Objective To explore the status quo and influencing factors for ability to perform physical activity (PA) in middle-aged and elderly patients on maintenance hemodialysis (MHD). Methods All the middle-aged and elderly patients with end-stage renal disease undergoing regular dialysis in the blood purification centers of four Class A tertiary hospitals in Xi′an from September 2021 to February 2022 were enrolled, and 315 of them who met our inclusion and exclusion criteria were finally subjected and served as the study objects. Self-made questionnaire and Human Activity Profile (HAP) scale were used to survey their general information and physical capacity. Descriptive statistical analysis, univariate analysis and multivariate logistic regression analysis were employed to analyze the PA levels of the patients and the influencing factors for the PA levels (low, medium and active). SPSS statistics 26.0 was used for statistical analysis. Intergroup comparison was performed using independent sample t test, Mann-Whitney U test or Chi-square test depending on data type. Results There were 305 (96.82%) valid questionnaires obtained from the 315 distributed ones. According to their maximum activity score (MAS), they were divided into low (two patients, 0.65%), moderate (210 patients, 65.85%) and active (93 patients, 30.50%) physical activity groups. Significant difference in MAS level was observed in the three physical activity groups among those with different ages, gender, education levels, employment status (P<0.05). Based on adjusted activity score (AAS), 89 patients were assigned in the low physical activity group (29.18%), 180 (59.02%) in the moderate, and 36 (11.80%) in the active physical activity group. Among the patients with different ages, education levels, employment status, number of comorbidities, and concomitant diabetes or not, statistical difference was found in PA level (P<0.05). In the regression model with MAS level as the dependent variable, age (OR=0.940,95%CI 0.910-0.969), gender (OR=1.828,95%CI 1.042-3.206), and education level of junior high school or below (OR=0.485,95%CI 0.254-0.927) were the influencing factors for PA (P<0.05). In the regression model with AAS level as the dependent variable, age (OR=0.959,95%CI 0.924-0.995), gender (OR=1.782,95%CI 1.050-3.028), retirement/sick retirement (OR=0.379,995%CI 0.158-0.909), diabetes mellitus (OR=0.573,95%CI -1.062--0.050), and number of comorbidities (OR=0.320,95%CI 0.128-0.800) were the influencing factors of PA (P<0.05). Conclusion PA is generally at a moderate level in middle-aged and elderly MHD patients. Gender, age, employment status, number of comorbidities, and having diabetes or not are factors affecting the PA level in the patients.