Background Exercise is increasingly recommended for haemodialysis patients with chronic kidney disease, yet the evidence from meta-analyses remains fragmented, and its methodological quality has not been systematically evaluated. Methods We systematically searched Embase, PubMed/MEDLINE, Cochrane Library, and Web of Science up to January 2026. We evaluated the methodological quality of studies using the ''Measurement Tool to Assess Systematic Reviews 2''. We used GRADE system to rate the evidence level for each outcome as high, moderate, low, or very low. Results We reviewed 11 meta-analyses. Aerobic exercise significantly improved dialysis adequacy (Kt/V) (weighted mean difference (WMD) = 0.08; 95% confidence interval (CI) = 0.00, 0.15), cardiorespiratory fitness (VO2 peak) (WMD = 2.07; 95% CI = 0.42-3.72), six-minute walk test (6MWT) (WMD= 64.98; 95% CI = 43.96-86.11); systolic blood pressure (SBP) (WMD = -10.07; 95% CI = -16.35, -3.78), C-reactive protein (CRP) (WMD = -3.28; 95% CI = -4.68, -1.88), and depression (standardised mean difference = -0.93; 95% CI = -1.32, -0.55). Aerobic exercise did not significantly affect diastolic blood pressure (DBP), physical component score (PCS), mental component score (MCS), or serum phosphorus. Resistance exercise significantly improved 6MWT (WMD= 68.50; 95% CI = 29.05, 107.96) and PCS (mean difference = 10.05; 95% CI = 2.95, 17.14) with no significant effects on Kt/V, CRP, or depression. Combined exercise improved VO2 peak, DBP, PCS, MCS, CRP, and depression, but not Kt/V, 6MWT, or SBP. Conclusions Aerobic exercise may improve cardiorespiratory fitness, dialysis efficiency, inflammation, and depression; resistance may enhance muscle strength and physical function; combined training offers the broadest benefits. Individualized prescriptions are supported, but high-certainty evidence is lacking. Registration PROSPERO: CRD420251244373
[1]Cent South Univ, Xiangya Hosp, Dept Orthopaed, Changsha, Hunan, Peoples R China.
[2]Cent South Univ, Xiangya Hosp, Natl Clin Res Ctr Geriatr Disorders, Changsha, Hunan, Peoples R China.
[3]Cent South Univ, Xiangya Sch Med, Changsha, Hunan, Peoples R China.
[4]Chinese Acad Med Sci & Peking Union Med Coll, China Japan Friendship Hosp, Dept Orthopaed Surg, Beijing, Peoples R China.
[5]Cent South Univ, Changde Hosp, Peoples Hosp Changde City 1, Xiangya Sch Med, Changde, Peoples R China.
(8.0+极速模式)