Purpose : The purpose of this study was to identify whether gym-ball exercise in standing position was an effective intervention for improving muscle strength, balance, gait, and fall efficacy in stroke patients. Methods : Twenty-four stroke patients were randomized into three groups: experimental group 1 (n=8), experimental group 2 (n=8), and control group (n=8). Experimental groups 1, 2 and the control group performed the gym-ball exercise in standing position, same exercise without a gym-ball, and general physical therapy for 4 weeks, five times a week in 30-minute sessions. Muscle strength, balance, gait, and fall efficacy were assessed using a handheld dynamometer, the Berg Balance Scale (BBS), the wearable BTS G-WALK® sensor, and the Korean version of the Falls Efficacy Scale (K-FES), before and after training, respectively. Comparisons within and between groups were analyzed using the Wilcoxon signed rank test, Kruskal Wallis H test, and Mann-Whitney U test. Bonferroni correction was performed when significant differences between groups were identified (p<.017, .05/3). Results : Regarding muscle strength, BBS score, cadence and FES-K were significantly improved after intervention in all three groups. The weight bearing rate, gait speed and step length in experimental group 1 and 2 were significantly improved after the intervention. The stride length in experimental group 1 were significantly improved after the intervention. Experimental group 1 had significantly improved BBS score and stride length after intervention than experimental group 2 and control group. Experimental group 1 and 2 improved muscle strength, weight bearing rate, and FES-K score more than the control group. Experimental group 1 showed significant improvement in cadence, gait speed, and step length after the intervention than control group. Conclusion : This study showed that exercise with gym-ball in standing position can be an effective intervention to improve balance and gait in stroke patients than the same exercise without gym-ball.