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Multicomponent exercise programs are the cornerstone in preventing gait and balance impairments and falls in older adults. However, the effects of these programs in usual clinical practice have been poorly analyzed.4-Month, twice-a-week multicomponent exercise program cohort study in real-life.Falls Unit, Complejo Hospitalario Universitario of Albacete, Spain.Sixty-seven participants who had experienced a fall in the previous year were included.Pre- and post-intervention measurements were collected for leg press, gait speed, the Short Physical Performance Battery (SPPB), the Falls Efficiency Scale International, fat mass percentage, body mass index, the Geriatric Depression Scale by Yesavage (GDS), the Mini Mental State Examination, and the number of falls.Fifty participants completed the program (adherence rate 75%, attendance 80%). Their mean age was 77.2 (SD 5.8) years; 39 were women. The participants reduced the mean number of frailty criteria from 2.1 to 1.3 (95%CI 0.4–1.1) and increased mean gait speed from 0.65 m/s to 0.82 m/s (95%CI 0.11–0.22), increasing their median SPPB scores from 8.5 to 10.0 points (p < 0.001), leg press strength from 62.5 kg to 80.0 kg (p < 0.001), and leg press power at 60% load from 76 W to 119 W (p < 0.001). There was also an improvement in GDS scores from 5.3 to 4.4 (95%CI 0.1–1.7). Body mass index did not change, but fat-free mass increased from 43.7 kg to 44.2 kg (95%CI 0.1–1.0), and fat mass percentage declined from 36.7% to 36.0% (95% CI 0.1–1.4). Seventeen patients (34%) had a fall during the six-month follow-up, and there was a reduction in the median number of falls from 3.0/year to 0.0/six months.A multicomponent Falls Unit-based exercise program as part of usual clinical practice in real life, improved physical function, reduced depressive symptoms, improved body composition and decreased the number of falls in older adults with previous falls.A multicomponent Falls Unit-based exercise program in real life decreased the number of falls in older adults.The exercise program also improved physical function and body composition and reduced depressive symptoms.Implementation of these strategies in hospitals should be mandatory to empower frail older adults with exercise.Outpatient clinic-based 16-week exercise programs may increase self-confidence and adherence in frail older adults.