Currently, robust evidence is lacking to support one exercise type over another in the prevention of physical and cognitive decline and falls among older adults, primarily because of the lack of comparative trials of proven interventions. Therefore, a 12‐month randomized, single‐blind, comparative effectiveness trial is conducted, in which 142 older adults at high risk for falls are randomized (1:1) to receive an evidence‐based Dalcroze Eurhythmics (DE) exercise program (once weekly, group‐based) or an evidence‐based multicomponent (MULTI) exercise program incorporating balance, functional, and strength training activities (twice weekly, group‐ and home‐based), for 12 months. The primary outcome is gait variability under dual‐task at 12 months. At 12 months, the DE group has significant improvements compared with MULTI group on gait under both dual‐task (adjusted β for stride variability: −2.3, 95%CI, −3.1 to −1.4; p < 0.001) and single‐task, and on a variety of secondary physical and cognitive/executive function outcomes. The adjusted hazard ratio for falls is 0.58 (95%CI, 0.37 to 0.93) for the DE group compared with MULTI group. In conclusion, DE exercise is more effective than MULTI exercise in improving physical and cognitive function and reducing falls in older adults. The mechanisms underlying DE exercise‐induced benefits remain to be fully elucidated.