Inclusion Criteria:  Dialysis history ≥ 1 year Without myocardial infarction within past 3 months Regular dialysis 3 times a week Ability to consent Doctor's consent  Exclusion Criteria:  Unstable cardiac status (angina, decompensated congestive heart failure, severe arteriovenous stenosis, uncontrolled arrhythmias, etc.) Active infection or acute medical illness Hemodynamic instability Labile glycemic control Unable to exercise (lower extremity amputation with no prosthesis) having severe musculoskeletal pain at rest or with minimal activity Unable to sit, stand or walk unassisted (walking device such as cane or walker allowed) Having shortness of breath at rest or with activities of daily living (NYHA Class IV)