Objective To evaluate the effectiveness of multi-component exercise intervention based on the integral conceptual model of frailty during dialysis in elderly patients with frailty undergoing maintenance hemodialysis.Methods A convenience sampling me-thod was used to recruit 76 elderly patients with frailty undergoing maintenance hemodialysis between September 2024 and Feb-ruary 2025.Patients undergoing dialysis on Monday, Wednesday, and Friday (n=38) served as the control group and received routine care.Patients undergoing dialysis on Tuesday, Thursday, and Saturday (n=38) comprised the intervention group and received multi-component exercise intervention based on the integral conceptual model of frailty during dialysis.Assessments of frailty, muscle strength, exercise endurance, and physical function were conducted before the intervention, after 4 weeks, and after 12 weeks.Results Following the intervention, comparisons of Tilburg Frailty Indicator （TFI）, grip strength, six-minute walking distance, and Short Physical Performance Battery (SPPB) score between the two groups showed statistically significant differences in the group effect (except for grip strength), time effect, and group-by-time interaction effect (all P＜0.05).Conclusion The multi-component exercise intervention during dialysis based on the integral conceptual model of frailty can effectively improve the frailty status of elderly patients with frailty undergoing maintenance hemodialysis.Additionally, it enhances muscle strength, exercise endurance, and physical function of patients.