The study investigated the effects of an intradialytic exercise program on autonomic function and dialysis efficacy in maintenance hemodialysis in 18 patients. The patients undertook a 6-month intradialysis exercise program. Each session consisted of a 5-minute warm-up, 40-minute main exercise program, and 5-minute cool-down period. Autonomic symptom questionnaire and autonomic function test by heart rate variability on supine and standing position, and dialysis efficacy were assessed at the beginning and end of the study by comparison using the Wilcoxson signed rank test. Heart rate variability in the supine position was not improved. In the standing position the ratio between the low frequency and high frequency (LF/HF) increased significantly after 6 months of exercise (p＜0.05), with the LF component being normally dominant. Statistical differences were evident at 6 months in autonomic symptoms questionnaire and autonomic function (p＜0.05), but not in dialysis efficacy. The results suggest that intradialytic exercise is an effective therapy to improve autonomic symptoms and a heart rate variability parameter.