End-stage renal disease (ESRD) is a major health problem in the United States. Many patients with ESRD experience a decline in physical functioning as a result of the disease process and its associated sequelae. Cardiovascular changes, anemia, and skeletal muscle weakness contribute significantly to this decreased capacity, leading, in many instances, to a primarily sedentary lifestyle. Studies conducted on the effectiveness of exercise training for patients with ESRD reveal numerous physiological and psychological benefits, particularly when training is continued for several months. However, the number of structured exercise programs available as part of a rehabilitation program for ESRD patients is limited. This article provides an overview of the role of exercise for patients with renal disease, and a case study illustrates how nurses, in collaboration with the interdisciplinary team, can be effective in preventing continued deconditioning and in maintaining a more positive outlook in patients with ESRD.