Purpose <p>Exercise rehabilitation is the preferred strategy for treating frailty in elderly patients on maintenance hemodialysis (MHD). However, the relevant contents are scattered. This study summarizes the best evidence for exercise rehabilitation in frail elderly MHD patients, to provide high-quality evidence-based references for clinical practice.</p> Methods <p>By following the “6S” pyramid model, top–down searches were conducted in computerized decision support systems, international guideline websites, websites of chronic kidney disease professional associations, and various databases, with a timeframe from the inception of the database to January 2025. The quality evaluation, extraction, and synthesis of the evidence were conducted independently by 2 researchers.</p> Results <p>A total of 19 articles were included, including 6 guidelines, 1 recommended practice, 6 expert consensus, 4 evidence summaries, and 2 systematic reviews. Thirty-nine pieces of best evidence were synthesized into 8 themes, including multidisciplinary team, exercise assessment, exercise procedure, exercise intensity, exercise types, exercise frequency and duration, exercise safety, and exercise support.</p> Conclusion <p>The best evidence for exercise rehabilitation in frail elderly MHD patients in this study is clinically practical, can provide evidence-based support for medical staff to implement exercise rehabilitation program and improve frailty outcomes in elderly MHD patients.</p>