Study Hypothesis: The combination of aerobic and resistance exercise training will improve walking speed compared to either individual intervention.

Brief Summary:

Sixty hemodialysis participants who meet inclusion and exclusion criteria will be randomized to 20 weeks of supervised exercise, using either: (i) on-dialysis aerobic exercise using a bike ergometer; (ii) pre-dialysis leg strength training using weights; or (iii) both. The primary outcome is walking speed over 4-metres. Secondary outcomes will include:

(i) short physical performance battery; (ii) health-related quality of life [EuroQOL-5D-5L]; (iii) Dialysis recovery time; (iv) Nottingham extended activities of daily living (EADL) index; (v) Leg strength; (vi) body composition and anthropometry.

Inclusion Criteria:

• At least 18 years of age
• On hemodialysis minimum of 3 times per week
• On hemodialysis > 3 consecutive months

Exclusion Criteria:

• Inability to provide consent
• Inability to walk 4-metres
• Chest pain with exertion or myocardial infarction in past 6-months
• Pre-dialysis systolic blood pressure > 200 mm Hg or diastolic BP > 100 mm Hg in past 2-weeks
• Functional or cardiorespiratory limitations preventing use of cycle ergometer for at least five-minutes or the ability to perform single maximum rep with each of resistance exercises described
• Joint replacement or lower extremity fracture in previous 6-months
• Severe cognitive impairment
• Currently using corticosteroids >5 mg/day
• Pre-dialysis serum potassium in previous month less than 3.5 or greater than 6.0 mmol/L.
• Attending nephrologist feels exercise is medically contraindicated
• Scheduled living related kidney transplant in next 6 months