Quick Answer
Hypopressives is unsafe to practise if you are pregnant, have a heart condition, uncontrolled high blood pressure, a hiatal or inguinal hernia, COPD, a neuromuscular disorder, or have had recent abdominal or pelvic surgery. The apnea at the centre of the technique is a breath-hold, and breath-holding causes a genuine, temporary rise in blood pressure and heart rate, which is why these groups are excluded. If any of this applies to you, or you are simply unsure, check with your GP before starting, and there is usually a modified, breath-only version you can work with instead.
Something I’m asked constantly, often by women who have found Hypopressives online and want to know if it’s actually for them, is some version of “can I do this if I have X?” It’s a fair question, and I would rather give you a clear, honest answer than a vague reassurance, because the technique’s core move, the apnea, is genuinely not appropriate for everyone.
Why the Apnea Itself Is the Issue
Hypopressives works by having you exhale fully, then hold your breath while opening your rib cage without breathing in, a movement often called the “false inhale.” That breath-hold is what creates the low-pressure effect through the core, and it’s also exactly why certain people need to avoid it. Voluntary breath-holding triggers a well-documented cardiovascular response, similar to the diving reflex, involving a real, measurable, temporary rise in blood pressure and changes in heart rate as the body’s chemoreceptors and sympathetic nervous system respond (Physiology and Physiopathology of Breath-Holding Activity). For most healthy people that brief spike is not a concern. For someone with uncontrolled blood pressure or a heart condition, it’s exactly the kind of stress their body doesn’t need.
Who Should Avoid Hypopressives
A recent clinical study screening women for a Hypopressive exercise programme used the following exclusion criteria, which line up closely with what I ask every new client about before we start (Overactive Bladder Syndrome and Hypopressive Exercise, Pamukkale University):
- Pregnancy, at any stage
- Uncontrolled high blood pressure
- A heart condition
- A hiatal hernia
- A history of inguinal hernia
- COPD (chronic obstructive pulmonary disease)
- A neuromuscular disorder
- Recent abdominal or pelvic surgery
I’d add one more from my own years of teaching: the first 6 weeks after giving birth, while your body is still in its earliest stage of healing, whether that was a vaginal delivery or a caesarean.
It’s worth understanding briefly why each of these specifically matters, rather than just treating it as a list to check off. A hiatal hernia is where part of the stomach pushes up through the diaphragm, and the apnea asks the diaphragm to move through its full range against resistance, which can aggravate that. An inguinal hernia sits in the groin, and the intra-abdominal pressure changes involved in the technique can put strain on that same area. COPD affects how efficiently your lungs exchange oxygen and carbon dioxide, and a breath-hold on top of that can make you feel far more breathless than it should. None of these are arbitrary exclusions, they each map onto a genuine, specific way the technique interacts with that condition.
Why Pregnancy Specifically Is Excluded
This is the question I get most often, because so many of the women who find Hypopressives are pregnant or newly postnatal and want to start early. NHS guidance on exercise in pregnancy is direct on this point: you should not hold your breath during exercise, and after 16 weeks you should avoid lying flat on your back for any length of time, since the weight of the bump can press on the vein returning blood to your heart (NHS: Exercise in pregnancy). Both of those are central features of how a full Hypopressive apnea is normally practised.
That doesn’t mean pregnancy and Hypopressives don’t mix at all. In my own pregnancy-safe Hypopressives sessions, we work with the same postural and rib-breathing principles, minus the actual apnea, so you’re building the technique and the awareness you’ll need for the real thing once you’re cleared to start again, usually from 6 weeks postpartum after a straightforward vaginal birth or around 12 weeks after a caesarean.
What You Might Feel, and What’s Worth Mentioning
Even for people the technique is genuinely suitable for, it’s worth knowing what a normal first few sessions can feel like, so you know what’s expected and what isn’t. A bit of lightheadedness if you hold the breath longer than feels comfortable is common while you’re learning your own limits, and it settles as your technique improves and you learn to work within a comfortable range rather than pushing for a longer hold. Some people also notice their heart beating a little faster during the hold itself, which is the same temporary response described above, not a sign anything is wrong. You might also feel a mild pulling sensation through the ribs as they open, especially early on if your thoracic spine and ribs aren’t used to moving that freely, this tends to ease with practice as mobility improves.
What isn’t normal, and is worth stopping and mentioning to whoever’s teaching you, or to your GP if it persists: genuine dizziness that doesn’t settle once you’re breathing normally again, chest pain or tightness, a headache that comes on specifically during or right after the hold, or any visual disturbance during the breath-hold. None of these are “just part of learning it.”
If You Have a Contraindication, What Are Your Options
Having a contraindication doesn’t necessarily mean pelvic floor and core work is off the table entirely, it means the full apnea specifically isn’t appropriate for you right now. Depending on what applies to you, a pelvic health physiotherapist can often adapt the underlying principles, working on postural alignment and breath awareness without the actual breath-hold, similar to how I teach the pregnancy-adapted version. This is genuinely worth asking about rather than assuming your only option is to wait or do nothing.
When to Seek Assessment
This guide is educational and can’t tell you whether Hypopressives is the right fit for your specific health history. If you have a heart condition, uncontrolled blood pressure, a hernia, a neuromuscular condition, or you’ve had recent surgery, speak to your GP before starting, not after. If you’re pregnant, work with a pregnancy-adapted version rather than the full technique, and if you’re postnatal, wait for your 6 to 8 week check before beginning, or longer if you had a caesarean or a complicated birth. If you’re already practising and notice chest pain, a headache that comes on with the breath-hold, or dizziness that doesn’t settle, stop and get it checked before continuing.
If you want to understand more about what the technique actually involves before deciding whether it’s right for you, my full guide to Hypopressives covers how it works and who it tends to help most, and if a weak pelvic floor is what brought you here, this piece on Hypopressives for a weak pelvic floor goes into that specifically. If you don’t have any of the contraindications above, you’re welcome to start a free 14-day trial and try it for yourself.
