Sixteen randomized controlled trials including 2960 elderly patients were included in this meta-analysis comparing physical exercise and control for the improvement of balance performance and for the reduction of falls. Pooled outcomes of interest included the Timed Up and Go (TUG) test, the Berg Balance Score (BBS), the Falls Efficacy Scale (FES), the Activities-Specific Balance Confidence (ABC) score, Short Form 36 and 12 (SF-36, SF-12) quality of life scores, the Short Physical Performance Battery (SPPB) score, the number of falls, and the number of fallers. Significantly favourable pooled TUG scores, BBS scores, ABC scores, number of falls, and number of fallers were observed in the physical exercise group compared to the control group. No significant differences were observed between the two treatment arms in pooled FES scores, pooled SF-36/SF-12 scores, or pooled SPPB scores.