Cardiac exercise testing helps to assess how the heart and circulatory system respond to increasing physical exertion. During the test, heart activity, pulse, blood pressure and other parameters are monitored, making it possible to detect changes that are not always noticeable at rest.
Baltic American Clinic performs two exercise tests – cycle ergometry and the cardiopulmonary exercise test (CPET). Cycle ergometry is primarily used to assess how the heart’s electrical activity, rhythm and blood pressure respond to exertion. The cardiopulmonary exercise test additionally shows how the heart, lungs and muscles work during physical activity.
Before the test, the cardiologist assesses your state of health, determines whether the test is needed and chooses the most suitable method.
The possibility to schedule a cardiologist consultation and the tests you need without a long wait.
Cycle ergometry and the cardiopulmonary exercise test, according to individual indications.
The possibility to detect changes that may not appear at rest.
From the cardiologist’s assessment to discussion of the test results and further advice.
When is cardiac exercise testing needed?
Exercise tests may be recommended when the cause of symptoms needs to be found, when heart activity during physical activity needs to be assessed or to determine the body’s physical capacity.
The test may be prescribed if you have:
- Chest pain or pressure during physical exertion. The test may help to detect signs of insufficient blood supply to the heart muscle.
- Shortness of breath during physical activity. It helps to assess whether the symptoms may be related to heart, respiratory or physical capacity problems.
- Palpitations or rhythm disorders during physical exertion. The test may help to record exercise-induced changes in heart rhythm.
- Tiring quickly or reduced physical capacity. It makes it possible to assess objectively how the body responds to exertion.
- Suspected coronary heart disease. An exercise test may be one of the diagnostic methods, depending on individual risk.
- Heart disease that has already been diagnosed. It helps to assess exercise tolerance, treatment results or rehabilitation options.
- Plans for more intense sport. The test may be recommended if there are symptoms, heart disease or other medical indications.
- A need for precise assessment of physical capacity. The cardiopulmonary exercise test makes it possible to measure oxygen consumption and individual exercise limits.
The test is not necessary for every physically active person. Whether it is needed and which method is most suitable is decided by the cardiologist.
Which heart tests are performed during physical exertion?
Cycle ergometry – cardiac stress test
Cycle ergometry is a heart test performed while pedalling a special medical bicycle whose resistance is gradually increased.
During the test an electrocardiogram (ECG) is recorded, and heart rate, blood pressure and how the patient feels are monitored.
When is cycle ergometry performed?
The test may be prescribed when problems with the heart’s blood supply that occur during physical exertion are suspected, or to assess certain heart rhythm disorders, exercise tolerance or treatment results.
What does cycle ergometry show?
- Changes in the heart’s electrical activity. The ECG is recorded at rest, during exertion and during recovery.
- Possible signs of myocardial ischaemia. ECG changes that appear during exertion are assessed.
- Heart rhythm disorders. It is monitored whether physical exertion causes or worsens rhythm changes.
- Pulse and blood pressure response. How these parameters change as the load increases is assessed.
- Exercise tolerance. It is determined what load the patient can manage and whether symptoms appear.
Cycle ergometry does not directly show the anatomy of the coronary arteries, so in some cases additional tests may be needed.
How is cycle ergometry performed?
ECG electrodes are attached to the chest and a blood pressure cuff is placed on the arm.
The patient pedals the medical bicycle while the resistance is gradually increased according to the chosen test protocol. The ECG is monitored throughout, blood pressure is measured periodically and how the patient feels is assessed.
The test ends when the planned load level is reached, or earlier if symptoms or significant changes in the readings appear. After the exertion, the recovery of heart activity is monitored for some time.
Cardiopulmonary exercise test (CPET)
The cardiopulmonary exercise test is a comprehensive assessment of physical capacity that evaluates how the heart, respiratory and metabolic systems respond to physical exertion.
Unlike standard cycle ergometry, it also measures oxygen consumption, the amount of carbon dioxide exhaled and breathing parameters.
When is the cardiopulmonary exercise test performed?
The test may be recommended:
- When the cause of unexplained shortness of breath or reduced physical capacity needs to be found.
- To assess the functional status of patients with heart failure.
- When it needs to be determined whether physical capacity is limited more by the heart, the respiratory system or other factors.
- To plan an individual physical activity or rehabilitation load.
- When an objective assessment of aerobic capacity is needed.
What does the cardiopulmonary exercise test show?
- Maximal or peak oxygen uptake (VO₂ peak). One of the most important measures of aerobic physical capacity.
- Ventilatory thresholds. They help to determine how the body responds to increasing load and to choose the intensity of physical activity.
- Breathing efficiency. How the body ventilates the lungs during physical exertion is assessed.
- Heart and circulatory response. Changes in pulse, ECG and blood pressure are monitored.
- Possible causes of limited physical capacity. The test results help to assess the influence of the heart, lungs and other physiological factors.
How is the cardiopulmonary exercise test performed?
ECG electrodes are attached to the patient and a special breathing mask is fitted, through which respiratory gas exchange parameters are measured.
The load is gradually increased while pedalling the medical bicycle. During the test, heart activity, breathing, blood pressure and how the patient feels are monitored.
When the exertion ends, the body’s recovery is monitored. The data collected are analysed and individual conclusions are provided.
What is the difference between cycle ergometry and the cardiopulmonary exercise test?
Both tests are performed during physical exertion, but they differ in the range of parameters assessed and their diagnostic purpose.
| Parameter assessed | Cycle ergometry | Cardiopulmonary exercise test |
|---|---|---|
| Electrocardiogram (ECG) | Yes | Yes |
| Heart rate | Yes | Yes |
| Blood pressure | Yes | Yes |
| Heart rhythm disorders during exertion | Yes | Yes |
| Exercise tolerance | Yes | Yes |
| Oxygen consumption | No | Yes |
| Carbon dioxide output | No | Yes |
| Breathing efficiency | No | Yes |
| Assessment of aerobic capacity based on gas exchange | No | Yes |
Cycle ergometry is usually chosen when the main aim is to assess how the heart’s electrical activity, rhythm and blood pressure respond to physical exertion.
The cardiopulmonary exercise test provides additional information about how the heart, lungs and muscles work together and about physical capacity.
The most suitable test is recommended by the cardiologist, taking into account your symptoms, medical history and the purpose of the diagnostics.
How to prepare for cardiac exercise testing
For the test to be safe and the results as accurate as possible, it is recommended to follow this advice:
- Comfortable clothing and shoes. Wear clothes that do not restrict movement and sports shoes.
- Avoid intense physical exertion. Hard training sessions are not recommended on the day of the test.
- Eating before the test. Do not eat a heavy meal just before the test. Follow the clinic’s instructions on the exact interval before the test.
- Avoid stimulants. Avoid energy drinks. Follow the individual instructions about coffee and other caffeine-containing products.
- Medicines. Tell us about all the medicines you take. Some medicines, especially those that affect heart rate, may influence the results. Do not stop them on your own.
- Results of previous tests. Bring your ECG, echocardiography and cardiologist consultation reports.
- Changes in your health. If you develop a fever, new chest pain, marked shortness of breath or other acute symptoms before the test, inform the doctor.
If special preparation is needed, you will be told about it before the test.
When is cardiac exercise testing not performed?
Exercise tests are performed only after their safety has been assessed. In some cases physical exertion can be dangerous, so the test is postponed or another diagnostic method is chosen.
The main contraindications are:
- Acute coronary syndrome or unstable angina.
- Acute myocardial infarction, while the patient’s condition is still unstable.
- Uncontrolled, significant heart rhythm disorders.
- Decompensated heart failure.
- Acute myocarditis, pericarditis or other significant acute heart diseases.
- Symptomatic severe aortic valve stenosis.
- Acute pulmonary embolism or other dangerous thromboembolic conditions.
- Acute aortic disease, for example aortic dissection.
The test may also be postponed in case of very high uncontrolled blood pressure, an acute infection, marked limitations of movement or other conditions that would make physical exertion unsafe.
The final decision on whether to perform the test is made by the doctor.
Are cardiac exercise tests safe?
Cycle ergometry and the cardiopulmonary exercise test are non-invasive tests performed under the supervision of medical professionals.
During the test you may experience tiredness, shortness of breath, leg muscle fatigue or temporary discomfort. In rare cases significant heart rhythm or circulatory disorders may occur.
The patient’s state of health is assessed before the test, and the key parameters are monitored during it. If necessary, the exertion is stopped immediately.
Important: if you have new, severe or prolonged chest pain, marked shortness of breath, faint or suspect an acute heart problem, do not wait for a planned test. If you have life-threatening symptoms, call 112.
When are the test results available?
After the test, the doctor assesses the recorded parameters, changes in heart activity and the body’s response to physical exertion.
The cycle ergometry report includes ECG, pulse, blood pressure and exercise tolerance data.
The cardiopulmonary exercise test report additionally analyses oxygen consumption, breathing efficiency and other measures of physical capacity.
The time it takes to receive results depends on the type of test and the data analysis required. The doctor explains the conclusions and, if needed, recommends further tests, treatment or changes to physical activity.
Frequently asked questions
Is a cardiologist consultation needed for cardiac exercise testing?
Yes. A cardiologist consultation is required for this test. The doctor will assess your condition and prescribe the most suitable test – cycle ergometry or the cardiopulmonary exercise test.
A referral is not required for paid services at Baltic American Clinic and does not affect the clinic’s set prices.
Can cycle ergometry detect blocked heart arteries?
The test may show signs of myocardial ischaemia that appear during physical exertion, but it does not directly show the anatomy of the coronary arteries. If significant narrowing is suspected, additional tests may be needed.
Is it necessary to reach maximum exertion during the test?
Not always. The intensity of the load depends on the purpose of the test, the patient’s condition and the chosen protocol. The test may be stopped earlier if there are medical reasons.
Is a cardiac stress test suitable for older people?
Yes, if the patient’s state of health allows physical exertion to be performed safely. The doctor assesses individual indications, possible contraindications and physical abilities.
Can the test be performed if I take blood pressure medicines?
Usually yes, but some medicines may change how the heart responds to physical exertion. Before the test you must tell the doctor about the medicines you take and follow their instructions.
Is the cardiopulmonary exercise test suitable for people who do sport?
Yes. The test can help to assess aerobic capacity and determine individual exercise intensity limits. It is especially useful when a precise physiological assessment is needed or there are medical indications.
Can the test explain why I get tired quickly when exercising?
The cardiopulmonary exercise test can help to determine whether physical capacity is limited by the heart, the respiratory system or other physiological factors. In some cases additional tests are needed to establish the final cause.
How long does cardiac exercise testing take?
The active exercise part usually lasts from a few to around fifteen minutes. The whole visit takes longer, because you need to get ready, baseline readings must be recorded and recovery after the exertion must be monitored. The exact duration depends on the test method.
Can I drive and go back to work after the test?
If the test went without complications and you feel well, you can usually return to your normal activities. If significant symptoms occurred during the test, the doctor will give you individual advice.
Price of cardiac exercise testing
Prices of cycle ergometry and the cardiopulmonary exercise test are set according to Baltic American Clinic’s current price list.
The cardiologist consultation and the test are separate services. Their prices are calculated separately according to the clinic’s current price list. Additional tests or services, if they are not included in the price of the chosen service, are also charged separately.
A referral for paid services at Baltic American Clinic does not affect the clinic’s set prices.