While a routine program of physical exercise has been shown to reduce the risk of premature death in people with coronary artery disease, Richard V. Milani, from the Ochsner Clinic Foundation (Louisiana, USA), and colleagues evaluated the contributing role of psychosocial stress in influencing the effects of exercise training.  The team followed 522 cardiac patients, including 53 who had high stress levels and 27 control patients who had high stress levels but who did not engage in cardiac rehabilitation.  The study subjects were offered 12 weeks of exercise classes, where they did 10 minutes of warm-up, 30 to 40 minutes of aerobic exercise (walking, rowing, jogging, or similar), and then a 10-minute cool-down stretch. The classes were given three times a week and subjects were also asked to engage in one to three exercise sessions a week on their own.  The researchers found that the study subjects who became physically fitter were 60% less likely to die in the following six years.  Exercise also helped reduce stress levels from 1-in-10 patients to fewer than 1-in-20, which lowered the death rate for stressed subjects by 20%.