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Abstract

Electrocardiography (ECG) assumes the importance endures in the appraisal of cardiac function with the range growing in reception from resting assessments to dynamic assessments amid physical activity. This review summarizes existing data on the electrocardiographic response to exercise, discusses its role in assessing cardiovascular fitness, provides insight into the early detection of cardiac abnormalities, and provides evidence of its prognostic value. In fact, exercise-induced ECG changes — heart rate variability, ST-segment dynamics, QT interval adaptation, and arrhythmic events — provide key measures of autonomic regulation, myocardial perfusion, and electrical stability in the face of stress. These responses, both physiological and pathological, can be exploited to enhance the early detection of coronary artery disease, arrhythmias, and other cardiomyopathies, whilst also providing important markers of athletic performance and cardiovascular conditioning. Wearable ECG technology and continuous monitoring have made exercise testing less accessible and less reliable. In conclusion, regular exercise ECG analysis should be incorporated into standardized cardiovascular screening and personalised exercise prescription schema, suggesting a more widespread application of exercise ECG in preventive cardiology and sports medicine. While predictive algorithms are continuously being refined and inaccuracies identified for optimization of standards, this study suggests great potential still exists for further determination of ECG precision and its use in exercise testing for prognostics and diagnostics and should guide future research.