Clinical Case Database / Category: Patient Management

Supervising an exercise treadmill test

Publication details

James SG Signy, Stephen F Copeland, Janet A Scott, Mark Signy
Foundation Years Journal, volume 3, issue 2, p.20 (123Doc Education, London, March 2009)


The exercise treadmill test, usually performed to a graduated routine known as the Bruce protocol, has been a standard test for investigating chest pain and ischaemic heart disease (IHD) for many years and is still very widely used. As a Foundation Year colleague you may be asked as part of your programme in cardiology or acute medicine to assist with the supervision of these tests. When used properly they are easy to do, informative and a very useful contribution to the diagnosis and subsequent treatment of patients with ischaemic heart disease. In this short paper, we have tried to summarise the indications for treadmill testing, the pretest contraindications to look out for, the test itself, what constitutes a positive or negative test and the possible complications. It is by necessity a brief run-through and further reading is recommended below. The section about the test itself has been written by a senior cardiac physiologist and a consultant nurse. When supervising a test, you should always be accompanied by a well-qualified cardiac physiologist or nurse and do not feel any qualms about asking them for help and advice. Many of them have supervised literally thousands of tests.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


James SG Signy

Medical student
Peninsula Medical School

Stephen F Copeland

Senior Chief Cardiac Physiologist and Cardiac manager
Worthing Hospital

Janet A Scott

Consultant Nurse
Worthing Hospital

Mark Signy

Consultant Cardiologist
Worthing Hospital and Royal Sussex County Hospital


1. Sekhri N, Feder GS, Junghans C, Eldridge S, Umaipalan A, Madhu R, Hemingway H, Timmis AD. Incremental prognostic value of the exercise electrocardiogram in the initial assessment of patients with suspected angina: cohort study. BMJ, November 2008, 13(337):A2240.
2. Hill J, Timmis A. Exercise tolerance testing (review). BMJ, 4 May 2002, 324(7345):1084–1087.
3. Mark DB, Hlatky MAS, Harrell FE, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med, 1987, 106:793–800.
4. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines. J Am Coll Cardiol, 16 October 2002, 40(8):1531–1540 (full guideline on ACC website).
5. Clinical guidance by consensus: recommendations for clinical exercise tolerance testing. Society for Cardiological Science and Technology/British Cardiovascular Society 2008. (Guideline document.)
6. Abramson B. Electrocardiography in suspected angina. BMJ, November 2008, 13(337):A2340. 7. Gershlick AH, de Belder M, Chambers J, Hackett D, Keal R, Kelion A, Neubauer S, Pennell DJ, Rothman M, Signy M, Wilde P. Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society Working Group (review). Heart, April 2007, 93(4):423–431.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.