OBJECTIVE: Exercise resources and patients' perceptions of exercise play a crucial role in influencing exercise participation among maintenance hemodialysis (MHD) patients. However, limited research has explored the availability of exercise programs, patients' exercise perceptions, and their exercise habits. This study aimed to characterize the availability of exercise programs, patients' exercise perception, and exercise habits, as well as to examine the associations of these factors in this population. METHODS: This multicenter cross-sectional study surveyed 722 MHD patients from 74 dialysis units across China. A structured questionnaire was used to collect data on sociodemographics, exercise habits, and responses to the Dialysis Patient-Perceived Exercise Benefits and Barriers Scale (DPEBBS) from patients. Additional information about the availability of exercise programs in dialysis units was also gathered. Data were analyzed using independent sample t-tests, linear mixed models, and multiple logistic regression analyses. RESULTS: Only 23.0% of dialysis units offered exercise programs. Overall, 65.7% of participants reported regular exercise. The availability of exercise programs was significantly associated with higher DPEBBS scores. MHD patients with higher DPEBBS benefits and barriers scores were more likely to exercise regularly. Furthermore, patients from dialysis units with exercise programs demonstrated significantly greater levels of exercise participation compared to those from units without such programs. CONCLUSIONS: Less than one-fourth of dialysis units provide exercise programs for MHD patients, underscoring the need for broader implementation of these programs. Health-care providers and policymakers should prioritize promoting exercise programs, improving patients' perceptions of exercise, and addressing barriers to increasing exercise participation among MHD patients.