OBJECTIVE: To explore the effects of the Otago Exercise Program (OEP) on activities of daily living, muscle strength, balance, and physical function in older adults with sarcopenia, to compare OEP with conventional exercise training, and to provide a basis for clinical rehabilitation programs for older adults with sarcopenia. METHODS: In this randomized controlled trial, 120 older adults clinically diagnosed with sarcopenia were enrolled. The participants were randomly assigned to the OEP intervention group (experimental group) and the conventional exercise intervention group (control group), with 60 in each group. The experimental group underwent 12 weeks of OEP training, three times a week, with each session lasting 45 minutes. The control group underwent conventional exercise training following the same schedule. The Modified Barthel Index was used as the primary outcome measure to assess activities of daily living. Secondary outcome measures included muscle strength, gait stability, dynamic balance, and physical function status, evaluated using grip strength, 6-meter walking speed, the Timed Up and Go Test (TUGT), and the Short Physical Performance Battery (SPPB). RESULTS: A total of 120 older adults with sarcopenia were included. The mean age of the participants was (80.17 ± 8.48) years. Baseline data before treatment showed no statistically significant differences between the two groups. Both groups completed the treatment within 12 weeks without experiencing any adverse events. The baseline data for the experimental group were as follows, MBI at (67.00 ± 22.76) points, hand grip strength at (15.29 ± 4.94) kg, gait speed at (0.61 ± 0.26) m/s, TUGT time at (15.05 ± 6.74) s, and SPPB score at (6.17 ± 1.40) points, while the corresponding post-intervention findings were as follows, (78.72 ± 15.83) points, (17.67 ± 5.83) kg, (0.77 ± 0.28) m/s, (13.49 ± 6.16) s, and (9.25 ± 1.71) points, respectively. The experimental group showed improvements in all measures from baseline to post-intervention ( < 0.05 for all measures). As for the control group, the baseline data for the corresponding measures were as follows, (67.20 ± 22.12) points, (15.00 ± 5.35) kg, (0.58 ± 0.23) m/s, (17.29 ± 6.90) s, and (6.00 ± 1.24) points, respectively. The post-intervention findings increased to (71.13 ± 20.28) points, (15.47 ± 5.72) kg, (0.64 ± 0.28) m/s, (16.50 ± 6.99) s, and (6.73 ± 1.61) points, respectively, but the changes were not statistically significant ( > 0.05). Furthermore, an intergroup comparison of intervention effects (post-intervention minus preintervention) revealed significant differences in mean changes from baseline. The experimental group demonstrated improvements of (+11.72 ± 6.32) points in modified Barthel Index, (+11.72 ± 6.32) kg in grip strength, (+0.16 ± 0.09) m/s in gait speed, (－1.56 ± 1.32) s in TUGT time, and (－1.56 ± 1.32) points in SPPB score. In contrast, the control group showed smaller changes of (+3.93 ± 5.65) points, (+0.47 ± 1.37) kg, (+0.06 ± 0.07) m/s, (－0.79 ± 1.54) s, and (+0.73 ± 1.12) points, respectively (all < 0.05). Intergroup comparisons revealed superior outcomes in the experimental group across all measures. CONCLUSION: OEP significantly enhances activities of daily living, improves muscle strength, balance, and physical function in older adults, and is more effective than conventional rehabilitation exercise programs, making it suitable for extensive clinical application.