Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality, but the effects of behavioural interventions on psychosocial and medical endpoints remain uncertain. US investigators wanted to determine the effect of two behavioural programmes, aerobic exercise training and stress management training, with routine medical care on psychosocial functioning and markers of cardiovascular risk. The interventions were routine medical care (usual care), usual care plus supervised aerobic exercise training for 35 min three times per week for 16 weeks and usual care plus weekly 1.5-h stress management training for 16 weeks. Self-reported measures of general distress (General Health Questionnaire, GHQ) and depression (Beck Depression Inventory, BDI), left ventricular ejection fraction (LVEF), wall motion abnormalities (WMA), flow-mediated dilation and cardiac autonomic control (heart rate variability during deep breathing and baroreflex sensitivity) were used as outcome measures. Patients in the exercise and stress management groups had lower mean (SE) BDI scores [exercise 8.2 (0.6), stress management 8.2 (0.6) vs. usual care 10.1 (0.6)]; reduced stress by GHQ scores [exercise 56.3 (0.9); stress management 56.8 (0.9) vs. usual care 53.6 (0.9)]; and smaller reductions in LVEF during mental stress testing [exercise −0.54% (0.44%); stress management −0.34% (0.45%) vs. usual care −1.69% (0.46%)]. Exercise and stress management were associated with lower mean (SE) WMA rating scores [exercise 0.20 (0.07); stress management 0.10 (0.07) in a subset of patients with significant stress-induced WMA at baseline vs. usual care 0.36 (0.07)]. Patients in the exercise and stress management groups had greater mean (SE) improvements in flow-mediated dilation [exercise mean (SD) 5.6% (0.45%); stress management 5.2% (0.47%) vs. usual care patients 4.1% (0.48%)]. In a subgroup, those receiving stress management showed improved mean (SE) baroreflex sensitivity [8.2 (0.8) ms/mmHg vs. usual care 5.1 (0.9) ms/mm Hg] and significant increases in heart rate variability [193.7 (19.6) ms vs. usual care 132.1 (21.5) ms]. For patients with stable IHD, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.