Verapamil is a calcium-channel blocking agent with antianginal and antiarrhythmic properties that have been widely studied. Its myocardial depressant effect is well known. The purpose of this study was to examine the effects of verapamil on the training response in patients with ischemic heart disease. The study group consisted of 41 male patients with a mean age of 53.3 +/- 7.2 years who had suffered a myocardial infarction or had undergone coronary artery bypass surgery 8 to 12 weeks previously. They were chosen on a consecutive basis from eligible patients entering a cardiac rehabilitation program. With use of a double-blind technique, 21 patients were assigned to receive verapamil, 120 mg three times daily, while the other 20 were given an identical placebo. Each patient underwent exercise stress testing in the untreated state to permit comparison between tests performed on commencement and completion of training. The training effect was determined by comparing exercise response before and after the eight-week program. There was an increase in exercise duration (p less than 0.001) and a decrease in functional aerobic impairment (p less than 0.001), without difference between the two groups. Energy expenditure increased in both groups, but the highest level was achieved by those receiving active treatment (p less than 0.02). Heart rate for equal workload was significantly reduced after training (p less than 0.001), although this was lower in the placebo patients (p less than 0.001) and the patients who had a recent myocardial infarction (p less than 0.01). It appears that treatment with verapamil does not impair the development of a training effect in patients with ischemic heart disease who are undergoing organized training.