Exercise tolerance testing involves monitoring a patient's cardiovascular response to exercise by observing heart rate, blood pressure, and electrocardiogram. It is used to evaluate patients with suspected ischemic heart disease who have stable chest pain symptoms. The test follows standardized protocols that gradually increase workload and monitors the patient's physiological measures at set intervals during rest, exercise, and recovery periods. Contraindications and safety precautions are considered to ensure the test can be completed safely.

1. EXERCISE TOLERANCE TESTING
INTRODUCTION

2. Introduction
 Exercise Tolerance Testing is defined
as the observation and recording of
patient’s cardiovascular response to
exercise.
 Involves monitoring of HR, BP, ECG.

3. Clinical context for exercise
testing for patients with
suspected ischemic heart
disease.
*Electrocardiogram
interpretable unless pre-
excitation, electronically
paced rhythm, left bundle
branch block, or resting ST-
segment depression >1
mm.
Copyright © American Heart Association, Inc. All rights reserved.

4. Indications
 Patients who are candidates for exercise
testing may have stable symptoms
 Chest pain, may be stabilized by medical therapy
following symptoms of unstable chest pain, or
may be post–myocardial infarction or post-
revascularization patients.
 The clinician should first address whether the
diagnosis of coronary artery diseases (CAD) is
certain, based on the patient’s history,
electrocardiogram (ECG), an symptoms of chest
pain.
 If not, treadmill exercise testing may be useful.

5. Indications
 The ACC/AHA classifications I, II, and III are
used to summarize indications for exercise
testing:
 Class I: Conditions for which there is evidence
and/or general agreement that a given
procedure or treatment is useful and effective.
 Class II: Conditions for which there is conflicting
evidence and/or a divergence of opinion about
the usefulness/efficacy of a procedure or
treatment.

6. Contd…
 IIa: Weight of evidence/opinion is in favor
of usefulness/efficacy.
 IIb: Usefulness/efficacy is less well
established by evidence/opinion.
 Class III: Conditions for which there is
evidence and/or general agreement that
the procedure/treatment is not
useful/effective and in some cases may be
harmful.

7. Contra-Indications

8. PROCEDURE
 Further changes are made
accordingly Bruce Protocol.

9. Conducting the Test
 Explanation:
◦ Leaflets or illustrations before commencement
◦ Reasons and outcomes of testing
◦ Demonstration of procedure to relieve anxiety.
◦ Instruction for not to put excessive pressure on
rails of treadmill
◦ Report any uncomforts pre, peri or post testing.
◦ Any medications.
 Patient preparation:
◦ Skin surface cleaned with alcohol and abraded by
sandpapers to remove surface epidermis and oil.
◦ Position ECG electrodes according to the
following order.

10. ECG Electrode Placement

11. ECG Electrode Placement

12. Measurements during ETT
 ECG Testing every 30 sec interval. Also recorded
during rest, exercise and recovery phase of
testing.
 Blood pressure is taken at rest, exercise and
recovery phase in same intervals as of ECG.
 Heart beats are monitored continuously during all
phases for recording and noting any abnormal
rhythm or conduction rhythm.
 Heart beat and Blood Pressure need not be at
same pre-exercise levels, but should be stable
before test discontinued.

13. Treadmill Protocols

14. VO2max Prediction by Bruce
Protocol
 Where, ‘T’ is total time completed in minutes.

15. Duke Treadmill Score