A 58-year-old male with cirrhosis is admitted for routine mo…

A 58-year-old male with cirrhosis is admitted for routine monitoring. The patient has a history of esophageal varices, but has not experienced any bleeding episodes. He is prescribed propranolol for prophylactic treatment to reduce the risk of variceal bleeding. The patient is advised to avoid certain activities that could increase abdominal pressure. Which of the following activities should this patient avoid to reduce the risk of rupturing esophageal varices?