Is massage safe if you have a heart condition?

Many people find massage a great way to relax – which is especially important after a stressful cardiovascular event like a heart attack or finding out you have a condition like atrial fibrillation (AF) or high blood pressure (hypertension).

It is a complementary therapy you can use to manage stress, which in turn can also improve your cardiovascular health.

But it should never replace treatments prescribed by your doctor, and it’s not advised with some heart conditions, so always speak to your GP or nurse before having a massage.

How does massage work?

Massage involves someone using their hands or a tool to rub, knead or stroke the body’s soft tissues, including muscles, skin and tendons, to relieve tension and promote deep relaxation.

There are several different types of massage including:

• Aromatherapy – uses essential oils to heighten relaxation during massage.
• Reflexology – reflex points are massaged on the feet and hands.
• Swedish – uses gentle, flowing strokes to massage soft tissue.
• Deep tissue – involves slow, firmer strokes that are perceived as deeper pressure on the muscles and connective tissue.
• Sports – uses a combination of different soft tissue techniques on the muscles and joints.

It was once thought that massage could help boost circulation and control blood pressure by moving blood around the body.

But the latest research shows this is not the case. Massage only moves blood around in the area being massaged and this only happens in the short term. Blood pressure is only lowered in the short term too.

This is because research now suggests that massage’s benefits are not directly related to blood, tissue and muscles, but are due to the way it affects the nervous system and brain.

A 2019 study of osteopathy – a manual therapy that uses massage techniques – in the European Journal of Medical Research suggests massage acts on the autonomic nervous system (sympathetic and parasympathetic), which regulates involuntary body functions like blood pressure, heart rate, and the ‘flight or fight’ stress response.

The findings suggest the therapy moves the body from a stressed state (sympathetic) to a relaxed state (parasympathetic).

Research published in 2024 in Nature Human Behaviour shows that touch intervention, including massage, on average twice a week for 20 minutes, lowers systolic blood pressure, heart rate and improves sleep quality – all of which are essential for heart health.

The meta-analysis of 137 studies, which included a review of 75 additional studies, also suggests that massage lowers a chemical in the body called cortisol, which in turn reduces stress.

The findings confirm that touch is a powerful way to support cardiovascular health by lowering stress.

What to watch out for with different heart issues

Atrial fibrillation (AF)

In most cases, light to moderate relaxation massage, like Swedish massage, is considered safe is you have AF as it can help reduce stress and in doing so lower AF triggers.

But it’s best to avoid massage if you have worsening AF symptoms and if you recently had cardioversion or catheter ablation.

Neck massage is also not recommended at any time. If you’re concerned, consult your doctor before going ahead.

Heart attack or heart surgery

If you’ve had a heart attack or are recovering from heart surgery, it is common to feel anxious, so having a massage may help you to relax.

However, you may have wounds that need to heal after having tests, treatments and procedures, so make sure to ask your doctor how long you need to wait before you can have a massage.

Pacemaker or ICD

If you have a device such as a pacemaker or implantable cardioverter defibrillator (ICD), it is usually ok to have a massage, as long as the therapist avoids the chest area where the device was inserted.

But you should not have a massage after the device has been fitted until the wound at the insertion site has healed and it’s comfortable to lie on your front and back.

Cardiovascular medicines

It’s safe to have a massage on most heart medicines. But if you take blood thinners (anticoagulant medicines) such as warfarin or apixaban, you may find you bruise much more easily, so deep tissue massage will not be suitable.

Heart failure

If you have heart failure, your doctor may advise you to just have gentle massages while sitting up – not lying down, especially if you have breathing difficulties when you lie flat.

This might limit you to hands, arms, legs, feet (reflexology), head and neck massages.

High blood pressure

Research shows that blood pressure can be lower after massage, with 1 paper reporting that twice weekly back and foot massage for 3 weeks reduced high blood pressure in women.

But these reductions have only been seen in the short term, meaning massage is not effective if you have been diagnosed with high blood pressure (hypertension) that requires long-term treatment with medicines.

6 tips for a safe massage

Massage is a complementary therapy and should never replace any treatments prescribed by your doctor.

Before booking in, check your massage therapist is qualified by going to the Complementary and Natural Healthcare Council website where you can search for practitioners.

You can also look at the General Council for Manual Therapies (GCMT) website to see if they’re a member of one the professional associations listed there.

Also, be aware that, because most massages are preformed lying down, they can cause short-term changes to blood pressure that can make you feel lightheaded when you get up. They can also lead to dehydration, so make sure you drink plenty of water before and after.

1. Avoid eating a heavy meal or drinking alcohol before your massage.
2. Tell the massage therapist about your heart condition and any medicines you are taking.
3. Tell your therapist if at any time during the massage you feel uncomfortable or unwell.
4. When finished, sit up gradually and get off get off the massage table slowly.
5. Have a drink of water and sit quietly for a few minutes before leaving.

What to read next...