5 Things You Should Know About Exercise ECG


It's used for diagnosis

According to joint guidelines published by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), the goal of exercise stress testing is to exclude the presence of obstructive CAD or predict the likelihood of obstructive CAD. This can be determined based on the extent and severity of ECG changes and angina that may occur during exercise-induced ischemia.1


It's used to help assess patient risk

Several scoring systems have been developed that combine multiple endpoints to improve the diagnostic accuracy of exercise ECG, such as the Duke Treadmill Score (DTS). Calculating the DTS can help evaluate patient cardiovascular risk.5

Exercise time in minutes − (5 x ST deviation) − (4 x exercise angina)a = Duke Treadmill Score (−25 to +15)

a0 = no angina; 1 = nonlimiting angina; 2 = exercise-limiting angina.

LOW ≥+5
MODERATE −10 to +4
HIGH ≤−11


It provides important patient health information

Exercise stress testing is the preferred method of stress testing because exercise capacity is one of the strongest indicators of long-term risk in patients with known or suspected CAD.1,5

ACCF/AHA guidelines indicate that exercise ECG provides information about1:

  • Exercise capacity and duration
  • Exercise-induced chest pain
  • Hemodynamic response to exercise
  • Chronotropic incompetence
  • Ventricular arrhythmias
  • Heart rate recovery


It's appropriate for certain patients

ACCF/AHA guidelines say that the right candidates for exercise ECG are capable of performing at least moderate physical functioning—they can do moderate household, yard, or recreational work, and most activities of daily living. They have no disabling conditions that would prevent them from undergoing an exercise stress test. Also, the right candidates for exercise ECG have an interpretable resting ECG.1


It's not for everyone

According to ACCF/AHA guidelines, patients with resting ECG abnormalities may not be appropriate for exercise ECG. Resting ST-segment abnormalities related to left ventricular hypertrophy, left bundle-branch block, ventricular-paced rhythm, or any resting ST-segment depression ≥0.5 mm may prevent accurate interpretation. Additionally, ST-segment changes can be influenced by right bundle-branch block and certain medications. Patients who cannot undergo exercise stress testing can be considered for pharmacologic stress testing.1

Patients who may not be appropriate for exercise ECG1:

  • Cannot achieve at least moderate physical function or exercise
  • Have comorbidities that limit their mobility