SPA WELLNESS: Treating Clients with Heart Conditions

There’s no better time than American Heart Month to refresh your knowledge about heart disease, and the spa clients who are living with it.



When a client walks into your day spa with tight back muscles or facial acne, you have some idea of how to proceed, and with what specific caution. But what about the conditions they have that you don’t know about—like heart disease? Can you assume that your clients will always be thorough and forthcoming on your intake forms about that? Probably not. In fact, it might not even occur to them that you should know about the heart attack they suffered five years ago, nor that they’ve been diagnosed with arrhythmia (irregular heartbeat). Worse still, they might not know yet themselves when they have a heart condition. Proper handling of what you know—and don’t know—about a guest’s heart health can help you avoid any surprises that might damage your client relationships, or your spa’s reputation.

How Likely is the Problem?

Heart disease, also known as cardiovascular disease or coronary heart disease, causes one out of every four deaths in America, according to the American Heart Association. One in three women will develop some form of heart disease in her lifetime. In Hispanic, Asian and African-American populations, those statistics are even higher. Heart disease kills more women than cancer does, partially because it tends to strike women at a later age than it does men. Early diagnosis of risk factors and increasing treatment options are helping to combat the problem, but because heart disease doesn’t always manifest outward and obvious symptoms, the question of who will and who won’t develop heart disease remains something of a mystery.

The good news is, many people diagnosed with a heart condition are leading full and active lives. They may very well come to your spa as part of an adopted healthy lifestyle. And, with just a few cautionary measures, you may be able to contribute to their long lives and lasting wellbeing.

What’s Going on in Their Bodies?

Heart disease occurs when blood flow to the heart is restricted, often due to a narrowing of the arteries. Plaque—a combination of cholesterol, fat and other substances—builds up along the artery walls, making it more difficult for a normal blood stream to pass through. When the arteries harden, that condition is known as arteriosclerosis. Arrhythmias can cause heart disease, as can hypertension, which puts a strain on the heart, arteries and other vital organs. Any single factor or combination of factors can lead to a myocardial infarction, or heart attack, which occurs when blood is so severely restricted that flow is cut off to the heart, depriving it of oxygen.

The most common warning sign of a heart attack is angina, or chest pain. However, women in particular are prone to experiencing symptoms that are not as obvious. Even during a heart attack, a woman’s symptoms tend to remain vague; she might feel some fullness in the chest or abdomen, shortness of breath, lightheadedness, extreme fatigue, or pain in the arms, back or jaw. Because these symptoms could signal just about anything, women don’t always take action, and minor heart attacks often go undiagnosed.

For those aware that they’re living with a heart condition, regular day spa visits fit beautifully into a quest for a long, healthy life. “Sometimes people become sick because the life-force energy in their body, or qi, is drained,” says Manchester, Connecticut, integrative cardiologist Dr. Stephen Sinatra, founder of the HeartMD Institute and author ofh.The Great Cholesterol Myth. “The hands of a therapist can help renew their qi and facilitate the body’s own natural ability to heal,” Sinatra says. “Also, when people are dealing with a chronic illness they can become depressed, and touch helps with that.”

What Precautions Should You Take?

Most massage techniques are safe for heart patients but, as with any client, positioning and pressure levels should be continually monitored. “Swedish is perfectly safe. Deep-tissue or shiatsu modalities are fine as long as they don’t cause pain,” says Sinatra. “Common sense should guide the treatment—you shouldn’t use too much pressure on the chest walls of someone with a heart condition. And these clients shouldn’t receive treatments every day. The body needs a couple of days to recover.”

Long-time spa owner and DAYSPA advisory board member Tamara Friedman believes that a spa pro can never exercise too much caution. “My therapists ask clients a minimum of three times during a massage how the pressure is, whether they’re comfortable and if they need a change of position,” says the owner of Tamara Spa & Wellness in Farmington Hills, Michigan. Friedman also has personal experience with the spa’s power to help heart patients. Her husband had a heart attack at a young age and, as part of his ongoing healthy lifestyle, he now receives a massage weekly. “Massage improves the blood circulation, as well as the oxygen’s intake to the cells,” notes Friedman. “It helps prevent and relieve stress. After all, we had massage long before we had medicine—it’s an ancient healing art.”

Treatments involving temperature changes such as sauna or hot/cold therapies are not recommended for people with heart problems. “We suggest a beautiful lukewarm bath with aromatherapy instead,” says Friedman. Sinatra notes that recent Japanese studies have found saunas to be fine for people with congestive heart failure, but that it’s still probably best to steer those clients toward something else.

As for skin care, heart medicine can sensitize the dermis, so an esthetician needs to carefully determine which products and procedures can be tolerated. Exfoliation and body wraps are recommended for detoxification and relaxation—with a caveat. “Something like a mud or seaweed wrap is great,” says Sinatra, “but avoid exfoliation on the skin of the clients’ chest and abdomen.” Naturally, a client who has stents (expandable tubes placed in their arteries to help open them) or who uses a pacemaker (a device used to control abnormal heart rhythms) should be handled with special care.

A host of alternative therapies can improve quality of life for people with heart conditions. In addition to standard spa treatments, consider offering*:

Nutritional counseling: Famed physician Dr. Dean Ornish has written many books on low-fat vegetarian diets and their ability to reverse or prevent heart disease. There are many other dietary strategies on the market, too.

Herbal and nutritional supplements: Hawthorne berry, garlic, ginger, Omega-3 fatty acids, antioxidants and flaxseed are all known to support heart health.

Yoga, tai chi, qi gong and meditation: These practices all help facilitate healthy blood flow.

Personal training and exercise counseling: This is a surefire way to help clients improve their cardiovascular health.

*CAUTION: Always have clients check with their physicians before beginning any new treatments or approaches that can impact their health.

Some additional safeguards to keep in mind when treating these individuals:

• Review with the client the entire treatment protocol before you begin.

• Be aware that some of these clients may prefer their feet to be positioned lower than their head.

• Don’t allow these clients to lie flat on their back for hours and hours.

• Make sure clients stay properly hydrated.

• Be sure the client communicates if the positioning is uncomfortable, especially to the chest, jaw or neck.

• Be aware and intuitive. If the client’s skin becomes red, cold or clammy, if they exhibit facial grimaces, if they become short of breath or begin breathing heavily or coughing, stop the treatment immediately—even if they haven’t expressed distress.

Protect Yourself

There are several ways to protect yourself from liability should a client with a heart condition become unwell during his or her time at your spa. The first is the intake form. All questions are fair game, including whether clients have a history of heart problems, and whether they are taking any medications for them. If they answer yes, you can steer them toward treatments that you know to be perfectly safe.

What if that client requests a treatment that increases body temperature or in some other way puts stress on the heart? Attorney and DAYSPA advisory board member Michael L. Antoline suggests, “It’s not unreasonable for the spa to ask the client to show the spa menu to their doctor first, then return with a note specifying which treatments would be suitable for them.” That way, you haven’t refused the treatment they desire; you’ve just included their doctor in the decision.”

If a client doesn’t reveal their heart problems and chooses a risky treatment, you’ve done due diligence by asking, explains Antoline. “If they withhold information, there’s a limit to what a spa owner can do,” he says. Your intake form should include a disclaimer stating that treatments are performed at the client’s own risk, should they have concealed any relevant health information.

If a client begins to exhibit symptoms during a treatment, you and your staff must respond, even if the client doesn’t say anything. Stop the treatment immediately. If the client, for example, becomes slightly short of breath during a treatment, then adjusts her position until her breathing returns to normal, you could ask her whether or not she’d like to continue the treatment. But, if the client says, “I’m having pain radiating down my left side,” or you or staff notice extremely labored breathing, you must stop the treatment and call for immediate medical attention.

“This is your business and you have a duty of care,” says Antoline. “If you see someone on the street clutching their chest you do not have to act, but if they are in your spa, you do.” Hopefully, this is information you’ll never have to use at your spa. But it’s important to have a policy, and to train all staff to observe and respond.

Andrea Renskoff is a Los Angeles-based freelance writer.

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