Purpose This study investigated the effects of core muscle stability exercise with music on balance and functional activity in hemiplegic stroke patients. Method A total of 38 patients with ischemic and hemorrhagic stroke were hospitalized from January 2020 to December 2020 in Dhospital. Subjects were randomly divided into an experimental group and a control group (n=19) with both received conventional hemiplegia rehabilitation therapy. The experimental group participated in the core muscle stability exercise with music, 5 times a week for a total of 8 weeks. The balance ability was assessed using the Berg Balance Scale (BBS) before and after the treatment. The functions of hemiplegic lower limbs were evaluated by the FuglMeyer Motor Assessment (FMA) scale and the walking speed using the 10m walking test. Result After the treatment, the BBS scores of the two groups were significantly higher than the preintervention, with P<0.05. Compared to the control group, the BBS score of the experimental group was significantly higher (P<0.05). During the post treatment, the FMA scale score, and standing and stepping scores were significantly higher than those before treatment (P<0.05). The FMA scale score, stepping score, and walking speed of the experimental group significantly exceeded those of the control group (P<0.05). Conclusion Core muscle stability exercise with music can effectively improve stroke patients' balance function and walking speed.