Who can have an exercise stress test?

A stress test is appropriate for patients who have symptoms consistent with cardiac ischaemia (chest pain, breathlessness on exertion), known cardiac disease that may be worsened by exercise, or a first-degree relative with a suspected heritable arrhythmia. Importantly, a stress test is NOT appropriate for someone who is asymptomatic and has a normal cardiac examination — it should not be used as a general cardiac screening tool in healthy people.

Is an exercise stress test safe?

Yes, when performed under appropriate conditions. Under Australian MBS requirements, two people trained in CPR must be present — the person performing the test plus a second person immediately available at the premises. The staff must also be trained specifically in exercise testing. The test is stopped if you develop significant symptoms, ECG changes, or blood pressure abnormalities during the test.

What Is an Exercise Stress Test (Treadmill ECG)?

What is it?

An exercise stress test (also called a treadmill test, stress ECG, or exercise ECG) records your heart's electrical activity continuously while you walk or run on a treadmill (or pedal an exercise bike). The effort makes your heart work harder — which can reveal problems with blood flow or rhythm that are invisible when you're at rest.

Your blood pressure and heart rate are monitored throughout. The test takes about 30–60 minutes including preparation, warm-up, exercise, and recovery monitoring.

Who is this test for — and who isn't it for?

✓ Appropriate for

Chest pain or pressure on exertion
Breathlessness on exertion that may be cardiac
Known cardiac disease that may be worsened by exercise
First-degree relative with a suspected heritable arrhythmia (e.g. Long QT, CPVT)
Assessing exercise capacity after a cardiac event

✗ NOT appropriate for

Asymptomatic patients with a normal cardiac examination — not a routine screening test
Known cardiac disease that is stable and not progressing
Abnormal resting ECG that would prevent result interpretation (e.g. LBBB, paced rhythm)
Recent heart attack, unstable angina, or severe aortic stenosis (relative contraindication — specialist decision)

This is an important point: under MBS rules (DR.1.2), item 11729 explicitly cannot be claimed for a patient who is asymptomatic and has a normal cardiac examination. If you've been referred for a stress test, it means your doctor has a specific clinical reason.

What to expect

Preparation: Wear comfortable shoes and clothing. Avoid heavy meals and caffeine for a few hours beforehand. Your doctor may advise holding certain heart medications — ask specifically if unsure.
Set-up: Electrode patches placed on your chest for a 12-lead ECG. A blood pressure cuff goes on your arm. A resting ECG is recorded first.
Exercise: The treadmill speed and incline increase gradually in stages (usually a modified Bruce protocol). The goal is to reach a target heart rate — typically 85% of your maximum predicted heart rate (roughly 220 minus your age).
Monitoring: The team watches your ECG and blood pressure continuously. Tell them immediately if you feel chest pain, severe breathlessness, dizziness, or leg pain.
Recovery: You slow to a walk and are monitored for 5–10 minutes after stopping. Results are usually discussed shortly afterwards or at a follow-up appointment.

Safety

Stress tests are safe when performed properly. Under Australian MBS requirements, two people trained in CPR must be present — the person performing the test and a second person immediately available on the premises. Staff must also be specifically trained in exercise testing protocols.

Serious complications (heart attack or dangerous arrhythmia) are rare — about 1 in 10,000 tests. The test is immediately stopped if significant ECG changes, symptoms, or blood pressure abnormalities occur.

Cost and Medicare

🇦🇺 Australia — MBS item 11729

Medicare fee: $182.15. Medicare benefit: 85% ($154.85). Under MBS rule DR.1.2 the service must either be referred (the patient is referred to a specialist or consultant physician) or requested by another doctor — the rules define both routes. Applicable once in any 24 months. A minimum 20-minute monitoring period is required. Verify at mbsonline.gov.au.

🇬🇧 United Kingdom — NHS

Exercise ECG (exercise tolerance test / ETT) is available free on NHS when referred by a GP or cardiologist. Usually performed at a cardiology department or cardiac physiologist service. No cost to the patient.

🇳🇿 New Zealand

Available via cardiology referral, subsidised under Health NZ. Performed at hospital cardiology departments. No direct patient cost for the test once referred.

🇨🇦 Canada

Covered under provincial health insurance when referred by a physician. Performed at hospital cardiology or community cardiac testing centres. No out-of-pocket cost for the test itself.