this study aims To assess the effect of intradialytic exercise program on sleep quality, depression and anxiety in HD Patients.

Intradialytic exercise is a common recommendation given to encourage patients to be physically active. Previous studies have suggested that intradialytic exercise is effective in reducing fatigue severity, improving sleep quality, enhancing exercise tolerance, improving quality of life and even psychological status. Research also revealed that intradialytic exercise can increase the efficacy of dialysis, subsequently alleviating inflammation, improving nutrition and bone mineral density. Patients typically undergo two or three hemodialysis sessions a week, with each session lasting for approximately 4 hours. Since many patients maintain bed rest during HD sessions, intradialytic exercise can be a potentially useful approach to improve their health without consuming extra time during the interdialytic period.

Inclusion Criteria:

1. ESKD patients on maintenance hemodialysis for more than three months.
2. Age more than 18 years.

Exclusion Criteria:

1. Mentally or physically unfit patients or with severe psychiatric illness.
2. Patients who receive any psychotropic medications.
3. Patients with overt ischemic heart disease or cardiac decompensation.
4. Anemic patients (Hb ≤ 8 mg/dl).
5. Patients presented with severe bone pains or muscle weakness secondary to chronic kidney disease-mineral and bone disorder (CKD-MBD).
6. Patients with advanced lower limbs joints disease.
7. Lower limb amputation.