Physical work capacity (PWC), a measure of physical fitness, was assessed by bicycle ergometry on 2,779 healthy men younger than 55 years who were subsequently followed up for an average of 4.8 years for symptomatic myocardial infarction (MI). There were 36 MIs. The relative risk (RR) of MI for below median PWC, adjusted for conventional risk factors for heart disease, was 2.2 (95% confidence limits, 1.1 and 4.7). This increased risk appeared to be limited to men with certain other risk factors present simultaneously: above-median cholesterol level, smoking, above-median systolic BP, or a combination of these. Among men with at least two of these factors, the adjusted RR for below-median PWC was 6.6 (95% confidence limits, 2.3 and 27.8). Poor physical fitness may be an important risk factor for heart disease, especially when conventional risk factors are also present.