Exercise Stress Test

What is an exercise stress test?

An exercise stress test, a treadmill test, or a cardiac stress test is a diagnostic procedure that assesses the heart’s function and response to physical activity.

A stress test usually involves the patient walking on a treadmill or riding a stationary bike. The doctor will carefully monitor the patient’s heart rhythm, blood pressure, and breathing.

Who performs exercise stress test?

A cardiologist usually performs the test with other healthcare professionals, such as exercise physiologists, nurses, or technicians who specialize in cardiac testing.

What is the purpose of the exercise stress test?

A doctor may recommend a stress test for the following reasons:

  • Diagnosing coronary artery disease: A stress test can help diagnose coronary artery disease when the major blood vessels supplying the heart become damaged or diseased. It helps identify areas of reduced blood flow to the heart caused by narrowed or blocked coronary arteries.
  • Diagnosing heart rhythm problems: An exercise stress test is useful in diagnosing heart rhythm abnormalities, also known as arrhythmias. It helps determine if the heart beats too fast, too slowly, or irregularly.
  • Guiding treatment of heart disorders: If the patient has already been diagnosed with a heart condition, an exercise stress test can assist in evaluating the effectiveness of the ongoing treatment. The test results help doctors make informed decisions regarding treatment plans.
  • Preoperative evaluation: Prior to certain surgeries, such as valve replacement or heart transplant, a stress test can be performed to assess the heart’s condition. This helps determine if the proposed surgery is safe and appropriate for the patient.

How exercise stress test is performed?

Performing an exercise stress test involves some essential steps.

Preparation before test

  • Dress comfortably and wear suitable exercise attire and shoes.
  • Consult with the doctor to determine whether any medications should be continued or temporarily halted prior to the test.
  • Avoid heavy meals immediately before the test, but make sure not to skip regular meals.
  • Refrain from consuming caffeine or smoking on the test day, as they can influence heart rate.

During the test

  • Electrodes are attached to the chest to monitor the heart’s electrical activity.
  • A blood pressure cuff is placed on the arm to measure blood pressure throughout the test.
  • The patient will be asked to walk on a treadmill or pedal a stationary bicycle. The intensity and speed of the exercise will gradually increase.
  • During the exercise, the heart’s electrical activity is continuously monitored via an electrocardiogram (ECG).
  • Inform the healthcare team, if any discomfort, chest pain, dizziness, or other symptoms arise during the test.
  • The exercise stress test typically lasts approximately 10-15 minutes, although the duration may vary based on the patient’s fitness levels and symptom presentation.
  • After completing or ceasing the exercise stress test, the doctor will closely monitor symptoms, heart rate, blood pressure, and ECG until they return to a normal range. This monitoring period usually lasts for about 15 minutes. Once the heart rate has sufficiently recovered and stabilized, the patient will be cleared to go home.

The results of a stress test assist the doctor in planning or modifying a treatment plan. If the test reveals that the heart is functioning well, further tests may not be necessary.

However, if the stress test suggests the possibility of coronary artery disease, the doctor may recommend a coronary angiogram. This test helps visualize any blockages present in the heart arteries.

Who should not have an exercise stress test?

Some common contraindications for performing a stress test include

  • Acute coronary syndrome: If an individual is currently experiencing symptoms of acute coronary syndrome, such as unstable angina or a recent heart attack, a stress test may be postponed until their condition stabilizes.
  • Uncontrolled hypertension: Individuals with severely uncontrolled high blood pressure may not be suitable candidates for a stress test. High blood pressure can strain the heart during exercise, posing a risk to the individual’s health.
  • Significant heart valve disease: In cases of severe heart valve disease, where the narrowing or leakage of valves is significant, the stress test may not provide accurate or useful information. Other diagnostic methods may be more appropriate.
  • Severe heart failure: Individuals with severe heart failure, where the heart’s pumping function is significantly compromised, may not be able to tolerate the physical stress imposed by a stress test.
  • Acute systemic infection: If an individual has an active infection, postponing the stress test until the infection is resolved is generally recommended.


  1. Exercise Stress Test. Available from: https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-tes
  2. Exercise Stress Test. Available from: https://my.clevelandclinic.org/health/diagnostics/16984-exercise-stress-test
  3. Stress Test. Available from: https://www.mayoclinic.org/tests-procedures/stress-test/about/pac-20385234
  4. Hill J, Timmis A. Exercise tolerance testing. BMJ. 2002 May 4;324(7345):1084-7.

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