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Exercise has no effect on hiatal hernias. Exercise, however, can increase acid reflux in people who are prone to acid reflux, presumably those individuals with weak lower esophageal sphincter muscles. (Exercise increases intra-abdominal pressure and can force stomach acid back into the esophagus through a weak lower esophageal sphincter.) The effects of alcohol and tobacco on the effectiveness of Protonix or related drugs (proton pump inhibitors or PPI's) are minimal, however, both alcohol and tobacco aggravate the underlying acid-related conditions for which Protonix is used, and they should be discouraged.