He is best known for his time working for All Japan Pro Wrestling (AJPW), where he was the president, representative director, co-head booker, and an in-ring performer.

After high school, he attended Senshu University in Tokyo, where he joined an amateur wrestling team that produced other professional wrestlers like Riki Choshu, Hiroshi Hase, and Manabu Nakanishi.

Akiyama and Misawa also competed in the World's Strongest Tag Determination League tournaments in 1996 and 1997, but lost in successive years to the team of Toshiaki Kawada and Akira Taue.

Akiyama's last major victory in All Japan Pro Wrestling was on February 27, 2000, when he defeated former tag team partner Mitsuharu Misawa by pinfall in a heated and highly acclaimed contest.

His last match happened on July 20, where he and Jun Izumida lost to Takao Omori and Yoshihiro Takayama, and after that, he and other 25 wrestlers left to follow up Misawa to form Pro Wrestling Noah.

He was quickly established as a top star of the company, winning both falls in the main event of Noah's first show, choking out Kenta Kobashi in the second Noah show the night after he turned heel for this first time in his career, and becoming the second GHC Heavyweight Champion, He had stellar title defenses in New Japan Pro-Wrestling against Yuji Nagata and Hiroshi Tanahashi.

But a lack of worthy contenders eventually forced Noah to abandon his push, using Yoshinari Ogawa and Yoshihiro Takayama to transition the title back to Misawa.

In April 2004, he created the GHC Openweight Hardcore Championship to get back into singles competitions, and adapting an attitude manifested by wearing trunks that were odd colors for him.

On January 22, 2006, Akiyama defeated Akira Taue to become the GHC Heavyweight Champion for the second time, defending the title against Minoru Suzuki on March 5 and Masao Inoue on April 24.

Akiyama was defeated by Naomichi Marufuji on Noah's September 9 Nippon Budokan show in his third defense of the GHC Heavyweight Title.

Following his title loss to Naomichi Marufuji, Akiyama made good his promise to Tsuyoshi Kikuchi, going back to wearing blue trunks, and wrestling mainly in the undercard.

Akiyama competed at New Japan Pro-Wrestling's third Annual "Wrestle Kingdom in Tokyo Dome" show, defeating Manabu Nakanishi.

After making his return later that year, Akiyama continued to wrestle sporadically whilst struggling with back injuries and the burden of post traumatic stress syndrome, following the death of Mitsuharu Misawa.

On January 22, Akiyama and Saito defeated Bad Intentions (Giant Bernard and Karl Anderson) to win the GHC Tag Team Championship.

[13][14] On January 26, 2013, Akiyama, Atsushi Aoki, Go Shiozaki, Kotaro Suzuki and Yoshinobu Kanemaru, all of whom had quit Noah at the same time, announced that they had joined All Japan Pro Wrestling, reforming the "Burning" stable, which he previously formed with Kenta Kobashi in the late 1990s.

[15] On March 17, Akiyama and Shiozaki defeated Get Wild (Manabu Soya and Takao Omori) to win the World Tag Team Championship.

[19] On July 5, following a mass exodus led by Keiji Mutoh, it was announced that Akiyama, along with the rest of Burning, had signed an exclusive contract with All Japan.

[31] Akiyama runs the new All Japan Pro Wrestling through a company named Zen Nihon Puroresu Innovation, while also serving as the promotion's representative director.

With Takao Omori going down injured around this time, Akiyama revived his old partnership with Yuji Nagata to challenge for the All Asia Tag Team Championship, held by NEXTREAM's Naoya Nomura and Yuma Aoyagi.

When Takao Omori returned from injury he too chose to revisit an old partnership – teaming with Manabu Nakanishi in a Wild Child reunion to unsuccessfully challenge both men's regular partners on March 25.

Despite saying in 2017 he wanted to take a step back from tournaments and main event titles, Akiyama participated in the 2018 Champion Carnival, presumably because of the large amount of injuries the rest of the roster was facing.

On December 7, DDT announced that, at the request of Akiyama and Tetsuya Endo, Kenta Kobashi had endorsed the reformation of Burning for its fourth incarnation.