Exercise During Hemodialysis: Impact on Sarcopenia and Sleep Quality

Inclusion Criteria: * Subjects currently enrolled in a Chronic Hemodialysis Unit. * Patients who have been on hemodialysis treatment for more than 3 months. * Subjects aged 40 years or older. * Hemoglobin levels greater than 10 mg/dl. * Ability to perform physical fitness assessment tests or dynamometry. * Willingness and ability to provide signed informed consent Exclusion Criteria: * Presence of intradialytic instability. * Medical conditions where exercise is contraindicated: active infectious process, neoplasms, uncontrolled arrhythmias, or left ventricular dysfunction (EF \< 35%). * Musculoskeletal or respiratory alterations that worsen with exercise. * Lower limb amputation without a prosthesis. * Cerebrovascular disease (stroke with sequelae or transient ischemic attacks within the previous 6 weeks). * Uncontrolled hypertension (Systolic BP \> 200 mmHg or Diastolic BP \> 120 mmHg). * Unstable angina (at rest or during exercise) or history of coronary bypass/ischemic heart disease within the previous 6 weeks. * Diabetes mellitus with severe decompensation (blood glucose \> 300 mg/dl). * Dialysis-related hypotension (mean blood pressure \< 90/70 mmHg). * Psychiatric or cognitive alterations that prevent collaboration with muscle training programs. * Presence of an arteriovenous fistula in a lower limb. * Motor neurological injury causing dysfunction that prevents the application of the strength protocol. * Hospitalization within the 3 months prior to the study. * Lack of cooperation (defined as failing to attend more than 25% of sessions) or inability to understand the treatment.