top of page

Breathwork And The Valsalva Manoeuvre As A Tool For Improved Gym Performance

Written by: Sam Mishra, Executive Contributor

Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.

Executive Contributor Sam Mishra

The topic that I chose for the final assessment of my midwifery degree, was care measures during labour to reduce the risk of perineal tears, one of which was the valsalva technique when giving birth, i.e. whether a woman should hold her breath to push.

Man lifting weights at the gym

Approximately 80% of women in the United Kingdom experience some form of perineal tear during childbirth. This can result in both immediate problems like pain and bleeding as well as long-term problems like dyspareunia, depression, sexual dysfunction, and incontinence. Approximately 20% of women experience these problems, which can negatively affect their relationships, ability to bond with their baby, and self-image. It has been proposed that certain techniques, including valsalva pushing, increase the risk of instrumental delivery, perineal damage, and related problems by decreasing uterine perfusion, foetal hypoxia, and maternal exhaustion.

Many years have passed, and I am no longer a midwife, but in my capacity as a breathwork facilitator and trauma practitioner, the valsalva technique continues to be interesting to me. It has been especially applicable in my personal training sessions, where I am regularly reminded to breathe by my trainer.

Benefits of breathwork

Too many of us breathe shallowly and quickly, or we have chronically poor breathing patterns, both of which can exacerbate anxiety disorders and other health problems. We frequently don't even realise how we are breathing, and when that happens, along with the fact that we unknowingly hold stress in our bodies, it becomes difficult for us to unwind. This negatively impacts our emotional and mental health, in addition to our physical health. I frequently witness this during the breathwork sessions I conduct for trauma clients.

Just like massage, there are many variations of breathwork, but they all support nervous system regulation. Breathwork can undoubtedly assist us in acknowledging and releasing our emotions. Breathing in a controlled manner signals the brain that we are safe, which initiates a response in the parasympathetic nervous system and overrides the sympathetic nervous system's dominance. Breathwork is a technique that helps reduce stress, anxiety, and depression as well as enhance sleep quality by lessening the stress reaction brought on by sympathetic nervous system activity. Breathwork is a useful skill in trauma recovery because it helps us feel more relaxed and more capable of managing emotional challenges when the stress hormones aren't running high all the time.

Every system in the body benefits from a balanced neural system, which also relieves chronic pain, stimulates the digestive system, and boosts vitality. In addition to improving our ability to concentrate mentally, activation of the parasympathetic nervous system also lowers blood pressure, increases the anti-inflammatory response, and strengthens the immune system. The immune system may be inhibited when the dominant sympathetic nervous system triggers the stress response since it is not required to fend off a threat. However, the stress response can be suppressed and the immune system can become more effective when the parasympathetic nervous system is activated.

It is therefore easy to see how learning to breathe in a controlled manner, strengthening the lungs, balancing the nervous system, and increasing lung capacity can help with gym performance by promoting a controlled exhalation upon exertion. Additionally, when we improve our lung capacity through a more controlled breathing pattern, we naturally improve oxygen delivery and athletic performance.

So why do people hold their breath during strength training without realising it? Despite believing that this makes the workout easier, research has shown that it really makes our performance less effective. The Valsalva manoeuvre, which involves holding the breath while bearing down, is a technique frequently employed by women during childbirth.

The Valsalva technique: What is it?

The Valsalva manoeuvre is a breathing exercise that can assist with lowering an elevated heart rate because it causes the intra-pressure to rise, which can alter blood pressure and heart rate, among other physiological effects. Most people regard it as a safe technique, and we frequently do it without even noticing, like when we push during a bowel movement, to help remove pus from the ears or to make your ears pop.

The Valsalva manoeuvre entails breath holding, pushing down with the abdominal and chest muscles, and forcing yourself to exhale quickly against your closed glottis, resulting in a rise in intrapleural pressure, which has multiple repercussions on the body.

The Valsalva manoeuvre is used when?

In the medical field, the Valsalva method is acknowledged for four primary purposes. As previously mentioned, it can be used to clear the ears, for example, when flying or scuba diving brings increased pressure to the ears owing to a change in altitude, or to increase intra-abdominal pressure to initiate a bowel movement. The idea that a woman will be able to push harder if she holds her breath during childbirth makes this technique, which is also employed for guided pushing, a contentious one among midwives.

Among physicians, however, the most frequent use is probably as a first line of treatment for supraventricular tachycardia (SVT), a fast heart rate of more than 100 beats per minute while at rest. Shortness of breath, palpitations, and chest pain result from the heart's inability to pump enough blood at such a high rate.

In addition to the medical uses, weightlifters appear to support the use of the Valsalva technique, intentionally or not, because it's thought to provide momentum and stabilise the core when lifting higher weights.

Why weight lifters love the Valsalva technique

Despite the fact that many people lift weights for the purpose of improving their mental health, strength training puts the body under stress due to various physiological processes brought on by the sympathetic nervous system's fight-or-flight response.

When strength training, some people may hold their breath because they are paying so much attention to the details of the exercise that they forget to breathe, but the main reason weightlifters hold their breath is that when the intensity of the workout increases, the core muscles provide more strength. For this reason, powerlifters in particular hold their breath to increase the stability of the pelvis and spine by raising intra-thoracic and intra-abdominal pressure.

Undoubtedly, this enhanced stability can prove beneficial while lifting heavier weights, but the valsalva method isn't usually advised (despite being inevitable for a brief moment when lifting heavy weights). This is due to the fact that breathing incorrectly when lifting weights has been linked to major health issues, such as heart issues, brain damage, and blackouts. The ideal way to breathe while exercising, particularly when lifting weights, is a topic of much discussion. Some studies suggest that you should inhale during the easiest part of the exercise and exhale during the hardest part.

Why is it not advised to perform the Valsalva manoeuvre?

The aorta—the main artery that carries oxygen-rich blood throughout the body—and the vena cava—the main vein that returns blood to the heart—can become compressed as a result of the increased intra-thoracic and intrapleural pressure brought on by a closed glottis and forced contractions of the diaphragm and abdominal muscles. When the blood pressure rises due to aortic compression, the baroreceptor sensor in the carotid artery triggers the parasympathetic nervous system. This lowers blood pressure, heart rate, and cardiac output—the volume of blood the heart pumps out with each beat—which might result in syncope, a transient loss of consciousness, or dizziness. But as a survival mechanism (a standard physiological reaction), the baroreceptors then detect this decline and suppress parasympathetic activity while promoting sympathetic activity. The quick return of venous blood flow to the heart following the client's exhalation raises blood pressure and places an abnormally high mechanical burden on the heart.

Holding our breath when lifting weights can lead to diminished blood flow (and therefore reduced oxygenation) to the brain and hernias because of the increased intra-abdominal pressure. Additionally, holding our breath might induce blood pressure abnormalities and possibly fainting. Breathing through your mouth while lifting weights can cause an unnatural rise in middle ear pressure, which can cause problems with your hearing.

Although it might not seem like a huge problem to hold your breath, using the right breathing technique is crucial yet sometimes disregarded. For weightlifters, it's important to breathe freely rather than holding their breath while working out. They should concentrate on inhaling steadily as they drop the weight and exhaling gradually as they exert effort. This is why weightlifters may find it more advantageous to practice other breathwork techniques, like pranayama, rather than the Valsalva technique. These techniques will strengthen and expand lung capacity while also boosting the anti-inflammatory response and balancing the nervous system, which stabilises the sympathetic-parasympathetic balance.

What does the research say?

The main worry for weightlifters using the Valsalva technique is the vascular complications that follow the blood pressure changes. These problems most frequently arise during isometric or heavy resistance exercises, which involve greater effort.

Beginners are advised to breathe in and out while performing repetitive low-intensity lifts, especially when the weight is held on the chest. However, when performing strength exercises, they should breathe out during the sticking phase, which is the forced part of the movement. When feasible, forced expirations are advised for seasoned clients instead of the Valsalva manoeuvre. High intra-abdominal pressure is thought to be beneficial for maximal efforts because it reduces the compressive load on the intervertebral discs and may reduce the risk of disc injury while also improving lifting capacity. However, the client shouldn't inhale to the fullest before a lift because this will needlessly raise intra-thoracic pressure.

According to one particular analysis, clients who engaged in more intense workouts with heavier weights reported two and a half times the likelihood of headaches and blocked sensations, as well as double the likelihood of tinnitus and vertigo, in comparison to those who engaged in lower intensity activities. Why add to the physiological hazards associated with excessive weight lifting by employing inadequate breathing techniques?

It is advised that beginners avoid using exercises like squats, deadlifts, and leg presses until they have completed progressive conditioning for lifting heavier loads that lead to high intra-abdominal and intra-thoracic pressure. Intra-abdominal pressure and intrathoracic pressure do play important roles in resistance training.

It's important to keep in mind that strength training is advised to reduce the risk of age-related loss of muscle mass or weakness following illness or inactivity. Additionally, heavier loads can cause a spontaneous Valsalva manoeuvre, which elevates blood pressure even more. However, purposeful use of the technique is usually discouraged, especially in light of the possibility that high arterial pressure from heavy resistance exercise could increase the risk of stroke in young, healthy adults. However, this risk is significantly decreased when the exercise is carried out with an open glottis (or without Valsalva).

Increased blood pressure and heart rate will happen even if weightlifters are not pushing down on a closed glottis but are exerting power without the pressure from breathing, despite speculation that many do not truly conduct a true Valsalva during lifting.


It's critical that people who work out at the gym understand the proper lifting and breathing techniques. By breathing systematically, we can all control our breathing for increased athletic performance, workout recovery, reduced stress, heart rate, and improved general wellbeing. There are significantly more advantages to using breathwork on a regular basis than there are to utilising the Valsalva technique during gym workouts. Breathing deeply and slowly can activate our parasympathetic nervous system and direct our healing towards the central nervous system, positively impacting other systems of the body without any side effects.

You can lessen anxiety and improve your ability to fully recover from strenuous physical exercise by focusing on slower, deeper breaths and exhales instead of shallow ones. In order to concentrate on problems, it can also assist you in de-stressing and activating the cognitive area of the brain. Breathwork also helps to improve cardiovascular performance by reducing heart rate.

Follow me on Facebook, Instagram, LinkedIn, and visit my website for more info!

Sam Mishra Brainz Magazine

Sam Mishra, Executive Contributor Brainz Magazine

Sam Mishra (The Medical Massage Lady), is a multi-award winning massage therapist, aromatherapist, accredited course tutor, oncology practitioner, trauma practitioner and breathwork facilitator. Her medical background as a nurse and a midwife, combined with her own experiences of childhood disability and abuse, have resulted in a diverse and specialised service. She is motivated by the adversity she has faced, using it as a driving force in her charity work and in offering the vulnerable a means of support. Her aim is to educate about medical conditions using easily understood language, to avoid inappropriate treatments being carried out and for health promotion purposes in the general public.



  • Benet, N., Kumar, V., Sharma, M. & Gurwan, B. (2023) Effect of Valsalva Maneuver by Heavy Weight Lifters on Ear and Its Attributes. Indian Journal of Otolaryngology-Head and Neck Surgery Apr;75(Suppl 1):535-540

  • Blazek, D., Stastny, P., Maszczyk, A., Krawczyk, M., Matykiewicz, P. & Petr, M. (2019) Systematic Review of Intra-abdominal and Intrathoracic Pressures Initiated By the Valsalva Manoeuvre During High-Intensity Resistance Exercises. Biology of Sport. Dec;36(4):373-386

  • Bosomworth, A. & Bettany-Saltikov, J. (2006) Just Take a Deep Breath…A Review to Compare the Effects of Spontaneous Versus Directed Valsalva Pushing in the Second Stage of Labour on Maternal and Foetal Wellbeing. MIDIRS Midwifery Digest 16:2 p157-166.

  • Childs, J.D (1999) The Impact of the Valsalva Maneuver During Resistance Exercise. Strength and Conditioning Journal 21(2):p 54, April

  • de Virgilio, C., Nelson, R.J. & Milliken, J. (2013) Holding Your Breath? It Could Be Harming Your Health and Weightlifting Form. 

  • Drury, K.A. (2021) Cardiovascular Adaptations to Repeated Valsalva Manoeuvres in Powerlifting Athletes.

  • Hackett, DA and Chow, CM. (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

  • Lepley, A. S & Hatzel, B. M (2010) Effects of Weightlifting and Breathing Technique on Blood Pressure and Heart Rate. Journal of Strength and Conditioning Research 24(8):p 2179-2183, August.

  • MacDougal, 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

  • 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 May;76(5):457-62.

  • Niewiadomski, W., Pilis, W., Laskowska, D., Gąsiorowska, A., Cybulski, G. & Strasz, A. (2012) Effects of a Brief Valsalva Manoeuvre on Hemodynamic Response to Strength Exercises. Clinical Physiology and Functional Imaging. Mar;32(2):145-57.



  • linkedin-brainz
  • facebook-brainz
  • instagram-04


bottom of page