This is a randomized trial with participants recruited from one dialysis unit of a Brazilian university hospital. Hemodialysis patients were assigned to receive the resistance exercise combined with an aerobic training or the resistance training alone for a period of 10 weeks. The functional performance of patients was assessed before and after the intervention through the six-minute walk test (6MWT). The difference over time of the 6MWT was compared between the groups through multivariate linear regression.

Thirteen patients were allocated for each group of intervention. The difference in distance walked before and after intervention in the combined training group was of +39.7 (61.4) meters, and this difference in the resistance training group was of -19.2 (53.9) meters, p=0.01. In multivariate analysis with adjustment for age, skin color, gender, hematocrit, time since starting dialysis, Kt/V and baseline values of 6MWT, the type of training remained significantly associated with the amount of increase in walked distance.

Although the best protocol of exercise for patients on dialysis is not yet clear, in the investigators sample of hemodialysis patients the combination of aerobic and resistance training was more effective to improve functional performance.

Inclusion Criteria:

• to be on hemodialysis therapy for longer than 3 months
• to be already included in the resistance training protocol during dialysis
• to receive erythropoietin for the treatment of anemia
• hemoglobin level greater than 9.0 g/dL
• to be able to maintain sitting and standing balance and ambulatory without assistance.

Exclusion Criteria:

• symptomatic ischemic heart disease
• recent myocardial infarction of less than 6 months
• uncontrolled hypertension
• pericardial or pleural friction rub
• aortic stenosis
• active musculoskeletal lower-extremity problem, or history of vertebral fracture caused by osteoporosis
• patients were also excluded if they participated in formal organized exercise programs outside the dialysis unit.