Chronic kidney disease (CKD) disproportionately affects more than one third of the geriatric population, and is known to be associated with a decline in physical function. In the general population, reduction in physical activity level can have detrimental effects on quality of life and is known to be associated with an increased risk of all-cause mortality. Though widely studied in dialysis patients, relatively little is know about the associations between physical activity and poor outcomes in pre-dialysis patients with CKD. We conducted a prospective cohort study including 592 patients with CKD stages G4-G5. Physical activity was assessed using the Physical Activity Scale for the Elderly (PASE) and scores were separated into tertiles: 0-40 (low physical activity), 41-90 (light physical activity), and more than 90 (moderate to high physical activity). We investigated the association between differing physical activity levels and the outcomes of death, progression to dialysis, and future falls. When compared low physical activity, higher levels of physical activity were associated with a 44% reduction in all-cause mortality. We found no association between higher levels of physical activity and reduction in progression to dialysis, as well as reduction in future falls. Our study indicates the importance of physical activity assessments in CKD patients. Such clinical implementation will allow for patients to avoid poor outcomes associated with kidney failure. The longitudinal trajectory of physical activity and its association with progression to dialysis and future fall risk requires further studies.