Fortunately, the literature on exercise among patients on hemodialysis has grown too broad to be included in a single review. The focus of this review is on interventional studies, with an emphasis on those studies that included a control group. The good news is that there is ample evidence that exercise can improve fitness (VO(2) peak), physical functioning, and some cardiovascular risk factors in the dialysis population. However, there have been few comparative studies, and there is no consensus regarding the most beneficial regimen or the one most acceptable to large numbers of patients. A new set of recommendations from the American College of Sports Medicine and the American Heart Association for older individuals and individuals with chronic diseases is relevant for our patient population and can be used to guide exercise prescription until disease-specific data are available to fill the gap.