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Strength Training & Pregnancy
By Julia Rosenthal, DPT, PRPC, CPPC
For years, pregnant individuals were often told to take it easy and limit physical activity. But as research has evolved, we’ve learned that staying active during pregnancy has some serious perks, from boosting your mood to helping with postpartum recovery. The conversation has shifted from “take it easy” to “keep moving!” Still, there’s one topic that tends to bring up some debate: lifting heavy weights while pregnant and, more specifically, the use of the Valsalva maneuver.
So, what exactly is the Valsalva maneuver? It’s that thing you do when you take a deep breath, hold it, and then push out against a closed mouth and nose—essentially, it’s your body’s way of creating pressure in your chest and abdomen. This pressure helps stabilize your core, making it easier to handle heavy loads, whether you’re lifting weights or just bracing yourself during a tough task. It’s a key part of how your body manages those big efforts.
Now, if you’re pregnant, you might have heard that using the Valsalva maneuver isn’t the best idea. The concerns? Transient spikes in blood pressure, decreased blood flow to the placenta, and added strain on your pelvic floor. But here’s the catch: these recommendations aren’t based on solid evidence that the Valsalva maneuver actually causes these issues—because that evidence doesn’t really exist. Instead, these guidelines are on the conservative side, just like how all resistance training during pregnancy used to be discouraged until we learned how beneficial it can be.
In fact, recent research is starting to challenge the idea that the Valsalva maneuver is off-limits during pregnancy. A study by Prevett and colleagues surveyed female lifters who continued lifting heavy (we’re talking 80% of their one-rep max) throughout their pregnancies. The results? These women reported lower rates of gestational hypertension, preeclampsia, and gestational diabetes compared to the general population. The study didn’t show that using the Valsalva maneuver led to more pregnancy or delivery complications. Quite the opposite—those who kept up their heavy training right up to delivery actually had about 50% fewer complications than those who scaled back.
But what about the pelvic floor? As a pelvic floor therapist, I’m always thinking about how these things impact those all-important muscles. The pelvic floor works in tandem with your abdominal muscles and diaphragm during the Valsalva maneuver, so it’s crucial for weightlifting athletes—especially those who are pregnant—to know how to perform it correctly. In my practice, I often teach clients to take a short, quick exhale after inhaling and before holding their breath. This way, they can feel the core stability that the Valsalva maneuver is supposed to create. If they start to notice symptoms like heaviness in the pelvis, incontinence, or pelvic pain during heavy lifts, it’s a sign that we might need to adjust their technique or tweak their training plan.
In some cases, the changes happening in a pregnant body can make it tricky to find the right pressure strategy under the same heavy loads they were lifting before pregnancy. That’s when I might suggest scaling back for a bit until we find what works. Pregnancy brings rapid changes, and sometimes it just takes a little time to adapt.
In summary, while the research is starting to show that the Valsalva maneuver might be safe during pregnancy, I’ve found in my own practice that managing increased intra-abdominal pressure (IAP) can be more challenging during this time. That’s why working with a pelvic floor therapist can be so valuable for weightlifting athletes during pregnancy. Together, we can fine-tune how they perform the Valsalva maneuver or make smart adjustments to their training program to address any new pelvic floor symptoms. My goal is to help my pregnant clients stay strong and keep lifting throughout their pregnancies, so they can enjoy all the benefits that research is beginning to confirm.
Dr. Julia Rosenthal, DPT, PRPC, CPPC treats patients with all pelvic health conditions. Her approach integrates hands-on techniques with movement, exercise, and loading. Whether you’re living with chronic pain or experiencing pelvic floor dysfunction, no symptom or question is off-limits. She believes that physical therapy is about helping patients identify their values and goals, and providing individualized care that helps them take charge of their lives.
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