Exercise Stress Testing

What is Exercise Stress Testing?

Exercise stress testing is a non-invasive test that checks how a child’s heart works during exercise. By monitoring the heart, lungs, and muscles while your child exercises, doctors can see how their body responds to physical activity. It’s commonly done in older children and teens with heart symptoms or conditions to help them participate safely in physical activities.



Dr Yousssef, Paediatric Cardiology Kogarah & Westmead

Who Should Have an Exercise Stress Test?

Exercise stress testing may be recommended for children and teens who:

  • Show symptoms like chest pain, dizziness, shortness of breath, or a fast heartbeat when active.
  • Have a known heart condition (e.g., congenital heart defect) and need to see how exercise affects their heart.
  • Have had heart surgery or procedures and need to check what level of activity is safe.
  • Are athletes needing clearance for sports.


Benefits of Exercise Stress Testing

This test provides important information to help manage your child’s heart health, including:

  • Detecting Heart Irregularities: Identifies any unusual heart rhythms or responses during exercise.
  • Assessing Fitness and Capacity: Shows how well the heart manages physical activity and overall fitness.
  • Guiding Treatment Plans: Helps doctors adjust treatments for better heart health.
  • Evaluating Recovery: Checks progress after heart surgery to ensure the heart is healing well.
  • Supporting Safe Activity: Determines a safe level of physical activity for children with heart conditions.


Types of Exercise Stress Testing

  • Standard Treadmill or Bicycle Test: The child exercises on a treadmill or bike while heart rate, blood pressure, and oxygen levels are monitored.
  • Stress Echocardiogram: This procedure combines exercise with an ultrasound of the heart to measure how well it pumps blood before and after exercise.
  • Pharmacologic Stress Test: Medication simulates exercise effects on the heart for children unable to exercise.


Alternatives to Exercise Stress Testing

If an exercise test isn’t suitable, alternatives may include:

  • Resting Echocardiogram: Uses ultrasound to see the heart’s structure and function at rest.
  • Holter Monitor: A portable device that records heart activity over 24-48 hours.
  • Cardiac MRI: Uses imaging to get detailed heart pictures without needing exercise.
  • Cardiopulmonary Exercise Test (CPET): Measures how well the heart and lungs work together during exercise.


Preparing for an Exercise Stress Test

To help the test go smoothly, follow these guidelines:

  • Medical Review: Discuss your child’s symptoms, health history, and current medications with the doctor.
  • Comfortable Clothing: Have your child wear loose clothing and sneakers suitable for exercise.
  • Avoid Heavy Meals: Light snacks may be allowed, but avoid heavy meals 2-4 hours before the test.
  • Limit Caffeine: Avoid caffeine or stimulants 24 hours before the test as they can affect heart rate.


What Happens During an Exercise Stress Test?

  • Preparation: Sticky patches (electrodes) are placed on the chest to monitor the heart. Blood pressure and oxygen levels are also checked.
  • Exercise Phase: Your child walks on a treadmill or pedals a stationary bike. The test starts easy and gradually increases in intensity. During this time, the team checks heart rate, breathing, and response to exercise.
  • Observation and Safety: The team watches carefully and will stop the test if your child feels discomfort.


What to Expect After the Test

After exercise, there’s a cool-down phase where your child gradually slows down to let their heart rate and breathing return to normal. Medical staff will check the results and may share some initial findings. Any adhesive patches are removed, and the doctor may discuss the results immediately or schedule a follow-up.


Prognosis After an Exercise Stress Test

If the results are normal, it usually means your child’s heart can handle the activity safely. If there are any unusual findings, your child’s doctor may suggest further tests or adjustments to treatment. Early detection of any issues allows for timely treatment, which can make a big difference in managing their heart health.


Risks of Exercise Stress Testing

Exercise stress testing is very safe and well-tolerated in children. However, some minor risks include:

  • Mild Discomfort: Temporary fatigue or minor muscle soreness.
  • Dizziness: Rarely, children may feel dizzy due to blood pressure changes.
  • Arrhythmias: Exercise may bring on an irregular heartbeat that needs further monitoring.
  • Injury: Minimal risk of a fall or muscle strain during the exercise.
  • Serious Cardiac Events: These are very rare, but emergency equipment and trained staff are on hand, just in case.


What if the Test is Delayed?

Delaying the test could delay diagnosing or managing a heart condition, possibly leading to restrictions on physical activity for safety. Early testing helps ensure that any necessary treatment or activity adjustments can be made promptly.