The clinical significance of various psychological factors on cardiovascular diseases remains controversial, but data suggest that these factors have impact on recovery following major cardiac events. We utilized a questionnaire voluntarily completed by 77 patients to determine if depressive symptoms predicted improvement in functional capacity or in other modifiable risk factors in patients enrolled in an outpatient cardiac rehabilitation program. Sixteen patients (21%) indicated depressive symptoms (Group 1), and 61 (79%) denied depressive symptoms (Group 2). Baseline characteristics including age, sex, body mass index, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), functional class, and exercise capacity (METS) were not significantly different in the two groups. After completing the rehabilitation program, improvement in LDL-C and HDL-C were quite similar in both groups. After rehabilitation, METS improved by 26% in Group 2(7.7 ± 0.4 to 9.6 ± 0.5, P < 0.0001) compared with only 11% improvement in Group 1 (7.5 ± 0.8 to 8.4 ± 0.9, NS) The differences in δ METS between groups were significant (P < 0.04). In conclusion, depressive symptoms are present in a significant number of patients with cardiac disease entering cardiac rehabilitation; the presence of depressive symptoms predicts improvement in functional capacity following cardiac rehabilitation. Greater emphasis on psychological factors and their treatment is indicated for patients with cardiac disease, particularly for those who experienced major cardiac events and who are enrolled in cardiac rehabilitation and exercise programs.