“Remember to breath” someone says as they walk past you while you’re sporting your tomato face during a hard set of squats.
You nod, smile, and ignore them, but you also wonder . . . could they be right?
You’ve heard more and more noise about how holding your breath while lifting could be dangerous.
This technique is officially known as the Valsalva maneuver, and it’s become quite a controversial subject among us fitness folk.
Some say it increases your risk of fainting, aneurysm, stroke, and blood vessel damage. They also claim there’s no evidence that it improves your performance or makes lifting any safer, so it’s all risk and no reward.
This is why many trainers tell their clients to breathe continuously while lifting, why doctors often tell their patients not to use the Valsalva maneuver, and why the American Heart Association warns against it, too.
A few minutes of digging on the Internet brings up videos of people collapsing, dropping barbells on themselves, and passing out and crashing face first into the ground. (I’ll spare you the gory details, but if you want to see for yourself, Google “original deadlift passout video.” It’s not pretty).
Others say the Valsalva maneuver is not only safe, but an essential technique for safely lifting heavy weight.
Well, the short story is this:
The Valsalva maneuver could increase the risk of stroke, blood vessel damage, and fainting, but only for a handful of people with a high risk of cardiovascular problems. For otherwise healthy people, the Valsalva maneuver is a safe way to you lift more weight and will probably lower your risk of injury, too.
By the end of this article, you’ll know what the Valsalva maneuver is, why people use it, whether or not it’s as dangerous as many people say it is, who should and shouldn’t use it, how to do it correctly, and more.
Let’s start at square one.
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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.
Here’s what the glottis looks like:
Here’s what this process looks like during the squat:
Here’s someone using the Valsalva maneuver during the squat:
This is what it looks like during the deadlift:
And finally, the push-press:
(I’d include one for the bench press too, but it’s more obvious on these exercises).
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, but it’s more or less the same thing.
The reason people use the Valsalva maneuver is that it helps them 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 (there’s air in your lungs), it’s hard to bend the can. (In case you’re curious just how hard it is to crush a full soda can, watch this video).
Just because “everyone’s doing it” doesn’t prove it’s safe, though. Let’s see what the science says.
Many people claim that the Valsalva maneuver increases the risk of fainting, stroke, and blood vessel damage.
This is why so many trainers tell you things like “don’t forget to breathe,” why fitness gurus obsess over special breathing techniques during exercise, and why doctors recommend you avoid the Valsalva maneuver while lifting.
How true are those claims, though?
Well, the case against the Valsalva maneuver really boils down to this argument:
This argument isn’t completely false, but it’s more wrong than right.
That sounds unhealthy, but 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 walk to the refrigerator.
Weightlifting is unique, though, because it causes a much larger rise in blood pressure than other kinds of exercise no matter how you breathe, and this effect is much greater when you use the Valsalva maneuver.
For example, when 10 male athletes did leg press at 100 percent of their one-rep max, their average systolic blood pressure (the pressure in your vessels during heartbeats) was 200, but when they used the Valsalva maneuver it shot to over 300. (For reference, most healthy people have a resting systolic blood pressure of 90 to 120).
But, is that really dangerous?
Almost everyone reflexively does the Valsalva maneuver when lifting weights, so if it’s dangerous for everyone, then there should be a long list of incidents where people have injured themselves doing the Valsalva maneuver.
And that’s simply not the case.
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. There are zero cases of people dying from using the Valsalva maneuver.
In other words, you’re more many times more likely to die from dropping a barbell on your throat than you are from using the Valsalva maneuver.
That’s all well and good, but could the Valsalva maneuver slowly weaken blood vessels over time, setting people up for complications later?
First, experienced weightlifters have a smaller rise in blood pressure while using the Valsalva maneuver 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.
So, what about the people that did hurt themselves using the Valsalva maneuver?
Considering that the vast majority of people never have any issues, the most likely explanation is that these people may have had a preexisting condition that increased their chances of blood vessel damage.
Among the 19 cases where people hurt themselves, ruptured blood vessels in the eye, brain aneurysms, and air leaking into the chest cavity were the most common problems.
If someone has a genetic predisposition to any of these problems, then doing the Valsalva maneuver (and weightlifting in general), might increase their risk of injury.
In fact, anything that raises blood pressure could be risky for these people. This is one of the reasons why people often have heart attacks on the toilet. Pooping doesn’t kill these people, but the rise in blood pressure caused by straining on the commode is enough to trigger a heart attack in people who already have a weak cardiovascular system.
In other words, the Valsalva maneuver could be the straw that breaks the camel’s back, but it doesn’t cause these problems.
That just leaves one more question—does the Valsalva maneuver make people pass out while lifting?
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. When the Valsalva maneuver is done properly, you’re only holding your breath for a few seconds, 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.
The bottom line is that the rise in blood pressure caused by the Valsalva maneuver has never been proven to be dangerous for otherwise healthy lifters.
If you have a pre-existing heart problem or you’ve noticed chest pain, dizziness, or other red flags while doing the Valsalva, then obviously it would be smart to stop and talk with your doctor, but those problems are exceptionally rare.
To understand why, we need to step back and look at what causes muscle to grow in the first place.
As a natural lifter, the single biggest driver of muscle growth is progressive overload. That is, gradually exposing your muscles to greater and greater levels of tension over time.
The most reliable way to accomplish this is by doing lots of heavy, compound weightlifting.
Once you hit about 80 percent 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 as effectively under heavy loads without trapping some air in your torso.
If you don’t believe me, here’s a little experiment:
Try doing a set of squats with the heaviest weight you can for five reps—your five-rep max—following the advice of many trainers, which is to breath in on the descent and out as you stand up. If it’s a true five-rep max, chances are good that you’ll fail after a rep or two, and even if you don’t, research shows you probably could have used more weight if you’d used the Valsalva maneuver.
Instead of fighting this process, you’re better off using it to lift more weight. It’ll help you get stronger faster, which will help you build more muscle in the long run.
Now, there are three situations where you may not want to use the Valsalva maneuver:
1. You have a history of heart problems and/or high blood pressure.
As the Valsalva maneuver causes an increase in blood pressure, it’s no surprise that people generally recommend against it if you already have high blood pressure.
Likewise, if you’re at a high risk of heart problems or you’ve already had some kind of heart damage in the past, you may want to avoid this technique.
That said, there are many different kinds of “heart issues,” and not all of them prevent you from using the Valsalva maneuver. Everyone’s health history, condition, and risk differs, so you should talk to your doctor before you decide whether or not you use the Valsalva maneuver.
2. You get lightheaded when you use the Valsalva maneuver.
Large swings in blood pressure can cause you to become momentarily lightheaded, which is obviously not what you want when you’re doing a heavy bench press, squat, or overhead press.
This is mainly a problem for people who hold their breath for too long. If this has been an issue for you, try taking more frequent breaths before you rule out the Valsalva maneuver altogether. (More on how to do this in a moment).
3. You’ve injured yourself doing the Valsalva maneuver before.
Obviously, if you’ve ever injured yourself using the Valsalva maneuver (and you know it was due to the Valsalva and not something else), then you may be one of the few people who can’t do it safely.
However, keep in mind that your body does adapt and become better at dealing with these spikes in blood pressure as you become more experienced, so even then, it might not be a done deal.
The Valsalva maneuver has five steps:
- Take a deep breath of about 80 percent of your maximum lung capacity. Your belly should feel “full” but not so much that you have trouble keeping your mouth closed.
- Press your tongue against the roof of your mouth, and without letting any air escape, try to breathe out.
- Start the lift (descend to the bottom of a squat, stand up during the deadlift, lower the bar during bench, etc.).
- Once you’re past the “sticking point,” or the moment during the lift that’s hardest, breathe out as you finish the rep.
- Repeat for each rep in your set.
Here’s a good video that goes over the fine points of how to do this when lifting:
Remember, don’t hold your breath for more than one or two reps at a time, maybe three at most. Many powerlifters like to hold their breath for their first one or two reps, and then take a fresh breath for each subsequent set. Find what works for you, but make sure you’re breathing frequently enough that you aren’t getting lightheaded.
If you’re lifting with proper technique, you don’t have any pre-existing health problems, and you aren’t holding your breath for as long as you can while lifting weights, then there’s no reason not to do the Valsalva maneuver while lifting.
It’s going to help you lift more weight and reps with proper form, and it’s what most people find feels best anyway.
The only people who may want to avoid the Valsalva maneuver are:
If you don’t fall into one of those groups, then there’s no reason to avoid it.
To use the Valsalva maneuver, follow these five steps:
If you stick to those guidelines, then you’ll lift more weight and reps with better form.
Armistead Legge is the Editor-in-Chief for Muscle for Life and Legion Athletics. He has completed over 100 triathlons and cross-country, cycling, and adventure races, and has researched and written for over a dozen organizations, including the National Institutes of Health. When he isn't helping people get into the best shape of their lives, he's lifting weights, riding his bike, hiking, camping, reading, and making delicious food.