In a stress test — also known as an exercise or treadmill test — a doctor monitors a person’s heart rate as they exercise. It can show how well a person’s heart works during physical activity and help diagnose various heart conditions.
Some people, such as those with arthritis, may not be able to do the activities involved in an exercise stress test. Instead, a doctor will give these people a drug to make their heart work harder, as it might during exercise.
In this article, learn why a doctor may recommend a stress test and what to expect during one.
There are a few different ways of completing a stress test, depending on the person’s needs.
Exercise stress test
During a stress test, the doctor will aim to determine the person’s heart rate, blood pressure, breathing, and how tired they feel during different levels of physical activity.
Here is a step-by-step description of what happens during a stress test using a treadmill:
- Having attached sticky electrodes to the person’s chest to monitor the heart, the doctor will take some readings.
- Next, the person will stand on the treadmill.
- As the treadmill starts to move, the person will walk slowly.
- The treadmill speed will gradually increase.
- The treadmill may go into an uphill, or incline, position.
- Toward the end, the person may breathe into a mouthpiece to measure the air they breathe out.
- The treadmill will stop, and the person will lie down while the doctor takes their blood pressure and other readings.
The person will exercise for
If the person experiences any of the following, the doctor might
- high blood pressure
- low blood pressure
- arrhythmia, or irregular heartbeat
- chest pain
- shortness of breath
They may also stop the test if the electrocardiogram (EKG) device detects any unusual changes.
Qualified medical professionals are always on hand in case of any adverse effects.
Stress test without exercise
If a person cannot exercise, the doctor may use a certain medication to trigger the same process.
In this case, they will attach electrodes to the person’s chest and deliver the medication into their arm through an IV line. The medication will take 15–20 minutes to deliver.
The medication will stimulate the heart. It may cause effects similar to those that occur during exercise, such as flushing or shortness of breath.
Nuclear stress test
Depending on the results, the doctor may recommend a
Also known as a nuclear heart test or radionuclide scan, this can give a more detailed and accurate assessment of the heart.
The process is similar to that of the exercise stress test, but the doctor will inject a tracer dye into the arm to highlight the heart and blood flow on an image. The dye will also show any areas of the heart where blood is not flowing. This can suggest a blockage.
As with the exercise test, if a person cannot exercise, the doctor may use medication instead.
The person will then undergo an imaging test that involves a small amount of radiation, such as a single-photon emission computer tomography or cardiac PET test.
The doctor will take two sets of images, each covering 15–30 minutes. They will take the first just after the person has exercised and the second when their body is at rest, either later that day or the next day. They may also take “at rest” images before the person exercises.
In this way, the doctor can compare how the heart looks and functions normally and while under stress.
This test is not suitable for anyone who is or may be pregnant, as radiation may harm the fetus. Anyone who is breastfeeding should let the doctor know beforehand.
A doctor may advise the person not to consume caffeinated drinks or take certain medications on the day of the test. These substances could affect the results.
Anyone who usually has an inhaler should bring it to the test and ensure that the doctor knows about it.
Exercise stress test
A person should wear comfortable clothes and walking shoes.
The test involves the doctor hooking the person up to
- sticky patches, or electrodes, on the chest
- a blood pressure cuff around the arm
- a pulse monitor on the finger
A nurse may need to shave a person’s chest to allow the electrode patches to stick.
If the person is not exercising, they will receive an infusion of a certain medication into their arm through an IV line. This may cause shortness of breath or a headache.
Nuclear stress test
A person should avoid applying oil, lotion, or cream to their skin on the day of the nuclear stress test.
The doctor will give the person an injection of the tracer liquid. This may feel cold. The technician will take some images of the heart before exercising and after. A person lies flat on a table for these images.
The length of time spent exercising will depend on how often a person exercises and their medical history. The test may take a couple of hours.
What the doctor is monitoring
Some factors the doctor will aim to measure include:
Possible results of the exercise stress test include:
- normal blood flow during exercise and rest
- normal blood flow when resting but not during exercise, possibly indicating a blocked artery
- low blood flow when exercising and resting, suggesting coronary artery disease
- no dye in some parts of the heart, implying tissue damage
Doctors ask people to exercise at 85% of their maximum heart rate. They determine this by subtracting the person’s age from 220. If a person’s actual heart rate exceeds their “maximum,” the doctor may ask them to stop exercising.
Doctors may look at how well a person’s heart rate recovers after exercise. To measure this, they can subtract the heart rate one minute after exercise from the peak heart rate. If a person’s heart rate has dropped significantly, they have shown an
|Peak heart rate minus heart rate 1 minute after intense exercise||Performance|
|less than 12 beats per minute (bpm) in a walking recovery||abnormal|
|more than 12 bpm in a walking recovery||normal|
|less than 18 bpm in recovery lying on back||abnormal|
|more than 18 bpm in recovery lying on back||normal|
Doctors will also monitor a person’s blood pressure. Changes in diastolic blood pressure (DBP) or systolic blood pressure (SBP) can indicate certain conditions. Doctors
|Blood pressure readings||Indication|
|blood pressure increase of less than 10 mm Hg||people on blood pressure reduction medication will have a blunted response|
|DBP change of less than 10 mm Hg||peripheral vasodilation|
|sustained SBP drop of more than 10 mm Hg||severe left ventricle dysfunction, severe coronary artery disease|
|SBP of more than 250 mm Hg or DBP of more than 120 mm Hg||severe hypertension|
Sometimes doctors measure stress test results in metabolic equivalents or METS. These tell the doctor how well a person tolerates exercise. METS equate to oxygen uptake in milligrams, measured per kilogram per minute. This is a less exact measurement and depends on how doctors conduct the test.
|12 METS or more||excellent, any score |
If the results of the stress test raise no concerns, the person will need no further tests.
If the results are unclear or suggest that damage is present, the doctor may recommend further tests or treatment.
Stress tests can help a doctor diagnose various heart conditions. They can also help identify a person’s risk before undergoing an activity that may put a strain on their heart and show how well a person’s heart handles a workload.
A doctor may recommend a stress test if a person has symptoms that could indicate a heart condition, such as:
A doctor may also recommend a stress test if a person:
- is undergoing heart treatment
- is due to have heart surgery
- is considering starting a vigorous exercise program
According to a study that researchers presented at the American Thoracic Society conference in 2013, a stress test may also identify people with obstructive sleep apnea who are most at risk of experiencing life threatening complications.
When the heart pumps harder during exercise, the stress test can reveal issues such as low blood supply through the coronary arteries. These problems might not be apparent at other times.
Both the exercise stress test and the nuclear stress test are usually safe.
In rare cases, however, they could trigger adverse effects. These include a heart attack or changes in heart rhythm that do not disappear after the test.
A person should not undergo an exercise stress test if they:
People who are pregnant should not undergo certain stress tests.
Exercise stress test
Medical professionals typically do not recommend exercise stress tests during pregnancy, as they believe the risks outweigh the benefits. This is because pregnancy puts the cardiovascular system under additional pressure. However, researchers have safely conducted stress tests up to 38 weeks of gestation in the past.
Pregnant people should not undergo a nuclear stress test since it is harmful to a developing fetus.
Scientists have linked some pregnancy complications to a higher risk of cardiovascular disease. These include:
To screen for possible cardiovascular risks, doctors may use the following:
- exercise stress test
- isometric handgrip test
- cold pressor test
The pros of conducting an exercise stress test during pregnancy are that they can be a helpful indicator of fitness, and testing in the first trimester can help predict risks later in pregnancy.
The cons are that the test can be stressful for a pregnant person, they may require the use of a recumbent bicycle or other special equipment, and it can be tricky to determine how intense the exercise should be.
More research is needed to investigate whether the findings from an exercise stress test are worth the risks.
Prenatal non-stress test
The test takes around 20 minutes. Doctors perform it while a pregnant person sits in a reclining chair or lying with their belly tilting to the left.
Doctors may use the non-stress test in cases of:
- intrauterine growth restriction
- decreased fetal movement
- a person being near or past their due date
- pregnancy with multiples
- recurrent pregnancy loss
- gestational diabetes
- high blood pressure
- low amniotic fluid
- RhD-negative pregnant people carrying an RhD-positive fetus
- heart disease
- liver disease
- kidney disease
A stress test can show how well the heart is working and help diagnose various heart conditions.
It can also give an idea of how much strain a person’s heart can cope with. This can be helpful when planning for heart surgery or a vigorous exercise program.
The test usually involves walking on a treadmill while a doctor monitors heart activity. However, people with reduced mobility may need to receive a certain medication to produce a similar effect.
A stress test can give an idea of a person’s heart health and guide recommendations on exercise and other forms of therapy.