The objective of this study is to determine how protein supplementation, with or without exercise, affects functional capacity, strength, body composition, and physical activity in hemodialysis patients.

Inclusion Criteria:

• On hemodialysis for more than 3 months, on a thrice weekly hemodialysis program;
• Adequately dialyzed (Kt/V > 1.4).
• Age > 18 years old.
• Properly functioning AV Graft

Exclusion Criteria:

• Patients unable to perform exercise due to cardiovascular disease, osteoarthritis, etc.
• Pregnant women.
• Severe unstable underlying disease besides commonly associated with ESRD. Cardiac patients that are stable will be included.
• Patients hospitalized within the last month prior to the study.
• Patients will not perform the MRI if contraindication as determined using the VUMC MRI Procedure Screening Form (attached) or prior claustrophobic reaction in an MRI scanner.