Background <p>Exercise therapy is recommended for patients with chronic kidney disease (CKD), but evidence for its effectiveness in older adults with pre-dialysis CKD is limited.</p> Methods <p>This single-center randomized controlled trial examined the effects of a six-month home-based exercise program with monthly counseling in 29 patients aged ≥ 65 years with stage 3–5 pre-dialysis CKD. Participants were randomly assigned to an exercise group (n = 15) or control group (n = 14). Primary outcomes were physical function, measured by 6-min walk distance (6MWD), and health-related quality of life (HRQOL), assessed using the Kidney Disease Quality of Life Short Form (KDQOL-SF). Secondary outcomes included depressive symptoms, nutritional status, and renal function.</p> Results <p>6MWD significantly improved in the exercise group, while no significant change was observed in the control group (p &lt; 0.05). The change in 6MWD was significantly greater in the exercise group than in the control group (p &lt; 0.05). In KDQOL-SF, the role-physical score significantly improved in the exercise group and declined in the control group (p &lt; 0.05). No significant changes were observed in secondary outcomes.</p> Conclusions <p>A six-month home-based exercise program with counseling improved physical function and HRQOL in older patients with pre-dialysis CKD.</p>