This study will be carried out on sixty male and female patients. They will be recruited from National Institute of Kidney and Urology, Mataria,Their ages will be ranged from (40-60) years old these patients will be assigned into three groups (A, B and C). The design of this study will be a randomized controlled trail (RCT).The patients will be informed about the study procedure and signed the informed consent prepared for this study . The study will follow the instructions of ethical committee of faculty of physical therapy, Cairo University. Inclusive criteria
1. Maintenance hemodialysis ≥ 3 months.
2. BMI will be ranged from 18.5 to 29.9 kg/m².
3. Age ≥ 40years and ≤ 60 years.
4. Hemodialysis 3 times a week.
Exclusive criteria:
1. patients suffered from any central and peripheral nervous system diseases.
2. patients suffered from serious complications, such as heart failure, severe infection and malignant tumor.
3. uncontrolled hypertension with systolic blood pressure ⩾200 mm Hg and/or diastolic blood pressure ⩾120 mm Hg,
4. unstable angina
