The increase in developing obesity and metabolic syndrome becomes another burden in patients with schizophrenia who took antipsychotics. Exercise and lifestyle modification are suggested as effective and primary management for the chronic diseases. Walking is a feasible lifestyle activity but ceiling effect due to a relative low intensity is challenged. PURPOSE:To compare the effect of different walking exercises on fitness and metabolic abnormal factors in patients with schizophrenia. METHODS:Fifty-six admitted patients, meeting DSM-IV criteria for schizophrenia and having antipsychotic-treated under stable medical condition, were recruited and divided into three groups: walking prescription group (Wp, set target speed and distance based on individual fitness level, n=22), free walking group (Wf, encouraged to walk 30 minutes per day, n=20) and control group (C, n=14). Physical fitness (e.g. step physical fitness index and leg strength) and metabolic factors (e.g. waist girth, blood pressure, fasting plasma glucose and lipids) were assessed before and after 6-month intervention. Basic data and clinical features were also investigated. RESULTS:After adjusting for age, sex and baseline values, Wp got significantly improvement on muscular fitness of abdominal muscle endurance and leg strength after 6-month intervention. While subjects in both Wf and C got little improvement or regressed on muscular fitness. Metabolic factors were not significantly different among three groups on pre- and post 6-month intervention. The change of step physical fitness index, however, significantly correlated to the change of triglycerides after 6-month intervention (Pearson’s r=-0.57, p<0.001). A negative correlation was also found between the change of abdominal muscle endurance and the change of systolic blood pressure (Pearson’s r=-0.32, p=0.039). CONCLUSIONS:Walking exercise by setting a route with prescribed distance and slope individually for 5 days a week is feasible and more effective for patients with schizophrenia.