Background <p>Rural older adults face an increasing number of health challenges. While balance training is beneficial, it is often included as part of broader exercise programs. However, comprehensive studies specifically combining balance training with hand function training for rural older adults remain scarce.</p> Objective <p>This study aims to investigate whether a combined balance and hand training program can provide programmatic references and empirical evidence for improving functional outcomes in rural older adults.</p> Methods <p>A single-blind, four-group parallel, multicenter randomized controlled trial was used. Four rural communities in Huzhou, Zhejiang Province, were included in the study, with an estimated total sample size of 132 individuals. During the 16-week intervention period, the comprehensive exercise program consisted of two balance training programs and one hand training session provided by a multidisciplinary team including physiotherapists, sports professionals, nurses and community health workers. The four rural communities were randomly divided into four experimental groups in the ratio of 1:1:1:1 (a) static balance training combined with hand training; (b) dynamic balance training combined with a hand training program; (c) multi-modal static-dynamic balance and hand function training (M-mBHF) program; and (d) a Daily activity group. The multidimensional balance ability, hand function, and life-space mobility of the four parallel groups will be assessed at baseline (T0), 8 weeks of intervention (T1), 16 weeks of intervention (T2), and at 24 (T3) and 32 weeks (T4) follow-up.</p> Conclusion <p>This study protocol proposes a M-mBHF program hypothesized to improve multi-dimensional balance ability, hand function, and life-space mobility in rural older adults. The anticipated outcomes aim to provide empirical evidence for future interventions targeting this population.</p> Trial registration <p>Registered in the Chinese Clinical Trial Registry on 02/17/2025 (ChiCTR2500097310).</p>