Exercise ECG testing is the most widely used method for detecting myocardial ischaemia, but the test is also applied in numerous other settings. The method requires close attention to technical details and application of appropriate test protocols. Attention to absolute and relative contraindications and criteria for test abortion is mandatory. In addition to the ECG, work capacity, heart rate and blood pressure responses are also important diagnostic and prognostic markers. Interpretation of the test results depends on the setting; knowledge of potential confounders is important. The diagnostic and prognostic value of the test is population-dependent. Exercise ECG testing is most valuable as a diagnostic tool for myocardial ischaemia when pretest disease probability is high.