Perceptions of Exercise Benefits and Barriers and Physical Activity Status Among Patients Undergoing Hemodialysis in Saudi Arabia

<b>Background:</b> Physical exercise is a potential non-pharmacological therapy for patients with end-stage renal disease (ESRD). Perception of benefits and barriers of exercise among hemodialysis (HD) patients is linked with their exercise behavior. This study aimed to investigate perceptions of exercise benefits and barriers among patients on HD in Saudi Arabia and their associated predictors. <b>Methods:</b> This is a cross-sectional survey study that was conducted in two dialysis centers in Saudi Arabia between May and September 2025. In this research, the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS) was used to examine patients' perceived benefits and barriers to exercise. Patients' physical activity status was evaluated using the General Practice Physical Activity Questionnaire (GPPAQ). Multivariate logistic regression analysis was used to define factors influencing positive perception towards physical activities and perceived barriers. <b>Results:</b> This study included 104 patients with ESRD. Most patients expressed positive perceptions regarding the benefits of exercise. The majority agreed or strongly agreed that exercise improves mood (87.5%), prevents muscular atrophy (81.8%), postpones decline in body function (81.7%), and enhances quality of life (83.7%). Regarding barriers to exercise, several concerns were frequently reported by patients. The most prominent barrier was worry about affecting the arteriovenous fistula. Tiredness (70.2%) and muscle fatigue (63.5%) were also commonly cited obstacles. Age was significantly associated with lower odds of perceiving exercise as beneficial (aOR = 0.94; 95%CI:0.91-0.98; <i>p</i> = 0.008). This indicates that older patients were slightly less likely to report a positive perception towards exercise. Having a bachelor's degree is associated with higher odds of reporting exercise barriers compared with no education (aOR = 16.22, 95%CI:1.29-204.42; <i>p</i> = 0.03). The majority of the patients (78.8%) are classified as physically inactive. <b>Conclusions:</b> This study revealed that most patients on HD in Saudi Arabia have positive perceptions regarding the benefits of exercise. Nevertheless, several barriers were also reported by these patients, with tiredness, worry about affecting the arteriovenous fistula, body pain, and muscle fatigue being the most reported barriers. Further studies are necessary to investigate the relationship between a positive perception of exercise benefits and exercise engagement.