The Valsalva maneuver: its effect on intra-abdominal pressure and safety issues during resistance exercise

During resistance exercise, a brief Valsalva maneuver (VM) is unavoidable when lifting heavy loads (>80% of maximal voluntary contraction) or when lifting lighter loads to failure. It has been proposed that the performance of the VM during resistance exercise increases the stability of the spine because of augmented intra-abdominal pressure (IAP). However, resistance trainers are often advised to avoid the VM during resistance exercise because of potential adverse vascular events. The aim of this review was to establish the effect of the VM on IAP and to evaluate if the VM during resistance exercise is a safe practice. Relevant databases were searched to examine the effect of the VM on: (a) IAP and (b) hemodynamics during resistance exercise and reported adverse events. The data show that the VM alone increases IAP and that the VM augment IAP during various resistance exercises. An incremental rise in IAP was observed as the lifting intensity and effort increased, with IAP tending to be lower compared with peak IAP from the VM alone. The VM was associated with an increase in blood pressure during resistance exercise, but the VM alone was associated with greater hemodynamic changes. In conclusion, the VM effectively increases IAP, which may assist with spine stability and trunk rigidity during resistance exercise. The health risks associated with the VM during resistance exercise remain unconfirmed.