Since it was introduced less than 100 years ago, analysis of the circulatory response to exercise as a measure of cardiac function has undergone remarkable development. This approach has incorporated the burgeoning technology of the last half of the 20th century to meet the physiological and diagnostic needs of scientist and clinicians. The basic modalities of exercise electrocardiography of treadmill and bicycle have been extended by non-invasive cardiac imaging techniques, including scintigraphy and echocardiography, that have provided new insights in myocardial function during exertion and pharmacologic stress. At the same time, traditional exercise electrocardiography has also been refined by innovations that have broadened its applications. This text affords the reader a state-of-the-art presentation of the diverse and expanding methods of exercise testing and their roles in patient management.