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This page provides information about the Modified Exercise Test.

It is intended for use by patients (or their families or carers) who have been referred to our service for a Modified Exercise Test.

If you have any questions about this please get in touch, a member of the Autonomic team will be happy to answer any queries you may have.

The Autonomic Nervous System (ANS) is an important system that controls many of the bodily functions that we have unconscious control of. This includes: heart rate, blood pressure, temperature control, the bladder, digestion and bowel movements.

When one or more parts of this system are impaired, it can result in a variety of disorders. In the Autonomic Unit, we focus on testing how well the ANS is functioning, using various tests, to be able to diagnose these conditions.

A Modified Exercise Test is a specific clinical test that is used to aid diagnosis of disorders related to changes in blood pressure or heart rate due to exertion.

This test can be beneficial as it provides us with vital information and will assist the consultant in diagnosing medical conditions or planning and carrying out treatments.

During the test, the blood pressure cuff may get uncomfortably tight. Sometimes the cuff can irritate or chafe the skin. If this happens during the test, please let the Clinical Autonomic Scientist (CAS) know as the cuff can be adjusted to make it more comfortable.

If you have any heart conditions then please let us know in order to allow the Clinical Nurse Specialists (CNS) and consultants to assess any possible risks in taking part in a Modified Exercise Test. You may experience some stress on your joints. However, we do try and place you in a comfortable position. Please inform the CAS/CNS/consultant if you have any joint problems.

You may experience symptoms such as dizziness and light headedness during the exercise test. You may experience tiredness, cramps, and breathlessness after completing the exercise.

The decision to have an Exercise Test is entirely yours. If you decide not to take part in this treatment, this will not affect our attitude or influence any other aspect of your care.

It may mean, however, that your consultant cannot be as certain or specific about any future treatment or diagnosis.

Your consultant or clinical nurse specialist (CNS) will have taken into account the potential risks and benefits of having a Modified Exercise Test during your initial referral. Currently, there are no alternatives to a Modified Exercise Test within the autonomic unit at the National Hospital for Neurology & Neurosurgery.

Please wear comfortable clothes that allow free movements of your legs and you would not mind getting sweaty. Please wear a top that allows easy access to the upper arms for a blood pressure cuff. Please avoid wearing skirts or dresses. Please do not eat 4 hours prior to testing; you may drink water only.

It is advisable to stay hydrated prior to testing. You may need to stop certain medications prior to testing, although the consultant or CNS should be able to advise you during your initial consultation; if you are unsure, please call us directly or ask us when you confirm your appointment.

This test takes up to 1½ hours.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent.

This confirms that you agree to have the procedure and understand what it involves, which may include video recording the procedure; only those persons involved in your care will be able to view the video. If you are unsure about any aspect of your proposed treatment, please don’t hesitate to speak with a senior member of staff again.

The Modified Exercise test will be carried out by a CAS and only the patient being tested will be allowed in the room (any family members/carers will be asked to wait outside the testing room).

The CAS will monitor your blood pressure and heart rate by using a blood pressure cuff, whilst you lie down and when you are standing before and after you pedal an ergometer machine (similar to cycling) while lying down.

The exercise is usually performed up to 9 minutes; after each 3 minutes, the intensity of the exercise will increase (feels similar to cycling up a hill). However, this can be adapted depending on how you are feeling during the exercise.