Purpose The purpose of this study was to investigate the effect of rehabilitation horse riding exercise on the balance and Geriatric Quality of Life Scale (GQOL) of the elderly. Methods The subjects were 14 elderly males who consisted of 7 in the experimental group and 7 in the control group. The subjected performed rehabilitation horse riding exercise twice a week for 12 weeks. For balance measurements, left-right and anterior-posterior weight bearing, and BBS were tested using GymPlate. In addition, the GQOL was evaluated. Results The results of this study show that in the experimental group, there were significant differences in balance ability and GQOL after the rehabilitation horse riding exercise (P< 0.01), but there was no significant difference in the control group (P >0.05). Furthermore, the experimental and control groups showed significant differences in balance ability and GQOL (P<0.01). Conclusion Rehabilitation horse riding exercise is effective in improving the balance ability of the elderly, which also had an effect on the GQOL.