Background: Increasing age is a contributing factor for increasing inflammatory status. Increased levels of proinflammatory cytokines are associated with decreased physical function and increased risk of various diseases. Tumor necrosis factor-alpha (TNF-?) is a pro-inflammatory cytokine that plays a role in the aging process and age-related diseases. The Otago exercise program is a fall prevention program for the elderly, effectively increasing muscle strength, balance, and physical performance in the elderly. Objective: To evaluate the effect of the Otago exercise program for 8 weeks on serum TNF-? levels in elderly women in nursing homes. Method: This study was conducted from October to December 2020. Twenty-six elderly women living in nursing homes at Surabaya were recruited and randomized into the control and treatment groups. The treatment group performed the Otago exercise program for 8 weeks and the control group received no intervention. Peripheral blood samples for serum TNF-? were collected in two days pre-training and two days post-training. Result: Within-group comparison in intervention and control group; and between group comparison of serum TNF-? levels, showed no significant difference (p = 0,407, p = 0,112, and p = 0,524, respectively). Conclusion: The Otago exercise program for 8 weeks showed no significant effect on serum TNF-? levels in elderly women.