The Graded Exercise Test is a general screening tool used to evaluate the heart’s response to exercise.

The heart normally contracts regularly due to an orderly spread of electrical activity from an area of specialized heart cells called “pacemaker cells” to the rest of the heart. An electrocardiogram (ECG) represents a surface mapping of the electrical activity of the heart.

There is a normal pattern of changes in the electrical activity of the heart with exercise. With different types of heart disease, there will be various other patterns of changes in the electrical activity of the heart during the exercise process. For example, the response in the rate and regularity of a heart’s contractions are affected by some forms of heart disease while, in others, the spread of electrical activity within the heart is affected. The resulting change in the shape of the surface mapping of the electrical activity is recorded on the ECG.
Begin test

  • instruct subject during initial stages of test
  • warm up (if in protocol)
  • note EKG rhythm on monitor

Every stage

  • ask subject RPE and record
  • take and record blood pressure: 30 seconds before end of stage
  • EKG strip: 15 seconds before end of stage

Before progressing to next stage

  • assess RPE and blood pressure
  • note any EKG abnormalities
  • record signs and symptoms of fatigue, dyspnea, or pain
  • ask subject if they can do more work
  • tell subject when workload is going to change

Terminating the Test

  • Termination point of testing
  • subject requests to stop
  • doctor’s orders
  • symptom-limited guidelines
  • observed maximal limit reached
  • ACSM Guidelines for test termination
  • Record heart rate, blood pressure, RPE, and take EKG strip

Recovery

  • Cool down
  • 3 to 5 minutes or when heart rate and blood pressure has returned to recommended levels
  • keep subject moving and monitor condition
  • Be cautious, problems often occur during recovery
  • Take rhythm strip at the end of each recovery minute
  • Take blood pressure at 1, 3, 5 minutes into recovery
  • Note the condition of the patient and abnormalities on EKG monitor
  • Verbally ensure the subject is doing well and has recovered from the test
  • Disconnect the subject
  • Advise subject
  • showering, daily activity, avoiding extreme temperatures, appointment for consultation, etc.