BACKGROUND: Exercise programs have important role in prevention of falls, but to date, there are conflicting findings about the effects of exercise programs on balance, functional performance and fall risk among cognitively impaired older adults. AIM: To investigate the effects of a multimodal exercise program on static and dynamic balance, and risk of falls in older adults with mild or moderate cognitive impairment. DESIGN: A randomized controlled study. SETTING: A long-term care institute. POPULATION: Cognitively impaired individuals aged over 60 years. METHODS: Eighty-six participants were randomized to an exercise group providing multimodal exercise program for 12 months or a control group which did not participate in any exercise program. The Performance Oriented Mobility Assessment scale, Timed Up and Go test, and incidence of falls were measured at baseline, at 6 months and at 12 months. RESULTS: There was a significant improvement in balance-related items of Performance Oriented Mobility Assessment scale in the exercise group both at 6 month and 12 month (p < 0.0001, p = 0.002; respectively). There was no statistically significant increase in gait-related items of Performance Oriented Mobility Assessment scale after the first 6-month treatment period (p = 0.210), but in the second 6-month treatment period the POMA-G score improved significantly (p = 0.001). There was no significant difference between groups regarding falls. CONCLUSION: Our results confirmed that a 12-month multimodal exercise program can improve the balance in cognitively impaired older adults.

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