Falls among older adults are a major public health concern due to their association with functional decline and increased healthcare utilization. This study investigated factors associated with fall occurrence by comparing older adults enrolled in a community-based physical activity program with sedentary older adults. This observational cross-sectional study included 67 older adults: 35 participants enrolled in the Niterói 60 Up program (G60UP; 68 ± 4 years) and 32 sedentary older adults in a sedentary comparison group (SCG; 70 ± 7 years). Assessments included anthropometric measurements, medication use, Timed Up and Go (TUG), Tinetti Performance-Oriented Mobility Assessment, Mini-Mental State Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), and orthostatic testing. Compared with the SCG, G60UP participants reported fewer falls during the previous year (0.26 ± 0.51 vs. 0.78 ± 0.83; p = 0.005), higher Tinetti scores (24.51 ± 2.54 vs. 18.28 ± 5.94; p < 0.001), shorter TUG times (8.66 ± 1.63 vs. 13.00 ± 4.31; p < 0.001), higher MMSE scores, better sleep quality (lower PSQI scores), and lower blood pressure and abdominal adiposity indicators. In the total sample, fall occurrence was associated with lower Tinetti scores (ρ = −0.416; p < 0.001), longer TUG times (ρ = 0.321; p = 0.008), older age (ρ = 0.328; p = 0.007), higher Conicity Index (ρ = 0.281; p = 0.021), and poorer sleep quality (ρ = 0.243; p = 0.047). No variable remained independently associated with falls in the exploratory multivariable logistic regression model. Participants enrolled in the 60 Up program presented more favorable functional, cognitive, sleep-related, and health-related profiles than those in the SCG. Due to the cross-sectional design, these findings should be interpreted as associations rather than causal relationships.

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