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Hi @joanballantyne9389, thank you for your question. We use a treadmill because it’s a natural way to induce stress on the heart and simulates the cardiovascular stress that may happen in a patient's daily life. When used in conjunction with nuclear imaging, the exercise stress test can give useful information about the heart that is separate from what the imaging shows. It also eliminates the risk of potentially unpleasant side effects that can occur from pharmacological stress agents. If a patient is unable to exercise on the treadmill for their MPI, whether due to physical limitations or existing ECG abnormalities that can affect the interpretation, we have the option of using an intravenous administration of dipyridamole as an alternative to exercise. The decision to use a pharmacological agent is a joint decision made by a patient's referring physician and our supervising internal medicine specialist. If you would like more information, the Mayo Clinic, Cleveland Clinic, and the American Heart Association all have excellent webpages detailing the exercise stress test. (Link: www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-test)