitive mile run and during recovery.

YJ: Do you consider yoga to be a spiritual practice?

RLF: Absolutely. Being in the forest doing my running practice is for me the conduit to spirituality. I’m also an amateur astronomer. When I do trainings, I try to encourage people to think about something beyond the Self—for me this is the cosmos and all that it contains. I oftentimes use photographic slides to illustrate a far greater reality of nature—beautiful clusters of galaxies and supernova remnants that are imbued with color. This shows them that their existence and all their attachments are products of cosmic phenomena. We’re part of such a bigger consortium of cosmic events. And it’s reality-based. This isn’t stuff out of a van somewhere in Marin County.

YJ: What is your own personal practice?

RLF: Every morning at about 7:15, I go into the Duke forest and engage in a walking meditation for about 10 minutes starting at the trailhead—I like to get the ground under my feet. Then I do several flowing poses—Triangle, Legs up the Wall Pose on a tree or rock—and do one or two miles of what I call “yogic striding”: moderately paced, running at 40 to 60 percent effort, long strides as if you were running down a very gentle slope.

I often breathe in the Douillard method—abdominal nostril-breathing with a cognitive focus on muscle sense. I’m not thinking about what I have to do at home or at work.

YJ: Is your breathing coordinated with your footsteps?

RLF: Yes, but I don’t consciously control that. It happens naturally. After that I ease back into several basic poses and meditation. Then I go to my office. On days that I do this, my cognitive stamina is markedly improved. I don’t require my otherwise usual mocha latte.

YJ: Do you stargaze every night?

RLF: I usually go out at about 11 p.m., after I’ve read. On clear nights I’ll be out for an hour, just looking with my naked eye.

Ralph La Forge can be contacted at (919) 490-3794 or

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