If you already know you have coronary artery disease (after a stent, bypass, heart attack or an angiogram), a treadmill exercise test still has a useful job. It answers three practical questions: how much can you do, does exertion starve the heart of blood, and how risky is your heart overall? What it cannot do is tell you how narrow a particular artery is.
What the test answers, and what it does not
| Question | What the treadmill test contributes |
|---|---|
| How much exercise can I actually do? | The workload reached, how long you lasted, and what made you stop. |
| Does exertion cause ischaemia? | Evidence from your symptoms and the ECG. A stress echo or scan shows it more reliably and shows where. |
| Are there worrying responses? | Ischaemia at a low workload, poor fitness, rhythm problems and an abnormal blood pressure response all raise risk. |
| How narrow is my artery? | It cannot say. That needs a CT coronary angiogram or an invasive angiogram. |
1. Exercise capacity: what you can really do
Your own account of what you can manage is an estimate; a supervised test is a measurement. The report records the workload you reached and the reason you stopped, whether that was chest pain, breathlessness, tiredness or something else. If you stop because of knee pain, the test says little about your heart, so the result is always read against how hard you were able to work.
2. Inducible ischaemia: does supply meet demand?
Exercise makes the heart muscle need more oxygen. A narrowing that matters may stop blood flow rising enough, which shows up as symptoms and ECG changes. But how a narrowing behaves depends on more than its size: collateral vessels, the small blood vessels and your medication all play a part. So:
- a positive test does not translate into a "70%" or "90%" narrowing,
- a negative test does not mean your known disease is mild or gone, and
- a test where you could not work hard enough gives limited reassurance.
3. Risk: at what workload do problems appear?
The European Society of Cardiology (2024 chronic coronary syndromes guideline) lists the findings that point to higher risk: ECG ischaemia with symptoms at a low workload, poor exercise capacity, complex extra beats from the lower chambers and an abnormal blood pressure response. At the reassuring end, reaching more than 10 METs (roughly the top of Bruce stage 3) with a negative ECG and a low-risk Duke treadmill score is a good sign. Your overall risk still depends on your symptoms, how well the heart pumps and what your arteries look like.
Book an exercise treadmill test
Bruce protocol treadmill test with continuous 12-lead ECG and blood pressure monitoring, supervised and reported by a consultant cardiologist. £250, appointments typically within days, no referral needed.
Book an exercise testWhat UK and European guidance says
NICE (CG95) advises a non-invasive functional test for people with confirmed coronary artery disease when it is uncertain whether their chest pain is caused by ischaemia, and explicitly allows an exercise ECG instead of an imaging test for this (recommendation 1.3.4.4). NICE's advice against using an exercise ECG to diagnose or rule out stable angina (1.3.6.5) applies to people without known coronary disease, so it does not stop the test being used here. The ESC 2024 guideline likewise supports an exercise ECG in selected patients with known disease, and favours an imaging stress test when the question is how much ischaemia there is, where it is, or whether a stent or bypass would help.
Why taxi drivers might need one
Taxi and private hire drivers are licensed by their local council, and most councils apply the DVLA's Group 2 standard (the lorry and bus standard) to them, as the Department for Transport's best practice guidance advises. Under that standard, coronary artery disease usually means an exercise test:
- after a heart attack, stent or angina, at least 6 weeks on (3 months after bypass surgery), before the licence is issued or returned,
- every 3 years while you hold the licence with established coronary disease, and
- sometimes when you first apply or renew and your D4 form records a past heart problem.
For licensing the question is narrower than for your own care. The council wants to know you can complete 3 stages (9 minutes) of the Bruce protocol without angina, fainting, a fall in blood pressure of 20 mmHg or more, a rhythm problem needing treatment, or ischaemic ECG changes. You do not need to stop your heart tablets beforehand, and the council, not the clinic, makes the decision. A few councils, Birmingham City Council among them, arrange their own taxi medicals, so check what yours asks for before booking. Our guide to the D4 medical with a heart condition covers the full rules, including when an echocardiogram is needed too.
Is a treadmill test right for you?
It suits someone who is stable, can walk briskly on a treadmill and has a resting ECG that can be interpreted. A stress echocardiogram is usually the better choice when:
- the location or extent of ischaemia will decide your treatment, or
- your resting ECG is hard to read: left bundle branch block, a pacemaker rhythm, or marked ST changes at rest.
If you are having chest pain at rest or on light exertion, or have had a recent hospital admission, see your GP or cardiologist before booking any exercise test. If you have severe chest pain, breathlessness or collapse, call 999.
Book an exercise treadmill test
At OneMedicine, a CQC-registered clinic in Kings Heath, Birmingham, with free parking at the rear. Exercise treadmill test £250, or a stress echocardiogram £375 if imaging is the better test. Consultant cardiologist report, no referral needed.
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Specialist interest: Cardiovascular Medicine · OneMedicine, CQC-registered clinic