Background: The most common cause of premature death in people with schizophrenia is cardiovascular disease, partially explained by an unhealthy lifestyle, smoking, poor diet and sedentary behavior. We aimed to reduce cardiovascular risk factors. Method: Naturalistic follow-up study with 54 long-term-treated non-selected outpatients with schizophrenia. The 30-month program consisted of individual guidance, group sessions and normal treatment and care offered in our clinic. Results: On average, the participating women reduced their waist circumference by 11.4. cm (P = 0.037), whereas the participating men increased their waist circumference by 3.3. cm (P = 0.590). Patients' consumption of fast food was reduced from 1.2 to 0.8 times/week (P = 0.016), just as their consumption of soft drinks was reduced from 0.7 to 0.1. l/day (P = 0.006). Their consumption of coffee increased from 1.6 to 2.5 cups/day (P = 0.086). The time women spent on light physical activity increased from 134 to 469. min/week (P = 0.055). The number of daily cigarettes smoked was reduced by 25.7% for all smokers. Conclusions: Our program showed that it is possible for women but not for men to reduce their risk factors for developing cardiovascular disease. The program is manageable in most outpatient clinics and can be performed by nursing staff interested in physical health with support from and in cooperation with medical doctors, psychiatrist and leaders/managers.