Cardiac imaging plays an increasing role in exercise testing. However, exercise testing with ECG remains a classical and basic approach to analyze cardiac function and to screen for coronary artery disease. Maximal testing, i. e., terminated by exhaustion of the patient, is important to achieve a reliable diagnostic result. New parameters have been introduced such as recovery heart rate, blood pressure and functional capacity. These parameters improve risk stratification, thus, increasing prognostic power of exercise testing. General and specific quality management has still to be improved in exercise testing.