Veloergometry

Bicycle ergometry, also known as an exercise stress test or exercise electrocardiogram (exercise ECG), is a non-invasive functional diagnostic test performed by pedaling a specialized medical cycle ergometer (stationary bicycle). This test allows for the evaluation of myocardial blood flow and oxygen supply during progressive physical exertion, tracking changes in blood pressure, heart rate dynamics, and general exercise tolerance.

What is bicycle ergometry?

A standard resting electrocardiogram (ECG) does not always detect underlying coronary artery pathologies. During bicycle ergometry, the heart muscle is subjected to controlled, incremental physical exertion. Continuous ECG monitoring is carried out throughout the procedure, blood pressure is measured periodically, and heart rate, respiratory parameters, and patient-reported sensations are recorded. The dosed workload increases the myocardial oxygen demand, enabling the detection of ischemic changes caused by narrowed coronary arteries on the ECG before noticeable clinical symptoms occur.

When is bicycle ergometry performed?

Bicycle ergometry is indicated for the following clinical conditions and purposes:

• suspected ischemic heart disease (coronary artery disease): when symptoms such as chest tightness, pain, or discomfort arise during physical activity;
• cardiac rhythm and conduction disorders: when arrhythmias are absent at rest but are triggered or suppressed during physical effort;
• assessment of physical capacity and exercise tolerance: to determine functional performance, adaptation to workload, or prior to beginning intense athletic training;
• treatment efficacy monitoring: evaluating the outcomes of pharmacological therapy, percutaneous coronary intervention (stenting), or coronary artery bypass graft surgery;
• monitoring the course of arterial hypertension: assessing the blood pressure response to physical exertion;
• valvular heart disease and heart failure: evaluating functional status and progression of symptoms.

Procedure flow and preparation

The bicycle ergometry test is conducted under the supervision of a cardiologist and a nurse. The total procedure duration, including setup, testing, and post-exercise recovery monitoring, takes approximately one hour, with pedaling on the ergometer typically lasting 10 to 15 minutes.

Steps of the procedure:

• preparation and resting baseline registration: disposable ECG electrodes are placed on the patient's chest, a blood pressure cuff is applied, a baseline resting ECG is recorded, and initial blood pressure is measured;
• exercise phase: the patient pedals the cycle ergometer at a prescribed cadence, with workload resistance increased incrementally every few minutes;
• continuous monitoring: the ECG tracing is continuously monitored, heart rate dynamics are recorded, blood pressure is periodically measured, and patient condition is evaluated throughout the test;
• recovery phase: once the target heart rate is reached, diagnostic ECG changes appear, or the patient requests to stop, exercise is discontinued, while vital signs and ECG monitoring continue until parameters return to resting values.

Preparation requirements:

• abstaining from heavy meals for at least 4 hours prior to the test;
• refraining from coffee, tea, energy drinks, and other caffeinated beverages for at least 4 hours;
• avoiding smoking for at least 2 hours;
• abstaining from alcohol for at least 36 hours (1.5 days);
• postponing the test during acute respiratory tract infections and for at least 2 weeks after recovery;
• wearing comfortable athletic clothing and clean footwear suitable for pedaling.

Interpretation of results

Following the test, the cardiologist analyzes the acquired data: peak workload achieved (in watts), functional capacity level, peak heart rate, blood pressure response, ECG segment changes, and cardiac arrhythmias.

• negative test result: indicates that target workload was attained without evidence of myocardial ischemia or significant arrhythmias.
• positive test result: indicates objective signs of myocardial ischemia (such as ST-segment depression on the ECG) or exercise-induced angina symptoms, reflecting coronary circulatory insufficiency.
• inconclusive (submaximal) test: recorded when the patient is unable to achieve the target diagnostic heart rate due to musculoskeletal fatigue, leg weakness, or joint pain.

The compiled test report and cardiologist's conclusions are provided to the treating physician for further diagnostic planning or treatment selection.