How It Is Done
An exercise electrocardiogram (EKG or
ECG) is usually done in a doctor's office, clinic, or hospital lab by a health
professional or doctor. The test results are evaluated by an
family medicine doctor, or
Before the test
- Areas on your arms, legs, and chest where
small metal discs (electrodes) will be placed are cleaned and may be shaved to
provide a clean, smooth surface to attach the discs. A special EKG paste or
small pads soaked in alcohol may be placed between the discs and your skin to
improve conduction of the electrical impulses, but in many cases disposable
discs are used that do not require paste or alcohol.
- The electrodes
are hooked to a machine that traces your heart activity onto a piece of paper.
Your chest may be loosely wrapped with an elastic band to keep the electrodes
from falling off during exercise. A blood pressure cuff will be wrapped around
your upper arm so that your blood pressure can be checked every few minutes
during the test.
During the test
For exercise, you typically either walk
on a treadmill or pedal on a stationary bicycle while being monitored by an EKG
machine. Your EKG will be monitored on screen, and paper copies will be printed
out for later review before you start the exercise, at the end of each section
of exercise, and while you are recovering.
The test is usually
performed in a series of stages, each lasting 3 minutes. After each 3-minute
stage, the resistance or speed of the treadmill or bicycle is increased.
- For the treadmill test, the treadmill will move slowly in a level or slightly inclined
position. As the test progresses, the speed and steepness of the treadmill will
be increased so that you will be walking faster and at a greater
- For the stationary bicycle, you
will sit on the bicycle with the seat and handlebars adjusted so that you can
pedal comfortably. You can use the handlebars to help you balance, but you
should not use them to support your weight. You will be asked to pedal fast
enough to maintain a certain speed. The resistance will then be gradually
increased, making it harder to pedal.
- In both the treadmill and the bicycle tests, your EKG, heart
rate, and blood pressure will be recorded during the exercise. Your heart rate
and EKG will be recorded continuously. Your blood pressure is usually measured
during the second minute of each stage. It may be measured more frequently if
the readings are too high or too low. During the test, you might be asked to give a number that answers the question "How hard do you feel the exercise is?" The number will be on a scale from 6 to 20 and is called a rating of perceived exertion.
- The test continues until you
need to stop, until you reach your maximum heart rate, until you begin to show
symptoms of stress on your heart and lungs (such as fatigue, extreme shortness
of breath, or angina), or until the EKG tracing shows decreased blood flow to
your heart muscle.
- The test may also be stopped if you develop
serious irregular heartbeats or if your blood pressure drops below your resting
After the test