Inclusion Criteria:  greater than 18 years of age male or female ESKD on maintenance hemodialysis for 3 consecutive months adequate dialysis clearances (Kt/V greater than 1.2), able to participate in exercise program based on nephrologist evaluation able to provide written informed consent for participation, Compliance with dialysis treatment regimen (attended 75% of ordered dialysis treatments in the last 3 months.  Exclusion Criteria:  less than 18 years old on hemodialysis for < 3 consecutive months acute Kidney Injury diagnosis patients deemed clinically unstable by Nephrologist active foot ulcer unable to provide written consent refusal of participation lower limb amputations patients with dementia or severe cognitive impairment patients with Psychiatric disorders (who are not treated and unstable) pregnancy myocardial infarction in the last 6 months uncontrolled diabetes patients on chronic Midodrine therapy for intradialytic blood pressure support. deep vein thrombosis symptomatic peripheral vascular disease and/or recent lower extremities vascular intervention (i.e. bypass)