Physical exercise during hemodialysis improve hemodialysis patient functional level. Tiredness, fear and lack of motivation to do repetitive routine discourage patient to reach its benefit. Virtual reality, as clinical intervention, already shown its capability to help diabetes and stroke patient to regain their physical strength due its immensity and convenience. This systematic review of the literature review aims to investigate the impact of virtual reality exercise on physical strength and fatigue in hemodialysis patient     PubMed, EBSCO, and Google Scholar were all used to search for control/ clinical trials demonstrating the effect of virtual reality exercise on physical strength and fatigue in hemodialysis patient.   All studies showed improvement on physical strength in this population. VR exercise can also increase body composition, physical fitness, physical strength amd functional capacity. Also, one of the two studies showed significant decrease on fatigue level. There was limited supporting evidence to suggest that virtual reality exercise could reduce fatigue level.   based on findings, virtual reality exercise may improve physical strength, although more research needed to prove virtual reality effect on decreasing fatigue of hemodialysis patient. Virtual reality exercise can be an additional therapy for patient who undergoing hemodialysis.