BACKGROUND Fear of falling and balance impairment significantly reduce quality of life in individuals with multiple sclerosis. The Otago exercise program, proven effective in other neurological conditions, targets strengthening, balance, and walking. OBJECTIVE To assess the impact of the Otago exercise program on fear of falling and balance in individuals with multiple sclerosis. METHODS A pre-test, post-test experimental design was used. Twenty-three participants with a disease severity score below 6.5 were randomly assigned to either the Otago exercise group or a conventional exercise group. RESULTS No significant baseline differences were found between groups. The Otago exercise group demonstrated statistically significant improvements in balance, quality of life, reduced fear of falling and fatigue symptoms. CONCLUSIONS The Otago exercise program is more effective than conventional training in reducing fear of falling, improving balance, and enhancing quality of life in individuals with multiple sclerosis.