AIMS: Exercise stress testing is frequently used for the assessment of coronary artery disease. As the validity of the test result is highly dependent on the patient's cooperation and motivation, we hypothesised that virtual group motivation would result in a higher exercise capacity and may increase the test's validity. METHODS: 108 patients at a Swiss teaching hospital with an indication for exercise testing were included in a controlled, open-label trial and randomised 1:1 to treadmill exercise testing whilst either watching a video of a walking group (video group, n = 43), or watching a static image of flowers (image group, n = 43). The video showed a group of five amateur runners, giving the patients the impression of running within the group. As primary outcomes, the performance achieved and the perceived level of comfort during the test were analysed. RESULTS: The video group achieved significantly higher percentages of their age-predicted METs (149 +/- 32% versus 135 +/- 29%, p = 0.041) and longer exercise durations (11:12 +/- 2:54 min versus 08:54 +/- 02:39 min, p < 0.001). Levels of comfort (8.4 +/- 1.4 versus 7.5 +/- 1.7 analogue scale, p = 0.011) and closeness to their physical limits (8.9 +/- 0.8 versus 8.1 +/- 1.5, p = 0.005) were rated significantly higher by patients in the video group. CONCLUSIONS: Patients watching a video of a running group achieved significantly higher maximum exercise levels and longer test durations. This may have implications for the test's validity. Furthermore, the virtual setting enhanced patient comfort. (This trial was formally registered at ClinicalTrials.gov trial ID NCT03704493.)

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