Royal Sussex County Hospital. Princes Royal Hospital. Hove Polyclinic. Sussex Universities

The Exercise Tolerance Test

What is an exercise tolerance test or treadmill test?
Exercise tesiting is now a well established technique for evaluation heart disease. The test requires attaching a 12 lead ECG to your chest, recording a baseline ECG and then walking on a treadmill in pre-defined stages. The electrical activity and blood pressure of your heart will be monitored throughout the test.


Why do I need an exercise test?
In the majority of cases the treadmill test helps your consultant to diagnose and assess the severity of ischaemic heart disease (sometimes called coronary heart disease or coronary artery disease). This disease is due to narrowing of the coronary arteries. It can cause angina (chest pains) and other problems. So, if you develop chest pains you may be advised to have a treadmill test to help to clarify the cause.

Other indications for exercise testing are:

  • Investigation of abnormal heart rhythms (palpitations).
  • Abnormal heart rhythm provocation.
  • Assessment and/or provocation of symptoms.
  • Evaluation of drug treatment.
  • Evaluation of exercise tolerance.
  • To see how well you have recovered after a myocardial infarction (heart attack).
  • Assessment of asymptomatic people in high risk occupations like airline pilots.

What should I do before my test?

  • You should allow an hour for your appointment.
  • We advise good walking shoes or trainers, loose trousers or jogging bottoms. If you would like to wear shorts, changing facilities are available. We would appreciate long hair to be tied back, thankyou.
  • There are no shower facilities, you may need to bring a towel.
  • Please do not eat a heavy meal two hours before your test. You may wish to bring a dring for after your test but it must not be a chilled drink .
  • Alcohol should not be consumed within 12 hours of the test.
  • Please do not drink tea or coffee on the day of the test unless decaffeinated.
  • Please bring along a list of tablets you are currently taking and any inhalers ie Ventolin. Continue to take your usual medication unless advised otherwise by us. You may be asked to stop some or all of your heart drugs (especially Beta Blockers) for 48 hours before the test. If so, you should start them again after the test, unless told otherwise.
  • Gentle flexing of your leg muscles prior to walking can be beneficial but not essential.
  • Please discuss any worries you may have with us before you begin the test.

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What does the test involve?
You will be asked to take your top clothes off (ladies will be provided with a gown) and lye on a couch. Small patches (electrodes) connected to an ECG machine will be attached to various parts of your chest. The electrodes will pick up the electrical activity in your heart and will translate it into a way that can be interpreted by a doctor. The ECG is quite critical in assessing a heart rhythm disorder, the presence of any underlying heart problems, whether an arrhythmia is present, and whether it is an arrhythmia that requires treatment.
A blood pressure cuff with be connected to you arm and BP recordings will be taken and monitored by the physiologist at various intervals prior, during and post walking.

The treadmill starts off at a slow walking pace up a slight incline. The speed and gradient will increase every 3 minutes (bruce protocol). The physiologists will tell you when to stop but you can ask to stop the test at any time. During the test you will be asked how you are feeling and it is important to complete the test without stopping until told to do so unless you have a specific problem. The physiologist will need to know if you feel short of breath or have and chest pains. It is also important to let the physiologist know of any other problems you may experience such as leg pain or fatigue.

At the end of the test you will be asked to continue to walk very slowly for about 30 seconds – this helps avoid dizziness. When the treadmill is stopped the physiologist will ask you to rest in a chair, your BP and ECG will continue to be recorded for a minimum of 4 minutes whilst your heart rate slows down to near the pre-test level. You will then be asked to wait in the waiting area for a minimum of 15 minutes. You may have a drink but not a chilled drink. If you feel unwell you must inform the receptionist and a member of staff will see you.

The walking test can take anything from 0 to 15 minutes. Including preparartion and recovery time the complete test will take approximately 1/2 hour.

What are the risks?
An exercise test is completed without any problems in the vast majority of patients. If you do not have ischaemic heart disease then complications are rare. However, serious complications can occur in a small number of people who have ischaemic heart disease. The risk is to develop a myocardial infarction (heart attack) or an arrhythmia (serious heart irregularity) during the test. Medical help is near to hand to deal with possible problems.

Other Points to Note
If you are unable to keep your appointment it is very important for you to telephone us, even at short notice, so that your appointment can be given to someone else on the waiting list. The test can offer very valuable information about your condition for your consultant, and will influence the treatment you will be given afterwards.

When will I get my results?
Your consultant will tell you your results at your next clinic appointment. If you do not have a clinic appointment, you may be sent one after the test. The consultant may also contact your GP with the results.