Combining Moderate Aerobic Exercise With Inspiratory Muscle Training for Dialysis Patients With Atrial

Statement of the problem: Is there a difference between of inspiratory muscle training with aerobic exercise or inspiratory muscle training for hemodialysis patients with AF?? Purpose of the study: To find out the effect of combined inspiratory muscle training with aerobic exercise OR inspiratorty muscle traiting for hemodialysis CKD patients with atrial fibrillation as regards The following outcomes: 1. medical state of patient (heart rate, blood pressure, oxygen saturation) 2. lab analysis (GFR, Serum creatinine, blood urea and nitrogen (BUN) and INR) 3. maximum Inspiratory pressure (MIP) 4. period, duration of dialysis 5. short form questionnaire(SF36) 6. modified Borg scale

Inclusion Criteria * Patients from both gender * With chronic kidney failure(GFR\>30) * with atrial fibrillation * Unemployed living a sedentary lifestyle * Receive regular hemodialysis sessions at 2months ago * All of them have vascular access through arteriovenous fistula * Age range from 40-60 years * Fully understand purpose and procedure of study * Stable and have sufficient level of cognition and ability to understand instructions exclusion Criteria: Patients who meet one of the following criteria will be excluded * Real difficulties with understanding and signing The written informed consent * Recent sequela of cerebrovascular accidents * Osteoarticular or musculoskeletal diseases * Un controlled systemic hypertension * Un controlled diabetes * Un stable angina * Fever * Infectious disease * Acute respiratory failure * Recent acute myocardial infarction * Peripheral vascular diseases