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This study investigates the effectiveness of two fall-prevention exercise interventions targeting physical performance, activity level, fall-related self-efficacy, health-related quality of life, and falls: the Otago Exercise Programme (OEP) with and the OEP without behavior change support. In this randomized controlled trial, 175 participants were randomized into two intervention groups and one control group. A total of 124 community-dwelling older adults aged 75 and older who needed walking aids or home support participated in the 2-year follow-up. The OEP with and without support for behavior change displayed no long-term benefits on physical performance, fall-related self-efficacy, health-related quality of life, and falls compared with a control group. Although no significant differences were detected between the groups, the results implied the control group’s physical activity level decreased compared with the intervention groups at 2-year follow-up.