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

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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