The main difficulty of the challenge is linked to Magdalene's low Speed, which was already lower than average, but with Bucket of Lard and Thunder Thighs, it is now at a mere quarter of the average speed. Additionally, the Thunder Thighs effect can cause unwanted results when not paying attention, such as setting off Bomb Rocks or creating new monsters to fight.
The Thunder Thighs effect can easily give access to chests and other items trapped behind rocks. This will allow bombs to be used more liberally for finding secret rooms, as well as in combat.
Pills can be obtained from mushrooms, which may provide a much-needed Speed Up pill, but mushrooms can spawn poisonous clouds when destroyed, making this strategy risky.
Completing the Aprils Fool challenge allows Magdalene to spawn with a Speed Up pill, counteracting the heavy speed reduction from the challenge items and easily identifying future Speed Up pills.
In Repentance, the Speed Up pill is replaced with a Full Health pill, which can be useful to replenish Magdalene's health at the cost of her already low speed.
Destroying as many rocks as possible is a recommended strategy, as this may result in finding a trapdoor. This can lead Magdalene to a Crawl Space or Black Market, thereby allowing the player to obtain valuable items.
Magdalene's high starting Health makes it easier to take deals with the devil without harsh consequences.