Background: End-stage kidney disease (ESKD) is a growing public health that may predispose the patients to cerebral leanness and white matter complexty. Our aim to evaluating effect of different exercise types on the physical and mental performance as well as on the efficiency of dialysis process in HD patients. Methods: Interventional cohort study was carried out on 62 patients with (ESKD). divided into group I; 20 treated by low intensity aerobic exercise, Group II; 20 treated by low intensity anaerobic exercise and Group III: 22 treated by combined exercise intradialytic and dialysis off day. Efficacy of dialysis, physical performance, depressive symptoms and cognitive and executive function were measured at the beginning of and end of exercise program. Results: Combined exercise have a highly significant effect on modified mini-mental state exam (cognition)(P=0.0001) and a significant improvement on Addenbrooke's Cognitive Examination Revised (P