A sedentary lifestyle is one of the main causes of low physical capacity and an independent risk factor for death in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). The physical capacity of ESRD patients is 60% of an age-matched population with normal kidney function. Although muscular dysfunction is of crucial significance in low physical capacity, its etiology is more complex. The influence of uremic toxins, vitamin D3 deficiency, hyperparathyroidism, anemia, insulin resistance, androgen deficiency, mitochondrial dysfunction, malnutrition, inflammation, and cachexia are all taken into consideration. Physical rehabilitation improves physical proficiency, the performance of daily activities, and quality of life. In this review possible methods of rehabilitation and their advantages, disadvantages, and possible complications are presented.