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Exercise Tolerance Test (ETT)

An Exercise Test looks at the electrical activity of the heart while under physiological stress. This test is similar to a regular 12-lead ECG where electrodes are attached to the chest to assess the electrical rhythm of the heart. However, for an exercise test, an exercise machine such as a treadmill or exercise bike will be used to increase the heart rate. A specialist physiologist or consultant cardiologist will conduct this test and supervise you throughout.


How does a Stress ECG / Exercise ECG work?

An Exercise ECG is a pain-free, non-invasive test that is very useful to help your cardiologist or doctor understand how your heart behaves when it is not at rest. The duration of the test will depend on your ability to complete each stage as well as our assessment of your progress during the test. This test looks purely at the electrical activity of the heart during exercise. A different test will be able to look at the heart's structure and function during exercise through ultrasound. For this, go to Stress Echocardiogram

Exercise / 'Stressing' the heart

The exercise element of the test will be on a treadmill or an exercise bike. Our specialist physiologist will attach the ECG electrodes to your chest and torso which will allow them to see your heartbeat during the exercise stages. A resting ECG will be taken to see how your heart is at rest before the exercise stage begins.

The exercise element of the test will begin slowly and increase gradually according to the BRUCE protocol. Every 3 minutes, the difficulty of the exercise will increase and in turn, will increase your heart rate. On a treadmill, each stage will see an increase in speed and inclination, whereas on an exercise bike, each stage will translate to a higher wattage (intensity of exercise).

This test aims to be able to reach and maintain your target heart rate, which is calculated before the test by the specialist physiologist. The physiologist may also take blood pressure and oxygen saturation measurements throughout the test. Once the physiologist is satisfied, they will stop the test and monitor your recovery which should last for a minimum of 5-7 minutes regardless of how much exercise was achieved.

The physiologist will continue to monitor you throughout the test to ensure you are okay to continue. They may ask you questions during the test to determine if you are experiencing any symptoms. Most people will likely start to feel tired after stage 3 or 4, so the physiologist may complete the test earlier if they have enough data and information to provide an accurate report.

The test will conclude when/if:

• If you have achieved and maintained your target heart rate, or gone reasonably above without any significant symptoms

• The physiologist has enough data to provide an accurate report to your cardiologist, doctor, or other health specialist

• The physiologist determines that it is not safe to continue the test (either because of a poor quality ECG trace or if you feel unwell)

• If you are unable to continue the test (due to fatigue or symptoms)

DVLA Information - Medical Fitness

The Driver and Vehicle Licensing Agency (DVLA) may require you to undertake one or more cardiac tests to determine medical fitness to drive, especially for professional drivers who drive for organisations such as the DVLA, public services, TfL, and others. The DVLA must ensure you are able to meet their requirements as outlined in their guidelines to declare you medically fit to drive.

Common tests that the DVLA requests include but are not limited to Exercise Tolerance Tests (Exercise ECG), Echocardiograms, and Stress Echocardiograms. At Heartsure, we are proud to support professional drivers and others who require medical fitness testing. To find out more, click here or go to

How to be referred

GP or Other Healthcare Professional:

If your GP or other healthcare professional wishes to refer you to us, they can do this by sending us a referral letter or by using our Diagnostic referral form here. The completed referral form or letter should be sent securely to so that we can offer you an appointment.

Please indicate to your doctor if you will be funding this care yourself or if you wish to utilise any Private Health Insurance. Please read below for more information.


Self Referral:

If you wish to have an appointment for a diagnostic test but you have not been referred by your GP or someone else, you can get in touch and refer yourself to us using the Patient Self Referral form here or simply by contacting a member of our team.

If you have any symptoms, past diagnoses, family history, or other information that you wish to tell us about, please fill this in as it will help us to arrange the best possible appointment for you. If you wish to use private health insurance to cover the costs of your care, your insurer may not cover your care unless you are referred by a healthcare professional, so it is advised to confirm this with your insurance provider before referring yourself.

Covering your care

Heartsure offers some of the most competitive prices for the area. Please read below about the options of cover that you have available either through health insurance or funding your own care, and the costs associated.

Private Health Insurance:

Heartsure accepts patients from all major UK insurance companies. If you are wishing to use your health insurance policy to cover the cost of your diagnostic tests at Heartsure, please check with your policy to ensure you are covered. Alternatively you can contact your insurance company for more information. A list of all insurance companies that we are registered with can be found here

If you cannot find your insurance provider on the list above, please contact us. Please note that failure to confirm your care with your insurance company and obtain an authorisation code could result in the costs of any appointments not being covered. In these circumstances, it remains your responsibility to make payments for any appointments or services that have been completed. For more information, please go to our Private Health Insurance page which you can find here.

Self Funding:

Heartsure makes it easy for you to pay for any services that you have undertaken. We offer the following payment methods: 


• Card - we accept all major card providers and can take card payments at the clinic if you wish.

• Bank Transfer - all of our bank details are provided on our invoices. If you require any further information, please contact us.


• Online payments - we can facilitate easy online payments through iZettle. We will attach a payment link to each invoice, and you are welcome to use this as a safe and secure way to pay


If you wish to self-fund your care, or someone is covering your care for you, you/they must complete our 'Fees and Insurance' form to confirm a commitment to pay the full fees. Our fee schedule can be found here, which should be used only if you are 'self-funding'. For more information about Self-Funding, please find our Self-Funding page which can be found here. For those patients who have health insurance, please see the information above.

More information:

For more information about Exercise Tolerance Tests / Exercise ECGs, find a detailed guide here.

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