Akiyama conducted the Tokyo Symphony Orchestra in the Japanese premieres of Schoenberg's Moses und Aron, John Adams's El Niño and Helmut Lachenmann's Das Mädchen mit den Schwefelhölzern, among others.

He commissioned Jean Coulthard from Vancouver to compose Canada Mosaic for concerts in Asia, requesting solos for all principal players in the orchestra.

He returned to Japan in 1995 to become principal conductor and music advisor of the Hiroshima Symphony Orchestra.

In 2001, he was awarded the Purple Ribbon medal from the Japanese Government for his outstanding contribution to the country's musical culture.

[4][5] He received the Order of the Rising Sun with gold rays with rosette in 2011, and was named the Person of Cultural Merit in 2014.