My doc actually told me to avoid them, not just for the overheating factor but also something about it being hard to make sure they are clean enough and also something about the jets... I hadn't really looked into it any further as it hasn't been an issue but perhaps do some more research into it for your friend. HTH.
The physio at the Royal Brisbane uses a spa during their aqua classes. She explained that the issues are with temp in big swimming pool spas. The cleanliness issue would also be a factor in pool spas, but not bath spas as they would be as clean as just having a bath.
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