Background: The core of cardiac rehabilitation is structured exercise training. CR reduces 28-56% hospital readmission rate, and around 25 % increases cardiorespiratory fitness, thus there is a need to establish outpatient CR (Phase III) in Saudi Arabia (SA). Furthermore, the awareness of outpatient CR in SA is unknown.Aims: To determine the main barriers to establishing an outpatient CR program (Phase III) in the western region of SA, as well as assess the awareness of outpatient CR (Phase III) in the western region of SA. Methods: A cross-sectional study survey was conducted among physiotherapists, cardiologists and the cardiac surgeon using a questionnaire distributed electronically to determine the awareness level of outpatient CR and barriers to establishing outpatient CR (Phase III) in the western region of SA. Results: Of the 141 participants who completed the survey, our findings showed that 131 were aware of CR with 112 participants were not aware of the four phases of CR. There were three main barriers to establishing CR: no appropriate CR (96%), lack of awareness among healthcare professions of the comprehensive CR phases and its benefits (95%) and the lack of healthcare providers trained in CR (94%). Conclusions: To overcome the barriers to establishing CR outpatient centers in the western region of SA, it is recommended to provide more CR outpatient training programs to healthcare providers and raise the awareness of the CR phases, its benefits, and the risk factors for developing cardiac diseases among healthcare providers.

Background Hydrotherapy is an effective therapeutic modality in controlling pain and increasing blood flow, but its effect on Peripheral arterial diseases (PAD) is still unclear.Aim The aim of this systematic review was to investigate the effect of hydrotherapy on the arterial blood pressure in patients with PAD.Method A systematic review searches were conducted on the PubMed, Scopus, Physiotherapy Evidence Database (PEDro) and EBSCO databases from 2015 till 2022. Studies were eligible if randomized controlled trails (RCTs) investigating the effect of hydrotherapy on arterial blood pressure in patients with PAD. Qualitative data was extracted from six studies. Methodological quality was used to assess the risk of bias using the PEDro scale.Results A Meta-analysis was conducted on 6 RCTs (214 patients: 204 patients with PAD and 10 healthy subjects) to calculate the standardized mean difference (SMD) with 95% confidence interval (CI), and overall effect size (ES) of the ankle brachial index (ABI), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), 6-min-walk test (6MWT) distance, resting heart rate (RHR). The Meta-analysis showed that hydrotherapy had non-significant effects on the SBP (SMD 0.01 [95% CI -0.26-0.27]), the DBP (SMD − 0.18 [95% CI -0.58-0.22]), the ABI (SMD 0.08 [95% CI -0.57-0.73], 6MWT (SMD 0.45 [95% CI -0.19-1.08]), RHR (SMD − 0.19 [95% CI -0.52-0.14]).Conclusion The results of this review could not conclude the non-significant effects of the hydrotherapy in improving the SBP, ABI, DBP, RHR, and the 6MWT distance in patients with PAD.