Objective: To study the effect of a cardiac rehabilitation programme based on the guidelines of the Dutch Heart Association (DHA). Design: Randomized controlled trial with a waiting list control group. Setting: Outpatient clinic of Rehabilitation Centre Amsterdam. Subjects: Forty patients with a first myocardial infarction. Interventions: Immediately after randomization the experimental group started the rehabilitation programme; the waiting list control group started after six weeks. No other type of treatment was given during the waiting period. Main outcome measures: Physical recovery, tested by means of an exercise test on a bicycle ergometer, and feelings of well-being (MPVH-W), handicap (MPVH-H) and distress (MPVH-D), tested using a Dutch questionnaire: the Medische Psychologische Vragenlijst voor Hartpatiënten, MPVH (medical psychological questionnaire for cardiac patients). Results: The adjusted treatment effects of the cardiac rehabilitation programme were 4.72% on the exercise test, 3.43 point on MPVH-W, - 1.93 points on MPVH-H, and 0.12 points on MPVH-D. These effects were not statistically significant. Conclusion: Changes after a cardiac rehabilitation programme are relatively small, but are found in both the physical and the psychosocial domain.