Hold Your Breath - by Johnny Nguyen 

My internship in cardiac rehab at the Danville Regional Medical Center in Virginia taught me, among many things, the importance of always breathing during exercise. Continuous breathing during exertion prevents a dramatic rise in blood pressure, causing increased intra-abdominal pressure and, more concerning to the cardiac patient, intra-thoracic pressure, which is undesirable as this vasal and anatomical pressure puts a dangerous load on a diseased heart. “Breathe,” we would encourage the cardiac rehab patient, “you should always breathe through your exercises.”

The problem is that through the years this medical advice somehow leaked out of the clinic, down the hall, out the front door and to rest of the exercising world. Everyone is told to always breathe through all exercises, to never ever hold the breath during exertion because it is dangerous.

Amazingly enough, for millions of years before this medical advice was ever uttered people have survived this “dangerous” breath-holding maneuver during exertional activities such as picking up heavy objects, throwing stones, hunting game, jumping obstacles, horsing around with playmates, bowel elimination, or doing something as simple as standing up from a squatting position. If you were to ask any father to pick up his child from the ground, trained or untrained he would reflexively hold his breath momentarily.

Is this because he has no clue that picking up his son could cause his heart to explode? No (the son will effectively do that to the father when he turns a teenager). Rather, it’s because the body is smart enough to instinctively increase intra-abdominal and intra-thoracic pressure to optimize spinal stability. It is a built-in safety system. This breath-holding, or the Valsalva Maneuver, helps create a rigid corset around the spine to protect it from high-force actions such as heavy lifting or high-velocity movement. It has been shown that the Valsalva Maneuver helps reduce spinal stress during high-force situations, and that exhalation during similar periods increases the risk of spinal injury.

This Valsalva Maneuver also facilitates the increase in force output and the accuracy of quick actions, such as throwing, kicking, striking, lifting, shoving and jumping, as well as control during delicate and precise tasks such as archery and marksmanship (in which shooting occurs not just during a brief period of breath-holding but also exactly between heart beats, as to avoid unwanted perturbation).

While it is wise for patients with hypertension or heart disease to follow the clinical advice of continuous breathing during exercise (even though exercise should generally be modified to reflect the clinical condition of this population in the first place so that load forces remain low), it is appropriate for the average person to briefly adopt the Valsalva Maneuver during high-load activities.

Essentially, it is advisable that breath-holding should accompany and even precede high efforts, followed by controlled exhalation. This brief breath-holding may increase blood pressure slightly beyond what the high-force maneuver itself already does, but the potential increase in power output and motor accuracy along with, and more importantly, the protection afforded to the spine when employing the Valsalva Maneuver are well worth breaking the long-held concept that “you should always breathe through your exercises.”