You may have heard that holding your breath while you lift weights is dangerous.
Critics of the Valsalva maneuver—the technical definition for holding your breath while lifting weights—say it increases your risk of fainting, aneurysm, stroke, and blood vessel damage, and that there’s no evidence that it helps you lift more weight.
This is why many personal trainers tell their clients to breathe continuously through each rep, why doctors often tell their patients not to use the Valsalva maneuver, and why the American Heart Association warns against it, too.
Others say the Valsalva maneuver is not only safe, but an essential technique for safely lifting heavy weight.
The short answer is that while the Valsalva maneuver does increase the risk of stroke, blood vessel damage, and fainting, this is only true for a handful of people with a high risk of cardiovascular problems. For otherwise healthy people, the Valsalva maneuver will help you lift more weight and will probably lower your risk of weightlifting injury, too.
Table of Contents
The Valsalva maneuver is the process of forcefully breathing out against a closed windpipe.
Specifically, you try to breathe out while keeping your glottis (the space between your vocal cords) closed.
This technique traps air in your lungs and creates pressure inside your abdomen, known as “intra-abdominal pressure.”
When used in medicine, the Valsalva maneuver is used to help diagnose problems with the autonomic nervous system (ANS) and to bring down your heart rate if it gets too high.
When used by weightlifters, the Valsalva maneuver helps stabilize the torso against heavy loads and prevent the spine from bending during exercises like the squat, deadlift, and bench press.
The name “Valsalva” comes from a seventeenth-century physician Antonio Maria Valsalva, who studied the anatomy, function, and diseases of the ear. In the original version of what became known as the Valsalva maneuver, he instructed patients to exhale while holding their mouth and nose closed to clear fluid from the inner ear and test its function.
The Valsalva maneuver that’s used in weightlifting is different in that you don’t need to hold the nose closed, and instead exhale while keeping your windpipe sealed.
The reason people use the Valsalva maneuver is because it allows them to lift more weight.
As the lungs expand, they put pressure on the back, internal organs, and chest, and this helps your torso resist being bent or pushed out of position when you’re throwing around heavy weights.
The most common analogy people use to describe what’s going on is that of a soda can.
Imagine your upper body is a large cylinder, like an aluminum can. When the can is empty (you don’t have much or any air in your lungs), it’s relatively easy to bend. When the can is full and unopened (there’s air in your lungs), it’s almost impossible to bend the can.
Your upper body works more or less the same way. When you trap air in your lungs with the Valsalva maneuver, your torso becomes much more rigid and unbending. This allows you to lift more weight with good form, which is why almost everyone who lifts heavy weights intentionally or unintentionally uses this technique.
Many trainers, fitness “gurus,” and medical professionals argue that the Valsalva maneuver is dangerous because of its ability to rapidly spike blood pressure.
It’s true that the Valsalva maneuver can raise blood pressure three to four times above resting levels, but there’s little evidence this is bad for you. Any kind of exercise temporarily increases blood pressure. If it didn’t, your muscles wouldn’t have enough oxygen to keep contracting, and you’d never be able to do anything more strenuous than roll out of bed.
Weightlifting is unique, though, because it causes a much larger rise in blood pressure than other kinds of exercise, especially when using the Valsalva maneuver.
For example, a study conducted by scientists at Loma Linda University found that when healthy male athletes did a heavy leg press workout, their average systolic blood pressure (the pressure in your vessels during heartbeats) was 200. When they did the same workout using the Valsalva maneuver, their systolic blood pressure surged over 300. (For reference, most healthy people have a systolic blood pressure of 90 to 120).
Is this dangerous, though?
Almost everyone reflexively does the Valsalva maneuver when lifting weights, so if it’s dangerous for everyone, you’d expect many weightlifters to suffer problems like blood vessel damage, stroke, and fainting.
And this simply isn’t the case.
Experienced weightlifters also have a smaller rise in blood pressure than people who are new to weightlifting, which indicates that the heart and blood vessels adapt to handle these swings in blood pressure over time. This makes sense considering that the heart and blood vessels are muscles much like any other, and they both grow stronger and more resilient in response to strength training.
Although some people claim that the Valsalva maneuver increases the risk of stroke and aneurysm, any injuries (seemingly) related to the Valsalva maneuver are very, very rare.
In one of the largest reviews on this topic, researchers at the University of Sydney found only 19 cases of people who may have injured themselves using the Valsalva maneuver before 2011.
I say “may” because we don’t even know if these people were using the Valsalva maneuver. The injuries were thought to be related to a large increase in intra-abdominal pressure, but that happens with any kind of weightlifting regardless of how you breathe.
If we assume that these 19 injuries were thanks to the Valsalva maneuver, though, the risk is still small. For comparison, there were 25,335 weightlifting injuries recorded between 1990 and 2007, and 11 people died just from dropping weights on themselves between 1999 and 2002.
Among these 19 cases, ruptured blood vessels in the eye, brain aneurysms, and air leaking into the chest cavity were the most common injuries.
While this may seem concerning at first blush, keep in mind that all of these issues are strongly affected by genetics. In other words, it’s likely that most of the people who injured themselves using the Valsalva maneuver had a preexisting condition that increased their chances of blood vessel damage. Of course, these accidents could also have happened during any kind of strenuous exercise.
It’s possible that holding your breath, as you do during the Valsalva maneuver, could make you faint while lifting. And if you spend any time on YouTube, you may have seen this in action.
The thing is, most serious lifters don’t hold their breath for more than a rep or two, which isn’t usually enough time to cause lightheadedness or fainting. When the Valsalva maneuver is done properly, you’re only holding your breath for a few seconds before releasing the pressure, and this significantly reduces your chances of blacking out.
That doesn’t mean it couldn’t happen, but it’s not as likely as many people seem to think. Remember, too, that as you become more experienced your body adapts to better handle these swings in blood pressure, which also probably reduces your chances of fainting.
For most people, yes.
Research from The University of Queensland, Yale University School of Medicine, and the National Institute of Occupational Health shows that increased intra-abdominal pressure increases spinal stiffness and lumbar spine stability, and decreases spinal flexion when moving or resisting heavy loads.
In other words, when you increase your intra-abdominal pressure, you’re less likely to injure yourself while lifting and you’re better able to support heavy loads.
The only people who may want to avoid the Valsalva maneuver are those with a preexisting medical condition such as heart disease, or those who’ve suffered a medical injury related to high blood pressure, such as stroke.
The Valsalva maneuver has five steps:
- Take a deep “belly breath” of about 80% of your maximum lung capacity. As you breathe in, imagine your stomach inflating to the front, sides, and back. Your lungs should feel full but not so much that you have to struggle to keep your mouth closed.
- Press your tongue against the roof of your mouth, and without letting any air escape, try to breathe out. At the same time, flex your abs as hard as you can.
- Start the lift (descend to the bottom of a squat, stand up during the deadlift, lower the bar during bench, etc.). Don’t let any air escape, and keep flexing your abs.
- Once you’re past the “sticking point,” or the most difficult part of the rep, breathe out as you finish the rep
- Repeat as needed until you finish your set. You don’t need to release all of the air after each rep, nor should you try to hold your breath during the entire set. Instead, most people find they feel strongest when they hold their breath for two to three reps before taking a fresh breath
If you want to gain muscle and strength quickly and safely, you should use the Valsalva maneuver.
In fact, you basically have to use the Valsalva maneuver if you want to lift heavy weights. Research shows that once you’re using about 80% of your one-rep max, it’s impossible not to use the Valsalva maneuver to some degree. You simply can’t stabilize your upper body effectively under heavy loads without trapping some air in your torso.
Instead of fighting this phenomenon (by breathing in and out slowly throughout each rep, as many trainers advise), you’re better off using it to lift more weight.
People with a history of heart problems and/or high blood pressure should talk with their doctor before lifting heavy weights or trying the Valsalva maneuver.
As the Valsalva maneuver causes an increase in blood pressure, it’s not generally recommended for people with dangerously high blood pressure or those with heart disease or who’ve suffered heart damage in the past.
That said, everyone’s health history, circumstances, and risk differs, so you should talk to your doctor before you rule out the Valsalva maneuver altogether.
It’s normal to feel slightly lightheaded after a hard set, especially during compound exercises like the squat, bench press, and deadlift.
That said, you shouldn’t feel lightheaded during your sets. If this occurs, it’s usually because you held your breath for too long.
To avoid this problem, remember to take a fresh breath at least every two reps. If you’re still feeling lightheaded, take a fresh breath between each rep.
If you still feel lightheaded despite taking a breath between each rep, it’s possible you may not be resting enough between sets or are trying to trap too much air in your lungs at one time. To fix this, rest at least two to three minutes between sets and inhale slightly less before performing the Valsalva maneuver.
+ Scientific References
- Fleck, S. J., & Dean, L. S. (1987). Resistance-training experience and the pressor response during resistance exercise. Journal of Applied Physiology, 63(1), 116–120. https://doi.org/10.1152/jappl.19184.108.40.206
- Hackett, D. A., & Chow, C. M. (2013). The valsalva maneuver: Its effect on intra-abdominal pressure and safety issues during resistance exercise. Journal of Strength and Conditioning Research, 27(8), 2338–2345. https://doi.org/10.1519/JSC.0b013e31827de07d
- C J Porth, V S Bamrah, F E Tristani, & J J Smith. (n.d.). The Valsalva maneuver: mechanisms and clinical implications - PubMed. Retrieved March 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/6565684/
- Essendrop, M., Andersen, T. B., & Schibye, B. (2002). Increase in spinal stability obtained at levels of intra-abdominal pressure and back muscle activity realistic to work situations. Applied Ergonomics, 33(5), 471–476. https://doi.org/10.1016/S0003-6870(02)00028-5
- Cholewicki, J., Juluru, K., Radebold, A., Panjabi, M. M., & McGill, S. M. (1999). Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure. European Spine Journal, 8(5), 388–395. https://doi.org/10.1007/s005860050192
- Hodges, P. W., Eriksson, A. E. M., Shirley, D., & Gandevia, S. C. (2005). Intra-abdominal pressure increases stiffness of the lumbar spine. Journal of Biomechanics, 38(9), 1873–1880. https://doi.org/10.1016/j.jbiomech.2004.08.016
- Mohan, D., Munteanu, V., Coman, T., & Ciurea, A. V. (2015). Genetic factors involves in intracranial aneurysms--actualities. In Journal of medicine and life (Vol. 8, Issue 3, pp. 336–341). Carol Davila - University Press. /pmc/articles/PMC4556916/
- Wells, C. G., & Kalina, R. E. (1985). Progressive Inherited Retinal Arteriolar Tortuosity with Spontaneous Retinal Hemorrhages. Ophthalmology, 92(8), 1015–1024. https://doi.org/10.1016/S0161-6420(85)33905-2
- Chiu, H. T., & Garcia, C. K. (2006). Familial spontaneous pneumothorax. In Current Opinion in Pulmonary Medicine (Vol. 12, Issue 4, pp. 268–272). Curr Opin Pulm Med. https://doi.org/10.1097/01.mcp.0000230630.73139.f0
- Jumbelic, M. I. (2007). Traumatic Asphyxia in Weightlifters. Journal of Forensic Sciences, 52(3), 702–705. https://doi.org/10.1111/j.1556-4029.2007.00429.x
- Kerr, Z. Y., Collins, C. L., & Dawn Comstock, R. (2010). Epidemiology of Weight Training-Related Injuries Presenting to United States Emergency Departments, 1990 to 2007. In American Journal of Sports Medicine (Vol. 38, Issue 4, pp. 765–771). SAGE Publications Inc. https://doi.org/10.1177/0363546509351560
- Fernandes, T., Soci, U. P. R., & Oliveira, E. M. (2011). Eccentric and concentric cardiac hypertrophy induced by exercise training: MicroRNAs and molecular determinants. In Brazilian Journal of Medical and Biological Research (Vol. 44, Issue 9, pp. 836–847). Braz J Med Biol Res. https://doi.org/10.1590/S0100-879X2011007500112
- Nystoriak, M. A., & Bhatnagar, A. (2018). Cardiovascular Effects and Benefits of Exercise. In Frontiers in Cardiovascular Medicine (Vol. 5, p. 135). Frontiers Media S.A. https://doi.org/10.3389/fcvm.2018.00135
- Barauna, V. G., Rosa, K. T., Irigoyen, M. C., & de Oliveira, E. M. (2007). Effects of resistance training on ventricular function and hypertrophy in a rat model. Clinical Medicine and Research, 5(2), 114–120. https://doi.org/10.3121/cmr.2007.707
- Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., … Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American college of cardiology/American Heart Association task force on clinical practice guidelines. In Hypertension (Vol. 71, Issue 6, pp. 1269–1324). Lippincott Williams and Wilkins. https://doi.org/10.1161/HYP.0000000000000066
- Narloch, J. A., & Brandstater, M. E. (1995). Influence of breathing technique on arterial blood pressure during heavy weight lifting. Archives of Physical Medicine and Rehabilitation, 76(5), 457–462. https://doi.org/10.1016/S0003-9993(95)80578-8
- MacDougall, J. D., Tuxen, D., Sale, D. G., Moroz, J. R., & Sutton, J. R. (1985). Arterial blood pressure response to heavy resistance exercise. Journal of Applied Physiology, 58(3), 785–790. https://doi.org/10.1152/jappl.19220.127.116.115
- Wielemborek-Musial, K., Szmigielska, K., Leszczynska, J., & Jegier, A. (2016). Blood Pressure Response to Submaximal Exercise Test in Adults. BioMed Research International, 2016. https://doi.org/10.1155/2016/5607507
- Blanchard, T. W., Smith, C., & Grenier, S. G. (2016). In a dynamic lifting task, the relationship between cross-sectional abdominal muscle thickness and the corresponding muscle activity is affected by the combined use of a weightlifting belt and the Valsalva maneuver. Journal of Electromyography and Kinesiology, 28, 99–103. https://doi.org/10.1016/j.jelekin.2016.03.006
- Williams, M. A., Haskell, W. L., Ades, P. A., Amsterdam, E. A., Bittner, V., Franklin, B. A., Gulanick, M., Laing, S. T., & Stewart, K. J. (2007). Resistance exercise in individuals with and without cardiovascular disease: 2007 update: A scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. In Circulation (Vol. 116, Issue 5, pp. 572–584). Circulation. https://doi.org/10.1161/CIRCULATIONAHA.107.185214