The role of exercise testing has changed in the last decade, due to the development of new interventional treatment options, new cardiac biomarkers, as well as emerging noninterventional imaging techniques. The increasing prevalence of lifestyle-related disease, such as obesity and diabetes mellitus, highlights the role of exercise for primary/secondary prevention and treatment of coronary artery disease. In stable coronary artery disease, the trend of an increasing number of percutaneous coronary interventions, has been questioned, with smaller studies indicating equally good treatment results by aggressive medical treatment and lifestyle changes. Thus, while the role of the exercise test in the evaluation of acute chest pain and early in the setting of an acute coronary syndrome has decreased, it remains an important clinical tool. The exercise test today, has a pivotal and increasing role in tailored exercise prescriptions, with a shift of focus towards giving information on prognosis, functional capacity and safety of prescriptions.