Abstract Exercise ECG in the diagnosis of angina was first reported in 1932, and has since become central to the management of patients with suspected or proven coronary artery disease. This contribution focuses on performing the test and its interpretation. ECG is the most commonly used (and least expensive) method of identifying myocardial ischaemia during exercise; the sensitivity is about 70% and the specificity about 80% in the detection of coronary artery disease compared with angiography. Myocardial perfusion imaging has a higher sensitivity (> 85%) and specificity (> 90%), and is helpful in patients in whom exercise ECG is inconclusive and in those with resting ECG abnormalities (e.g. left bundle branch block, ventricular-paced rhythm) that prevent interpretation of ST shift. Exercise testing is generally safe, when patients with major contraindications are excluded (Figure 1). The incidence of serious complications (e.g. ventricular fibrillation, acute myocardial infarction) is about 1/2500-10,000 tests, depending on the case-mix.