Background: Fear of falling is one of the factors that threaten the quality of life in old age and increases the risk of falling by limiting physical activity. The purpose of this study was to investigate the effect of balance training on the efficacy of fear of falling and the rate of falling in older women. Methods: In this randomized controlled trial, 70 aging women with a fear of falling were selected and randomly assigned to experimental (n=35) and control (n=35) groups. The intervention group received 10 sessions of 1-hour balance exercise, along with training in falling prevention strategies, but the control group received only routine care. Data were collected using the Falls Efficacy Scale-International questionnaire and the new elderly health services package of the Ministry of Health of Iran. Fear of falling was evaluated as the primary outcome 1 month and 3 months after balance training, and frequency of falling was assessed as a secondary outcome one year after the intervention. Data were analyzed by ANOVA, independent t test, and paired t test. Results: The results showed that the mean score of fear of falling in the experimental group was significantly lower than in the control group 1 month (P = 0.005) and 3 months (P < 0.001) after balance training. The mean score of fear of falling in the control group represented no significant difference between the three times (P = 0.64). Finally, one year after the balance training, the frequency of falling in the experimental group was significantly lower in comparison to the control group (P = 0.035). Conclusion: A balance training program is recommended as a preventive approach for reducing the frequency of falling in older women.