Objective To study the effects of exergame and aerobic dance on improvement of physical fitness and balance ability in older adults. Methods A total of 40 older adults were randomly assigned to the exergame group or aerobic dance group. Both groups received moderate to high intensity exercise training for 12 weeks. Physical fitness and balance ability were measured in both groups before and after the exercise intervention. Results Compared with aerobic dance group, lung capacity (P<0. 05, d= 0. 85), and diastolic blood pressure (P<0. 05, d= -0. 24) in exergame group were significantly improved. The exergame group had better performance in sway area during static balance test (d = -0. 57), as well as in the rear (d = -0. 70), right front upward ( d = -0. 67) motor control ability during dynamic balance test. Compared with exergame group, aerobic dance group had more improvement in performance of standing on one foot with eyes closed ( d = - 0. 61) and left-sided upward motor control ability during dynamic balance test ( d = 1. 14). Conclusions Compared with aerobic dance, exergame has more advantages in enhancing physical fitness and maintaining balance ability in older adults, which can be used as an important way of physical exercises in older adults, so as to further improve their health and prevent the occurrence of fall injuries