This test is done at a medical center or health care provider's office.
The technician will place 10 flat, sticky patches called electrodes on your chest. These patches are attached to an ECG monitor that follows the electrical activity of your heart during the test.
You will walk on a treadmill or pedal on an exercise bicycle. Slowly (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline or with more resistance. It is like walking fast or jogging up a hill.
While you exercise, the activity of your heart is measured with an electrocardiogram (ECG). Your blood pressure readings are also taken.
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Wear comfortable shoes and loose clothing to allow you to exercise.
Ask your provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.
Tell your doctor if you are taking sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and have taken a dose within the past 24 to 48 hours.
You must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test. In most cases, you will be asked to avoid caffeine for 24 hours before the test. This includes:
Tea and coffee
All sodas, even ones that are labeled caffeine-free
Electrodes (conductive patches) will be placed on your chest to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.
The blood pressure cuff on your arm will be inflated every few minutes. This produces a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.
You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill (or the pedaling resistance) will slowly be increased.
Sometimes, people experience some of the following symptoms during the test:
A normal test will most often mean that you were able to exercise as long as or longer than most people of your age and gender. You also did not have symptoms or concerning changes in blood pressure or your ECG.
The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.
It may be hard to interpret the results of an exercise-only stress test in some people.
Balady GJ, Morise AP. Exercise electrocardiographic testing. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli MD, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 13.
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18):1929-1949. PMID: 25077860 www.ncbi.nlm.nih.gov/pubmed/25077860.
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA Guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935-2959. PMID: 24239921 www.ncbi.nlm.nih.gov/pubmed/24239921.
Morrow DA, de Lemos JA. Stable ischemic heart disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 61.
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 10/18/19 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.