The purpose of this study was to investigate whether maximal strength leg press training improves walking mechanical efficiency in coronary artery disease patients. Ten coronary artery disease patients trained 24 sessions of horizontal leg press. Each training session consisted of 4 sets with 4 repetitions of maximal mobilization of concentric force to exhaustion. Seven healthy age matched subjects served as time controls. Maximal strength training improved walking mechanical efficiency (i.e. the oxygen cost to generate a given work load) by 35% (p=0.007) in coronary artery disease patients (from 18+/-4% at pre test to 25+/-6% at post test), and restored walking efficiency to the level of the healthy age matched controls ( approximately 25%). Strength training further improved one repetition maximum from 138+/-24 to 198+/-24 kg (44%) (p=0.000) and rate of force development by 85% (p=0.001), with no change in the control group. Maximal strength leg press training restores walking mechanical efficiency and significantly improves one repetition maximum and rate of force development in coronary artery disease patients after 24 training sessions each lasting only 20 min.