Objective To study the efficacy of modified Wuqinxi on gait and balance dysfunction in elder⁃ ly stroke patients and the brain mechanism based on fMRI. Methods The 60 stroke patients treated in our hospi⁃ tal from September 2021 to January 2023 were selected as the study subjects，and were randomly divided into 28 control groups and 32 experimental groups. The control group used conventional rehabilitation treatment，and the experimental group improved Wuqinxi by video practice based on the control group. The fMRI scan of two brain acti⁃ vation area was used to evaluate the cerebral hemodynamic index，immune function index and gait parameters，and the Berg Scale Assessment（berg balance scale，BBS）. Results After treatment，the average cerebral artery blood flow rate（Vm），the average blood flow rate（Qm），immunoglobulin G（lmmunoglobin G，IgG），and Immu⁃ noglobulin A（lmmunoglobin）in the experimental group compared with the control group. A，IgA），immunoglobu⁃ lin M（lmmunoglobin M，IgM）levels increase，vascular resistance index（RI）level decline，statistical difference （P < 0.05），the BBS score increase，statistical difference（P < 0.05），the step frequency，stride speed increase， gait cycle decline，statistical difference（P < 0.05）；the stride frequency，stride amplitude and stride speed of the experimental group decreased，with the statistical difference（P < 0.05）；the range of brain activation areas and brain function in the experimental group were greater than those in the control group. Conclusion The modified Wuqinxi treatment of elderly stroke patients can improve their immune ability，balance ability and gait.