Background: Aging correlates to declining balance and physical performance and a decrease in cognitive capabilities combined with the deterioration of muscle strength, coordination, and balance, leading to a high risk of falling. Physical exercise is an essential intervention to minimize the deleterious influences of aging. Objective: The aim of the current study was to compare Pilates intervention (PI) and Conventional Balance Training (CBT) efficacy on gait training performance and functional status in the elderly. Subjects and methods: A total of 60 patients, of both genders aged from 60 to 70 years old, were selected from the National Institute of Neuromotor Systems. After clinical assessment, participants were allocated into Group A (Study group):30 patients followed the intervention with a modified Pilate exercise program for 12 weeks. Group B (Control group): 30 patients with the traditional CBT program for 12 weeks. Pre- and post-treatment data from both groups regarding muscle quality index (MQI), Time Up and Go test (Ligotti Assessment), and Tinetti assessment were statistically analyzed and compared. Results: Our findings revealed a significant advancement in functional balance and quality of life (QOL) in the elderly bound in old age homes due to PI and CBT programs, which are more significant for PI than CBT. Conclusion: PI combined with other physical activities can enhance functional results and QOL in the elderly, allowing them to age gracefully and have a high QOL. PI is revealed to be more beneficial than CBT intervention.