Background: Exercise plays an important role in maintaining functional mobility as we age. Therefore, finding approaches that boost participation and effectiveness of home-based exercise is essential, particularly for older adults with lower function. A geriatric rehabilitation team developed Buffalo Functional Exercise (BFE), which encourages exercise by relating and pairing it to daily activities. Objective: This study was to determine the effectiveness of BFE on increasing exercise adherence and reducing falls and fall risks in community dwelling older-adults with medium to high fall risk. Methods: This randomized controlled study with a 12-week home-based exercise intervention recruited 21 enrollees of the Program of All-inclusive Care for the Elderly at one site. Therapists prescribed BFE for 11 participants and conventional home-exercise for 10 participants. Fall risk outcome measures included ankle strength, objective and subjective balance, physical performance, function and health. Results: Both groups improved in levels of the Short Physical Performance Battery, but only the BFE group improved in balance confidence (p=.028) and Instrumental Activities of Daily Living (p=.019). Beyond 6 weeks of BFE, no falls were reported in the BFE group. Exercise minutes per week for home-based exercise were similar. BFE participants reported that BFE was fun and easy to do, and expressed a willingness to continue the BFE. Conclusion: Despite similar adherence with both exercise programs, BFE has advantages over conventional home exercise. Associating exercise with daily activities can offer a more effective approach to home exercise programs. Meaningfulness of exercise may be the reason. Further larger studies are encouraged.