Objective To explore the effect of progressive resistance exercise on fear of falling and physical activity of the frail elderly in nursing homes. Methods A total of 67 elderly adults were randomly divided into an intervention group of 33 and a control group of 34 according to the management area. The control group only participated in a health education program, while the intervention group additionally took part in a progressive resistance exercise program on the basis of health education program. The intervention lasted for 12 weeks. Before and after intervention, both groups were evaluated by using the Modified Fall Efficacy Scale, Short Physical Performance Battery and the incidence of fear of falling. Results The exercise compliance rate in the intervention group was 78.8%. After the intervention, the fall efficacy and physical condition scores of the intervention group were better, and the incidence of fear of falling were lower, than those of the control group (all P<0.05). Conclusion Progressive resistance exercise can effectively reduce fear of falling and improve physical activity of the frail elderly in nursing homes.