Cardio – Vascular Consequences of Straining at Weightlifting

Andrew Charniga

“Sinusoidal arrhythmia was observed in the majority (68%) of the lifters; it was different but not pathological”, Sinyakov, Stepanova, 1985

When the subject is strengthening the heart, improving cardio – vascular function and the like; aerobic activities such as jogging, cycling come to mind; straining to lift weights while holding the breath does not. In fact, the straining, characteristic of weightlifting training, including bodybuilding, where athletes strain to perform repetition lifts, punctuated with periods of breath holding, are considered harmful to the cardio – vascular system. Many in the medical field believe the cardio – vascular function does not benefit from strength training. In general, only prolonged low intensity repetitive movements like cycling are considered ‘aerobic’.

Figure 1. Breath holding is a natural reaction to straining. Holding the breath in the midst of straining facilitates muscle power. Charniga photo.  

A common medical assessment of cardio – vascular health is to attribute an arrythmic pulse a sign of heart disease. An arrhythmic pulse, also called atrial afibrillation (A- fib), is usually a condition doctors believe requires medical treatment:

“Some people with occasional A-fib need treatment.” Mayo clinic health book, 5th edition

Breath holding in the midst of straining is a natural reflex; a reflexive to the conditions of exerting maximum effort while lifting, running and so forth. In point of fact, the breath holding reflex is a facilitator of maximum muscular effort. (Zatsiorsky, 1995 ). The positive effect of breath holding while straining is called the “pneumo – muscular reflex”; where the rise intra – lung pressure stimulates muscular power (Zatsiorsky, 1995). Invariably a commonplace outcome of prolonged straining at lifting, sprinting and so forth, is a brief period of heart rate arrhythmia during the recovery phase; after straining has ceased.

The adaptations connected with of many years of weightlifting training and similar forms of straining associated with breath holding, i.e., thousands of a- fibrillar recovery episodes of heart rate, are unknown. However, some research of the long – term effects of weightlifting training, especially training connected with high levels of strain and associated breath holding has revealed several circumstances: 

1/ The heavy straining of chronic powerlifting does not negatively impact the cardio – vascular system;

2/ A lack of evidence of a negative impact on the cardio – vascular system from powerlifting contradicts contemporary beliefs. (Silva, et al , 2018).

3/ Weightlifters adapt to the difficult for circulation, conditions of straining and breath holding, without pathological manifestations. (Vorobeyev, 1977).

4/ Weightlifting does not cause an enlarged heart. (Vorobeyev, 1977).

5/ An increasing content of  haemoglobin and erythrocytes is an adaptation to breath holding during weightlifting exercises; because breath holding while straining stimulates the production of red blood cells (Vorobeyev, 1988).

6/ The weightlifter’s heart rate can reach 180 – 220 b/min in the classic clean and jerk exercise (Vorobeyev, 1988, Abadzhjiev, 1986).

7/ Weightlifting training does not have a significant affect on the morphology of the athlete’s heart. (Vorobeyev, 1977; Sinyakov, 1985)

8/ Heart rate increases during straining. Heart rate increases insignificantly for athletes who are well adapted to straining (1 – 3 beats for 5 seconds at the onset of straining), then quickly stabilizes. HR slows 5 – 8 seconds after straining has ceased and for some time is  lower than the initial level. (Sinyakov, 1985)

9/ “Weightlifters display a conditioned reflex before workouts to increased heart rate and a rise in systolic blood pressure. Optimal activation of the cardio – vascular system before training usually indicates the athlete is ‘tuning’ for the upcoming work, i.e., a defining of one’s work capacity.” A.N. Vorobeyev, 1977    

10/ Blood pressure is slightly higher in winter than in summer: Systolic pressure is 113 and 104 mm Hg; diastolic 72 and 70 mm Hg, respectively. A.N. Vorobeyev, 1977

11/ The majority of EKG indicators of the highly qualified weightlifters were found to be within the range of healthy person. A.N. Vorobeyev, 1977.

12/ The oxygen requirements of the brain increase exponentially under conditions of emotional excitation; consequently, weightlifters are more susceptible to Valsalva events: loss of conscious from straining while holding the breath in competitions and significantly less so in training. A.N. Vorobeyev, 1977 

13/  Electro -cardiographic data recorded in the early period of restoration of lifting is indicative of the strain on the heart. However, all EKG indicators return to normal after about 2 -3 minutes for the trained weightlifter. A.N. Vorobeyev, 1988

14/ “Highly qualified weightlifters have a small clockwise tilt in the heart relative to its dorso – ventral axis. We believe this rotation is due to the increased mass of its right ventricle.” A.N. Vorobeyev, 1977

Figure 2. The world’s strongest man; holding his breath as he strains to lift a record weight; will typically experience an arrhythmic pulse in the first 15 – 20 seconds of the recovery after straining has ceased. Charniga photo. 

Tests of cardio – vascular functions specific to weightlifters

One would expect there to be many episodes of breath – holding – straining conditions over a person’s life time; and, such episodes, by the many thousands for athletes; especially in the power sports of weightlifting, track and field and so forth. A period of arrhythmia for 15 – 20 seconds into the recovery after straining is a natural manifestation; not a pathology:

“The pulse is weak, arrhythmic, immediately following the press. Restoration of pulse rhythm is observed 15 – 20 seconds after the lifting and heart rate is 120 – 220 bpm; systolic pressure is 180 – 200 mm pt.ct.; diastolic increases 10 – 15 mm pt. ct.” Geselyevitch, 1981

The non – weightlifter’s cardio – vascular system is poorly adapted to the conditions of breath holding and straining. Whereas, the high level weightlifter’s circulating blood rises almost two – fold in comparison to the untrained. Furthermore, the weightlifter’s adaptation to the conditions of straining and breath holding contribute to longer times of straining (A.N. Vorobeyev, 1977, Geselyevitch, 1981).

Most tests of cardio – vascular function (EKG, Echo – cardiogram, Blood pressure, pulse, heart sounds) administered in various medical settings, doctor’s offices, clinics and hospitals are of a general nature and designed to detect health, fitness. They are not set up; nor do they attempt to identify non – pathological;  just different; specific to sports phenomena, such as 15 – 20 second periods  arrhythmia in the recovery phase after straining; especially with subjects who engage in power sports like weightlifting. 

Figure 3. Breath holding in the midst of straining can occur with the mouth open or closed; and is typically accompanied by visible vascular distension. Charniga photo. 

Sport specific tests for the straining/ breath holding conditions of weightlifting  begin with the recognition of the Lindgard phenomena: an intensification of heart and respiratory functions following work. Sport scientists have analyzed alterations of blood pressure and pulse rates (Vorobeyev 1977;1988; Geselyevitich, 1981; Sinyakov, Stepanova, 1985) to ascertain a weightlifter’s state of health, reaction to the training loading, state of fitness and susceptibility to over-training. 

Tests of cardio – vascular function typically administered in the medical setting are not designed for the breath – holding – straining athlete; and, as such, may register what is normal for weightlifters, an abnormality; even an assumption of a pathological condition. For instance, an arrhythmic pulse in the first 15 – 20 seconds of the recovery phase following straining at lifting is normal for weightlifters and other athletes exercising under similar conditions. The fact that such a ‘Lindgard’ phenomena as an arrhythmic recovery heart beat; can be a specific adaptation to many years and many thousands of breath – holding –  while – straining episodes; is typically not to be found in western medical texts and research. However, it has been studied in the USSR.   

In many, if not most cases, there is little or no effort made in medical exams to establish consistent base line conditions as points of reference to compare test results. For instance, Vorobeyev, 1977, recorded pulse and blood pressure of the Soviet national weightlifting team competing in international competitions: lying in bed, before rising; on an empty stomach. Pulse rates are affected by posture (sitting, lying, standing) even sitting with the head lowered, time of year, emotional state, and so forth. Blood pressure readings can vary according to a variety of factors as well; including the time of year. Some commonly used sport specific tests deserve consideration to aid in ascertaining an athlete’s state of health; or, current state of over – training.

Some sport specific tests of cardio – vascular reaction to ‘Valsalva’ conditions of breath holding while straining

The Valsalva phenomena is named after 17 th century Italian physician Antonio Maria Valsalva(1666 – 1723). A ‘Valsalva episode’ is most often associated in weightlifting with loss of motor control and even loss of consciousness from holding the breath amidst the straining to lift a (near)maximum weight. However, a ‘Valsalva’ effect is practically a catch all term for any number of medical tests connected with breath holding. Sports specific testing for straining while holding the breath are not commonly applied in medical settings such as doctors’ offices, hospitals and so forth. For the most part, pulse, blood pressure, EKG, echo-cardiogram, stress tests, some using chemical injection are the standard medical tests applied.

A potential complication associated with standard tests for anyone and everyone in a medical setting is the possibility of failure of medical personnel to distinguish between results designated aberrations;  which, may in fact be sports specific adaptations. See quote above about arrhythmia being different, but not pathological. Consequently, there are a number of sports specific tests of cardio function for  weightlifters which could prove useful in preventing one’s physiology being pigeon – holed into a pathology (

Some commonly applied sport specific tests for weightlifters used to diagnose current state and reaction to training:

Valsalva tests are performed seated. The athlete exhales through a U – shaped tube into a mercury manometer after first exhaling; followed by a deep inhalation. The athlete (subject) then strains following exhalation such that the mercury manometer level is held at 40 – 50 mm pt.ct. as long as possible. Pulse rate should rise after straining. Systolic pressure drops by 20 – 30 mm pt. ct.; diastolic rises by 5 – 10 mm pt. ct.; heart tone is difficult to detect; systolic drops by 60 – 80%; and, minute volume by twice as much. Increased time of straining is indicative of improved functional state in a number of sports (weightlifting, wrestling, Geselyevitch, 1981).

Burgeru’s straining test can be used to determine a weightlifter’s state of conditioning. Arterial pressure is taken 2 – 3 times with the athlete seated. Then the athlete is to take 10 deep breaths for a period of 20 seconds; at the end of which arterial pressure is taken. The athlete then exhales through a U – shaped tube into a manometer holding the mercury level at 40 – 60 mm pt.ct. Straining ceases after 20 seconds. Arterial pressure is taken immediately after straining begins; immediately after straining ceases; then every 20  seconds until the initial level returns. A drop in arterial pressure of more than 10 mm pt.ct., is a negative reaction. Systolic pressure rises after straining has ceased; lasting 40 seconds.

A rise in systolic arterial pressure for approximately 40 seconds after straining has ceased is normal. A drop in arterial pressure of more than 10 mm pt.ct. is a negative reaction to Burgeru’s straining test. (Sinyakov, A.F., Stepanova, S.V., 1985).

“Cardio – vascular activities undergo significant alteration during straining. Perhaps then, should one avoid it or at least significantly reduce straining? No, it allows one to develop great tension in the skeletal musculature.” A.N. Vorobeyev, 1988

Shtanga’s pressure test is carried out by having the subject perform a maximum inhalation; hold the breath for 15 – 20 seconds, then exhale forcefully for 2 – seconds (straining). This causes a sharp increase in intra – thoracic pressure; blood flow to the heart is sharply diminished. There is a significant rise in systolic pressure during the recuperation period immediately following the test. Blood pressure decreases 5- 10 mm pt.ct. when the contractile abilities are normal. Blood pressure is measured before the test, immediately after and after 2 – minutes. A 10 mm rise in blood pressure following the test is considered unsatisfactory (Sinyakov, 1985). 

The Shtanga procedure causes a significant rise in intra – thoracic pressure; blood flow to the heart diminishes sharply. These ‘Lindgard phenomena’ are interpreted with measurement of blood pressure: 

Sample of results of Shtanga’s pressure test: Normal BP130/70; immediately after test:140/75; Two minutes after test: 135/70. The 10 mm rise after the test is considered unsatisfactory. (Sinyakov, A.F., Stepanova, S.V)

Kevdin’s test consists of 40 squats in 30 seconds. Research with the Kevdin test showed heart rate increases by 48% in the first 10 seconds of recuperation compared to the initial levels; maximum blood pressure can rise up to 29%;  diastolic decreases by 10.5% and pulse pressure rose by 102%. Blood pressure and heart rate were found to restore in 30% of cases by the third minute.

“The circulatory system of the non – weightlifter is poorly adapted to the difficult conditions of weightlifting and straining. The organism’s rising need for blood is clearly insufficient; whereas, the qualified weightlifter’s volume of circulating blood rises almost two – fold during weightlifting. It is precisely this fact, where we see the special adaptation of the qualified weightlifter’s cardio – vascular system to weightlifting.” A.N. Vorobeyev, 1977

Adaption of the body’s blood circulation mechanism is specific to weightlifting. The weightlifter’s minute blood flow in training rises by two and three fold; while at the same time this indicator for untrained person rises insignificantly; no more the 60%. There is a clearly expressed rise in pulse rate, minute and systolic volume of blood flow after lifting weights. These are normal adaptations to weightlifting training. Knowledge of various sports specific tests of cardio – vascular function can be useful to accurately assess,  the specific to weightlifters, different, but nonetheless, non – pathological adaptations to straining while breath holding.

Additional notes for Cardiovascular consequences:

‘Left – Over Adaptations’

Is it not a novel idea, some adaptations of an athlete’s cardio – vascular system, ‘left – over’ from years of training; which may not be active so to speak; yet still discernable; could be useful to differentiate ‘different from pathology’?

For instance, 30 Swedish female elite swimmers were found to have heart volumes larger than would be expected (calculated) for their body mass. All were otherwise healthy. In fact, as one might expect, the swimmer who had the highest oxygen uptake and the largest heart was the best swimmer of the group.  These girls were re – examined years later. All were in good health and were essentially sedentary. Their maximum oxygen uptake was down from their swimming days to normal levels. However, their enlarged heart size remained. (Astrand, P- A., RoDAhl, K., Dahl, D., Stromme, S.,: cited from B.O. Eriksson, Lundin, and Saltin, 1975)   

One might conclude, with reasonable assuredness, an enlarged heart is an obvious, and likewise confirmed, adaptation to intense endurance training; the manifestation of which is not pathological. An enlarged heart, i.e., a ‘left – over adaptation’, need not be a problem of physiology:

“We came to the conclusion the training of even highly qualified weightlifters does not result in enlarged heart in the majority of cases. Heart dimension is physiologically determined only in endurance sportsmen. However, this does not exclude those cases where weightlifters with enlarged hearts have been training with 2 – 3 times larger volumes.” A.N. Vorobeyev, 1977

A.N. Vorobeyev (MD, PhD), came a similar conclusion; a different from what is believed to be a normal response to training; is not a pathology. Vorobeyev’s carried out extensive research as head coach of the USSR national weightlifting team of the late 1960s. Of the lifters comprising the team, whose body weights ranged from 56 kg to 160+ kgs; two were found to have enlarged hearts: Talts (90 kgs) and Zhabotinsky (+160 kgs). Zhabotinsky @193 cm/160kgs was found to have a heart volume of 1.225 cm³, i.e., a QR ratio of 8.0 cm³/kg. This would be considered a normal heart volume for someone of such a large body mass. On the other hand, regards Talts’ enlarged heart: 

“His heart volume was greater in both absolute and relative terms, according to the electro – cardio graphic indices with hypertrophy of the left ventricle as well.” A.N. Vorobeyev, 1977

It was reasoned Talts’ enlarged heart was not an abnormality; but, a ‘left over’ of his having participated in track and field for years prior to taking up weightlifting.

Figure 4. Heart volume can be a function of a specific adaptation to training and/or the mass of the body. Endurance athletes tend to have larger heart volumes than what is considered normal. Athletes who have a large body mass are expected to have larger heart volumes as well. Charniga photo. 

Research of weightlifter’s cardio – vascular function in response to intense training loads over a period of years have shown weightlifting training does not have a negative effect on the cardio – vascular system (Vorobeyev, 1977; 1988; Sinyakov, 1985). Furthermore, logic would dictate a ‘left – over adaptation’ such as a sinusoidal arrhythmia has some reactive protective elements:

“A sinusoidal arrhythmia was observed in the majority (68%) of the lifters; it was different; but not pathological.”

It is a logical assumption sinusoidal arrhythmia especially as it pertains to the first 15 – 20 seconds of the recovery phase from straining is a ‘left – over adaptation’ of weightlifting training: “different but not pathological”.

Furthermore, since very similar conditions are present in other events such as track and field; one should not leap to conclusions, ‘different’ is pathological.

In point of fact, if, ‘left – over’ cardio – respiratory adaptations from many years participation in sports such as weightlifting, i.e., conditions of straining while breath holding, manifest pathological cardio – respiratory alterations; weightlifters and other athletes who devote many years to training and competing under the “near – death” conditions of elite power sports; would be expected to be dropping like so many flies from all of that straining.   

How is it you know what you don’t know?

It has been well said “you are either part of the problem or part of the solution” (Eldrige Cleaver). Ignorance is never a solution. Yet it is ever so commonplace for various health practitioners, academics and so forth to express knowledge sans experience or proof; from the high ground of academic credentials, textbook knowledge, biased research, and/or just plain ignorance of research outside their purview.   

Consider the following question for the doctor column of Strength and Health magazine circa 1965:  

Ask the Doctor column from Strength & Health magazine; February 1965


“I am 18 years old and have been lifting weights and wrestling for the past five years. Recently, my doctor told me I have a functional heart murmur. On three visits to his office, he has heard it twice. He told me the wrestling and weight training are too strenuous, and that I must give them up. I feel great physically and do not get tired or winded. I love these two sports too much to give them up. What do you advise?” S&H, 02/1965

The doctor’s advice to the otherwise healthy young athlete was to give up weightlifting and wrestling because they were strenuous for his heart. This is a perfect example of a physician’s knowledge based on ignorance.

Consequently, it is easy to understand how such a ‘knowledge without knowledge’ bias is formed after many years of repetition that weightlifting and wrestling, for instance, are too strenuous for the heart. This is a commonplace example of a medical ‘knowledge without knowledge’ lacking any conceptualization of adaptations specific to stresses inherent in sport could be different from what is considered normal and at the same time strengthen one’s health. For instance:

“An enlarged heart (cardiomegaly) isn’t a disease, but rather a sign of another condition.The term “cardiomegaly” refers to an enlarged heart seen on any imaging test, including a chest X-ray. Other tests are then needed to diagnose the condition that’s causing the enlarged heart.”

The above ambiguity from the prestigious Mayo clinic website leaves out any possibility an enlarged heart could be sign of a benevolent adaptation to sport training. It is merely a sign something is wrong; not something is right.

“For sportsmen at rest, it is common knowledge, all things being equal, pulse rates, and shock volume are connected with the volume of the heart. The larger the heart volume, the larger the shock volume, the less the heart beats. The anatomical morphological features of the heart are connected with its functions. And, vice versa, its functional inabilities are reflected in its morphological structures.” A.N. Vorobeyev, 1977. Translated by Andrew Charniga.

Hence, the medical ambiguity surrounding an enlarged heart; arrhythmia and the like.    


/ Sinyakov, A.F., Stepanova, S.V. “Diagnostics of the functional state of the weightlifter’s cardio – vascular system, Tiiazhelaya Atletika, FIS, Moscow, 1985. Translated by Andrew Charniga

/ Vorobeyev, A.N., Tiiazhelaya Atletika, FIS, Moscow, 1977. Translated by Andrew Charniga

/ Zatsiorsky, V. M., Science and Practice of Strength Training, Human Kinetics, Champaign, IL. 1995

/ Diego Vidaletti Silva, et al, “Comparison of Cardiac and Vascular Parameters in Powerlifters and Long-Distance Runners: A Comparative Cross-Sectional Study” 2018 Dec; 111(6):772–781.doi: 10.5935/abc.20180167PMCID: 

/ Geselyevitch, V.A., Medical reference book for the coach, FIS, Moscow, 1981. Translated by Andrew Charniga.

/ Arinchin, N.I., Nedvyetskaya, G.D., “The Intra – Muscular Peripheral Heart”, Reports of the USSR Academy of Science, Volume 210, No.1, 1973. Translated by Andrew Charniga.

/ Charniga, A.,

/ Ulchenko, U. F., “Assessing the work – capacity of weightlifters with Shtanga’s functional pressure test”, Tiizhelaya Atletika Yezhegodnik, FIS Moscow, 1982 English translation sportivnypress Livonia, Michigan

Astrand, P- A., RoDAhl, K., Dahl, D., Stromme, S., TEXTBOOK OF Work Physiology pp172-3; 2003