Significance: End-Stage Renal Disease (ESRD) patients have compromised health-related quality of life due to limitations in physiological, psychological, and psychosocial constructs. Exercise is considered a “best practice” in other chronically diseased cohorts but is not routinely prescribed in patients receiving maintenance hemodialysis. Therefore, the purpose of the study was to observe the effects of regular exercise on health-related quality of life (HRQOL) and nutritional outcomes in ESRD patients. Design: Thirty four patients were recruited and randomly placed into an experimental (n=17) or control group (n=17) using a 4-block permuted randomized design to ensure equal sample sizes. The experimental group followed a stationary bicycle ergometer protocol using the Champ-Cycle stationary bicycle. The cycling protocol consisted of seven (7) minutes without resistance and a gradual increase in resistance as tolerated for a total of forty (40) minutes of exercise. Patients exercised three days a week during their dialysis sessions for eight months with compliance monitored by the nursing staff. Nutritional status and HRQOL measures were collected monthly for eight months. Three-day food records for each patient were used to monitor levels of sodium (mg), phosphorus (mg), potassium (mg), dietary protein intake (DPI), and total energy (kcal). Nutritionist V software was used to analyze food records. Nutritional intake was determined using the National Kidney Foundation's Diseases Outcomes Quality Initiative Adult Maintenance Dialysis Nutritional guidelines. Health-Related Quality of Life was measured using the Medical Outcomes Short-Form 36 (SF-36). Results: A pretest ANOVA revealed no significant differences in SF-36 scores, levels of albumin, phosphorous, potassium, sodium and total energy intake at baseline. Albumin levels increased in the exercise group by 20% (p=.001) after 8 months of exercise. The control group had significantly higher dietary phosphorus (p=.0005) and potassium (p=.002) intakes when compared to the experimental group. The control group had significantly higher bodily pain levels measured by the SF-36 (p=.001). Discussion: In the present study albumin levels increased throughout the study for the exercise group and was above 3.5 g/dL at 8 months suggesting exercise may aid in improving albumin levels. Improvement in quality of life with subjective improvements in bodily pain was observed which is a significant finding as ESRD patients report increased pain when compared to the general population. Conclusions: Exercise in this study population helped to improve nutritional status and HRQOL and may be a viable option for ESRD patients when attempting to improve medical outcomes.Keyword(s): disease prevention/wellness, exercise/fitness/physical activity, research