What is an Exercise Stress ECG Test?

This is a simple and most basic test of your heart’s functional response to physical stress. Walking on a treadmill at gradually increasing speeds and gradient makes your heart pump harder and faster than usual, and can reveal problems within your heart that might not be noticeable otherwise.

What are the benefits of a treadmill test?

  • Detects heart artery blockages that can cause chest pain, breathlessness, heart attack or sudden cardiac death
  • Detects abnormal heart rhythms resulting in irregular heart beats or palpitations (Arrhythmias)
  • Identifies life-threatening heart rhythms brought on by exercise that can lead to sudden cardiac death
  • Evaluates blood pressure response to exercise
  • Evaluates the effectiveness of your cardiac treatment plan
  • Guides the development of a safe exercise program especially in patients who have heart disease or suffered a heart attack before
  • Guides treatment of heart disorders eg timing for cardiac surgery such as valve replacement, heart transplantation in patients with heart failure and cardiac bypass surgery in patients with multiple heart artery blockages

Example 1 of a 45 year old asymptomatic patient who was found to have severe blockages of the heart arteries detected on routine health screening.

Normal-looking ECG before treadmill test

Significantly abnormal ECG during treadmill test suggestive of heart artery blockages


Example 2 of 30 year old man developing life-threatening abnormal heart rhythm during pre-athletic cardiac screening. This is one of the potential causes of sudden cardiac death in athletes participating in strenuous sports eg marathons.



Who will benefit from this test?

Patients with symptoms of

  • Chest pain
  • Shortness of breath
  • Irregular heart beats or palpitations
  • Recurrent giddiness or fainting spells
  • Patients who are planning to participate in strenuous sporting activities
  • Patients with a family history of sudden cardiac death
  • As part of Heart Screening

How to prepare for the test

  • Please wear comfortable sporting attire with shoes suitable for jogging
  • Wear a shirt that can be easily removed so as to facilitate placement of electrodes on the chest
  • Avoid any emollients or lotions on the day of the test as they interfere with the electrode-skin contact
  • You may consume a light meal 1 hour before your stress test
  • You may consume all your regular medications (if any) except medications which will slow down your heart rate eg beta-blockers. These medications need to be stopped for at least 24 hours before the test. Please check with the doctor if you are not sure which medications need to be stopped before the test
  • If you use an inhaler for asthma or other breathing problems, please bring it along with you and highlight it to our cardiac technician & doctor

How is the test performed?

Before the Test

  • Our cardiac technician will attach 10 ECG electrodes (small flat sticky patches) on your chest and a blood pressure cuff around your right arm. The electrodes are attached to ECG monitor that charts your heart’s electrical activity continuously during the test
  • Baseline measurements (Heart rate, Blood pressure and resting ECG) are recorded before the test is started

During the Test

  • Under continuous supervision of our cardiac technician and doctor on stand-by, you will start walking on the treadmill at a slow and gentle pace
  • The speed and gradient on the treadmill will increase gradually at 3- minute intervals. The machine will record the changes to your heart rate, blood pressure and ECG every 3 minutes. At regular intervals, our cardiac technician will ask you how you are feeling and determine when the test should be stopped
  • You will be asked to continue exercising until your heart rate has reached a set target or until you develop symptoms that don’t allow you to continue. These signs and symptoms may include:
  1. Moderate to severe chest, jaw or arm pain
  2. Severe shortness of breath
  3. Abnormally high or low blood pressure
  4. An abnormal heart rhythm
  5. Dizziness
  6. Certain changes in your electrocardiogram
  • You may stop the test at anytime you feel too uncomfortable to continue exercising

After the Test

  • You will walk slowly for a few minutes to cool down. Your heart rate, blood pressure and ECG will continue to be monitored until the levels are returning to normal
  • Our doctor will review the findings of treadmill test and give you the results of your test immediately. Further tests may be recommended if abnormalities are detected
  • The whole process typically takes about 30-45mins but the actual exercise time usually lasts only 7 to 12 minutes
  • When your exercise stress test is complete, you may return to your normal activities for the remainder of the day

How does the doctor use this test to manage my condition?

1. Normal test results

  • If the information gathered during the test reveal that your heart function is normal, no further tests will be needed. However, if your test results are normal and your symptoms continue or becomes worse, our doctor may recommend further tests (eg a stress echocardiogram, CT coronary angiogram or nuclear stress test) to gather more information about your heart function
  • If the purpose of your treadmill test was to guide treatment for a heart condition, our doctor will use data from the test to establish or modify your treatment plan, as needed

2. Abnormal test results

  • If the results of your treadmill suggest underlying blockages of the arteries of your heart or a heart rhythm irregularity, the information gathered during the test will be used to help our doctor develop a treatment plan. You may need additional tests and evaluations, such as a coronary angiogram, depending on the findings

Don't wait for your symptoms to worsen.

Early intervention can save your life. Heart conditions if left unchecked may lead to serious consequences that may have been avoidable with early treatment. Get peace of mind and let us help you find out if there's an underlying cause to your symptoms and provide a suitable treatment plan.

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