HD patients were found to have a lower LA strain than normal controls. Abid demonstrated that strain had a negative correlation with brain natriuretic peptide in patients strain has been demonstrated to be associated with left ventricular diastolic function. By combining the left ventricular diastolic parameter with transmitral wave velocity, a more accurate estimation of left ventricular filling pressure has been achieved. The ratio to early diastolic mitral annular velocity was reported to be well related to mean pulmonary capillary wedge pressure and useful in prediction of mortality. Hence, we hypothesize the combination index strain also can predict mortality in patients. Hence, the present study is designed to examine the ability strain and strain in the prediction of total and cardiovascular mortality in patients. Age, sex, current smoking history, and comorbidities were obtained from medical records or interviews with patients. The body mass index was calculated as the ratio of weight in kilograms divided by the square of height in meters. Laboratory data were measured from fasting blood samples and obtained within month of enrollment. Diabetes was diagnosed if fasting blood glucose was hypoglycemic agents were used to control blood sugar. Stroke was defined as a history of cerebral bleeding or infarction. Coronary artery disease was defined as a history of typical chest pain with a positive stress test, angiographically documented coronary artery disease, old myocardial infarction, or having undergone coronary artery bypass surgery or angioplasty. Heart failure was defined based on the Framingham criteria. Physical activity has been shown to have various positive effects on patient. Exercise is also crucial for retaining physical independence. Some of the important benefits linked to exercise include an improvement in physical fitness aerobic capacity dialysis adequacy measured as urea, quality of life, and reduced depressive symptoms. Exercise training can be delivered over different timings and modalities. For convenience, exercise is often delivered on dialysis days at a dialysis center before or during the dialysis procedure. Intradialytic exercise on a customized bicycle has been identified as the most prevalent form of organized exercise among patients, presumably because it does not involve any extra time, and the patient is supervised by medical staff while exercising. However, the patient’s movements are limited to a lying or sitting position. Other reported modalities of exercise training in studies with patients include resistance training, aerobic training out of the dialysis procedure, and combined resistance and aerobic training. Since there are many studies already published on the topic, it would be valuable to determine which modality is actually the most beneficial for a patient’s physical performance and overall benefit.