This chapter presents the discussion of reviewed related writing of authors that the researchers collected during the course of the study. Material reviewed came from different books, studies and other professional writings from both foreign and local books. Conceptual Literature The worldwide spa industry is worth in the region of US $40 billion and has grown at a phenomenal rate in the past ten years (Haden, 2007).
The growth of health food, gyms and the investment in leisure facilities proves that consumers are looking for more than relaxation during a break or holiday; this is unsurprising given time is so precious to contemporary consumers (Lynch, 2002). Harmsworth (2004: p. 173) claims that “the spa market is one of the fastest growing leisure sectors, where societal trends and aspirations find instant reflection in the developments on both the demand and supply sides.
The market is very fragmented, each segment catering for different customer needs, which continuously change in line with social and lifestyle changes. ” According to Libosada Jr. C. and Bosangit C. (2007) stated that spa is a resort with mineral or thermal water used for drinking and bathing. The term is derived from the name of a town in Belgium and has been applied to similar resort worldwide.
The Kentucky-based International Spa Association (ISPA), an organization which claims to set the standards for the spa industry makes no mention of water in its definition, arguing that “a spa serves as an educational and cultural institution that promotes and integrates individual wellness, health and fitness as well as social well-being, harmony and balance through wellness, prevention, therapy and rehabilitation of body, mind and soul” (Loverseed, 1998: p. 48).
Later, the ISPA offered an all-encompassing, holistic definition, claiming that spas are entities “devoted to enhancing overall well-being through a variety of professional services that encourage the renewal of mind, body and spirit” (Mintel, 2005). It is claimed by Jenner and Smith (2000) that visiting spas is one of the earliest forms of tourism. Spas found their beginnings thousands of years ago, when ancient civilisations used them for their healing properties and as an important part of their social structure (Vierville, 2003; Spaa, 2002).
The therapeutic use of baths was remarkably long-lived; such popularity was no doubt partly due to the fact that baths were both pleasant and, by the Roman imperial period at least, comparatively freely available (Jackson, 1990). It was after this time that public interest in baths began to peak (Spaa, 2002). Spa tourism has many varied definitions; there is no “officially” agreed upon definition of what a spa should or should not be – what makes it such?
Many believe that the word ‘spa’ is an acronym based on the Latin phrase “sanitas per aquas” – meaning ‘health through water’, in fact the Oxford English dictionary’s definition of a spa is from the Latin “solus per aqua” or “health by water” defined as “a place with mineral springs considered to have health-giving properties” (Loverseed, 1998). Thornton and Brutscher (2003) maintain that the word and the concept of spa actually originated from the time of the Roman Empire when battle weary legionnaires tried to find a way to recover from their military wounds and ailments.
Therefore suggesting that traditionally, water is not only inexplicably linked to the definition of spas, but that it is the water which defines it. The European Spas Association’s (ESPA) definition of a spa is also dependent upon the water element; they define a spa as „a mineral spring or a place or resort where such a spring is found? (Jenner and Smith, 2000). Unlike the ESPA, the British Spas Federation (BSF) reviewed
However, the BSF was later replaced by the Spa Business Association (SpaBa) who in turn redefined the spa, returning the centrality of the role of water by defining a spa as “an establishment providing a minimum of one approved water based treatment using water of known composition. The spa should be staffed by appropriately trained therapists and have minimum standards of furnishings. The water should be enhanced with minerals, either naturally or with an additive” (Mintel, 2005).
Others, especially in the USA, hold a far less rigid view of what constitutes a spa. The Kentucky-based International Spa Association (ISPA), an organization which claims to set the standards for the spa industry makes no mention of water in its definition, arguing that “a spa serves as an educational and cultural institution that promotes and integrates individual wellness, health and fitness as well as social well-being, harmony and balance through wellness, prevention, therapy and rehabilitation of body, mind and soul (Loverseed, 1998: p. 8). Later, the ISPA offered an all-encompassing, holistic definition, claiming that spas are “devoted to enhancing overall well-being through a variety of professional services that encourage the renewal of mind, body and spirit” (Mintel, 2005). It is claimed by Jenner and Smith (2000) that visiting spas is one of the earliest forms of tourism.
Spas found their beginnings thousands of years ago, when ancient civilisations used them for their healing properties and as an important part of their social structure (Vierville, 2003; Spaa, 2002). The therapeutic use of baths was remarkably long-lived; such popularity was no doubt partly due to the fact that baths were both pleasant and, by the Roman imperial period at least, comparatively freely available (Jackson, 1990).
It was after this time that public interest in baths began to peak (Spaa, 2002). By the medieval period, the idea that thermal springs could have medicinal properties was firmly established. But in the 18th and 19th centuries, taking the waters? began being a fashionable pastime for Europe?s upper classes. In fact, the popularity of this habit is what established places in the UK, such as Bath, Brighton and Harrogate, as early tourism destinations (Jenner and Smith, 2000).
Today’s spa is an interesting combination of ancient traditions and modern facilities; in recent years, the value of prevention, healthy lifestyles, and relaxation has been embraced by many and the spa is again finding its place in modern society as a place uniquely geared to address these needs (Register, 2005). In one of the major formative tradition for current pattern of health and well-ness spa tourism worldwide, the Roman Empire left behind a long list of spas all over Europe, which they built while they were occupying new territories.
With the demise of the Western Roman Empire in 450 AD, so too came the demise of the Roman bath tradition in Europe, although Spain, North Africa, and the Middle East maintained a highly developed bathing culture. This was a result of the influence of the Byzantine or Eastern Roman Empire and the subsequent Arab conquests and maintained the influence of Roman bathing tradition in those countries (The Spa Association, 2005).
The City of bath in England provides an example of the fusion of Roman history with later trends in spa and wellness demand and supply in Europe (White, 2000). After the springs had been abandoned as a bathing resource in 1978 (although not touristically or respect of their mineral waters), the Bath spa project was launched by the City Council in 1997 in order to restore bath to the leading spa town of England, with the expectation that the project would stimulate the revival of spa culture in the UK.
The hew spa facilities in Bath are just a short distance from the original Roman bath site and they used natural hot spring water drawn from the same springs that have served visitors for at least the last two thousand years. The new facilities are designed to offer relaxing and extended therapeutic treatments. Although they will not act as a cure for serious illness they will act as a cure for the human spirit, as outline in reference to the conservation statement for the adjacent Roman Baths (Clews, 2000).
In countries such as Hungary the change from centuries of thermal bathing culture to modern wellness facilities has been slower than in countries without a history of hot or mineral hot springs. In Budapest the increase use of day spas builds on the ancient way of relieving stress and physical ailments through hot water treatment, and day spas and wellness facilities are now being established in a society that is becoming more conscious of the importance of healthy lifestyle (LaForest, 2004).
In Budapest the locals congregate in public thermal baths such as the Szechenvi to relax, swim and take many of the cures and treatment on offer. They are also known for taking the national pastime of playing chess into thermal pools (The age, 2005). And further to the east in Russia the Soviet era thermal baths were an integral part of the national health system. In Europe Austria was one of the first countries to adopt the more recent concept of wellness and to act upon quickly.
The country affectively appeals to key tourist target groups by positioning itself to offer wellness treatments that unite the body, spirit, personal desire, culture, and natural resources embodied by the spring (Nahrstedt, 2002). Australia has an unmatched infrastructure when it comes to wellness holidays and health-related tourism, and was ranked number one in the world for quality of life and its healthcare services in the early 2000s (Garalli, 2002).
According to Nahrsetedt (2002) Austria boasts an intact natural environment in conjunction with its wellness spas, an association that is also very popular in the Japanese tourist market. In Japan itself though, with literally thousands of geothermal springs and the Japanese preference for authentic and unadulterated hot spring water, wellness centres are not yet developed to quite the same extent, leaving the European style wellness facility as a potential favorite for the Japanese while on holiday.
In Japan, in tradition hot springs have been developed into days spas known as kuahausu derived from the German word kurhaus, providing separates bathing areas for men and women with thermal mineral pools at different temperatures, a cold pool area with fountains and waterslides, bowling alleys, gyms, saunas and steam rooms, massage services, restaurants and bars, relaxation rooms, music rooms, and video games (Altman, 2000: 07). But the main bathing attractions are the traditional hot springs called Onsen.
Often used by groups of people who enjoy sharing a bath after leaving the world of corporate work behind? As well as families and couples, a trip to an Onsen is classed as the ultimate bonding experience because all are equal once they shed their designer clothes and other status symbols. The captain of Iceland, Reykjavik, has been designated on official spa city by the European Spa Association (Iceland Express, 2006). This seems well deserved a quite logical, because the Icelanders have many facilities where they can take care of their health, well-being and leisure.
Several active Volcanoes and high temperature geothermal field provide natural hot springs all over Iceland and most towns have at least one public geothermal swimming pool. The Health and Wellness Spa Industry Having said that, rising customer expectations concerning health and wellness are the foundation in which the modern health and wellness spa industry is building an ever-increasing supply of facilities for the medical and general (wellness) visitor, to the extent that this form of tourism is now worth in excess of 250 billion US dollars per year and attract some 150 billion active spa-goers world-wide (ISPA, 2007).
Caution is needed here though, because for example these figures are said to include 19. 1 million Japanese spa-goers. Japanese data (Beppu International Tourism Office, 2007) suggest that there are over 150 million Onsen users alone in that country (Chapter 9). This discrepancy would appear to relate to the varying definitions of wellness and spa use that were discussed earlier, where the Japanese tradition is more about simply bathing in hot water than about the American tradition of beauty spa that underlies the research undertaken by the International Spa Association.
As a result of this, many Japanese users may not be counted if the data are concentrating on analyzing the spa experience rather than the totality of health and wellness tourism based on the use of hot and mineral springs. The trend toward indulgence in a relaxing environment, which began after World War II (Foster & Keller, 2008), has thus turned into a global movement but one that is a significant departure from the original concept of health spa that mainly specialized in rehabilitation of recovering from illness and injury.
The new emphasis lies in prevention of disease and maintenance of good health more that cure, with high expectations regarding health improvement even if there are no particular health problems. Along with the body, mind and soul are also catered for in many spas in a holistic approach of creating harmony for those in need.
This often includes new-age treatments as well as the more traditional water-based therapy. The key element in all such facilities is water. Be it apart of the natural landscape surrounding a facility (ocean, rivers, lake and waterfalls), decoration in the background (pools, fountains) or an active treatment component, water is a very important element in the world of spas and wellness.
More and more spas without a natural hot springs are investigating the possibility if tapping into mineral geothermal water resources to enhance their business. The trend towards natural looking environments or setting is also evident in many spa hotels and resorts where swimming pools and thermal bathing facilities are designed and built to looks are natural as possible, with rock pools the most typical and widespread design.
The development of these spa and wellness water resources can be divided into two broad types: Hot spring: These are usually well known and general appreciated for their curative value and their therapeutic benefits based on both water temperature and mineral content; Mineral springs: These can be cold or warm water from a nature spring, with curative value based on the type and concentration of minerals in the water. Often, the water can be taken internally too and is bottled and distributed (Cooper, P. nd Cooper, M. , 2009). Current International Trends in Spa and Wellness Tourism The trends of indulging in a relaxing environment has turned into a global movement but one with a significant difference from the original concept of health and natural hot and mineral spring spas, which mainly specialized in rehabilitation. The new emphasis lies in the prevention of disease and in the maintenance of good health instead of cures, with high expectation regarding health improvements even if there are no specific problems.
Mind and soul are usually catered for long with the body in many spas using holistic approach of creating harmony for those in need, including new-age treatments as well as the more traditional rehabilitative therapies. The main center of attention at present appears to be a natural healing method incorporating Asian treatments accompanied by the esthetic appeal of Eastern lifestyles and culture, which are in great demand. Therapies of Asia origin are often combined with European balneotherapy and hydrotherapy as well as sport and fitness facilities to offer diversity of options in order to attract as many customers and client as possible.
Nearly all spas cater for aspects with special signature treatments to ensure that there are no missed opportunities (Cooper, P. and Cooper, M. , 2009). Characteristics of Spa Tourists Traditionally it has been women who have primarily used spas. However, a consumer research conducted by ISPA in 2003 determined that 29% of spa tourists around the world are men; this figure rose to 30% in 2004. As men continue to represent a significant proportion of the spa market, more spas are offering special treatments for them and men-only spas continue to open in cities around the world (Grihault, 2007; Mintel, 2005; Messerli and Oyama, 2004).
The Baby Boomer generation (45-60 years old) continues to be the core consumer base for the global spa tourism industry. According to Haden (2007) industry analysts have long known that health conscious Baby Boomers have been the main driving force behind the worldwide boom in the spa industry. However, some argue the appeal of the industry reaches a larger age-range; Swarbrooke (2000: p 78-79) claims that most visitors to spa sites are in the social classes A, B and C1 and are between 30 and 65 years of age.
Mintel (2005) have a similar view, claiming it is the 25-64 year old market who dominate the customer base for spas; this group tends not to be at the family life stage, and their members are as likely to be male as female. The average age of visitors to spas is currently 49 years (ETC, 2002). Yet Hudson (2003) argues that by 2050, 20 percent of the world’s population will be sixty years or older; and by 2150, this figure will increase to over 30percent. These claims seem dramatic; however it is clear from all the statistics available that the population is aging and that this trend is set to continue.
Latest research by International Database, US Census in 2007 confirms these figures and shows the number of people aged over 55 years is projected to reach 2. 6 billion or approximately 27. 7% of the world?s population by 2050. Thus, the number of individuals aged 55 and over is forecast to grow at a rate of about 4% per year over the next 43 years (Haden, 2007). According to a survey carried out by the British Market Research Bureau (BMRB), 70. 8% of those aged over 45 years had been on holiday in 2006, compared to 64. 9% of the general UK population.
A Mintel study of US travellers in 2005 revealed that those over 55 years are more inclined to take holidays lasting five days or longer. Maintaining health in retirement has become a top priority. In a 2006 study of US health and fitness clubs in May 2006, Mintel found that those aged over 55 years were far more likely to participate in some form of strenuous exercise five or more times a week than other segments of the population (Haden, 2007). If such predictions are dealt with wisely, the outlook for the industry appears to be positive; it will help to drive tourism’s growth in general and health-related travel in particular.
Taking this into consideration, such a shift will clearly have substantial implications for the international health and spa tourism industry. Research Literature Health spas had their origin in Europe and many resorts had name that were associated with spas. The popularity of mineral springs carried over to Northern America and the springs were the location of some of the earlier resort. It is important to differentiate between spa hotels and resort spas. Spas hotels cater only to spa clientele and all guests must participate in the meals, treatment and exercises.
On the other hand, resorts spas are amenities that are available to the guest, and charges are made for the various usage of spa (Liguori, S. and Gray, W. ). Administration of spa hotels heavily involves people with a medical background, whereas resort spas are merely operating departments of the resorts. Exercises-oriented facilities are swimming pools, tennis court, handball and racquetball courts, jogging trails, hiking and weight and aerobic training. Spa program include dietary program, massage, herbal wraps, exfoliation, that also therapy, facial and hydrotherapy.
Under both scenarios, staffing involves people experienced in the program and administrative personnel. Ways for boosting revenue The method presented in the previous section illustrated the overall contribution of resort spas to resort revenue, in order to offer more insight into how spa managers can increase their spa revenue, the author of this study conducted to an interview with a spa director of one of the leading resorts spa in Southwest Florida. The director state that resorts should first focus on guest experience to increase their sales.
In that director’s case, she mentioned that her resort was able to increase the incremental spending from $658 to $985 per night by packaging spa and other activities together. The director also stated that pre-arrival process is a critical component for revenue maximization. She offered a case as an example where she use a system called “power booking” in which a spa front desk agent was calling guest two to three days to prior to the spa reservation date and providing the opportunity for upgrades and additional bookings base on availability (Rutherford, D. and O’Fallon, M. 2011). According to O’Fallon M. and Rutherford D. (2011) stated that spas are booming such a significant component of the service menu for resorts and full service hotels that their absence, especially in amenity- rich resort environment, is glaring obvious.
Within the leisure industries in 2003, revenues related to spas ranked number four behind golf fees and dues ($19. 7 million0, cruise lines revenues ($14. 7 million), and health club revenues ($14. 1 million). At $11. 2 million, spa revenues outpaced amusement park revenues ($10. 3 million), box office receipts ($9. million), and vacation ownership sales ($5. 5 million (Thacker, 2004; Audi and Wright, 2004). In this section, we first examine trends that support a sea change in North Americans’ attitude toward spa demand demographics; we discuss the type of spas currently popular in the industry, development and operational considerations, the components of a spa experience, compensation issues, and trends in the spa industry. Spa demand According to the International SPA Associations research, between 2002 and 2003, 11% of the national population over the age of 16 made one or more spa visits.
This statistics shows that in xten Americans visited a spa during that period. Additionally, of these, 41% were visiting spas for the first time, indicating a larger population embracing spa usage. Age demographics show that 145% of clients are between the ages of 16 and 24, and over 50% are in the 24 to 44 age bracket. An emerging national statistics is the number of male visits to spas. 23% of spa visits and 29% of spa goers were men in 2003, trending toward special gender oriented treatments and male- only spas being opened worldwide. Spa selection criteria are determined by a number of factors.
An established and known environment for instance, as part of an established resort, club or destination spa often influences the decision, and does atmosphere, quality of treatment, and friendliness of staff. Additionally, among spa goers nine out of ten respondents report they would return for a similar experience. Most spa customers believe they receive good value for their spa dollar. On a 10 point scale, services were given an average of 8 for value; with massage generating 8. 8 on the value such as Canyon Ranch are opening in the day spa market, adding new competitive pressure on the independents.
Non-traditional players are also adding product supply. For example, corporations are creating in house spa environments, hospitals are adding wellness as part of their repertoire, and medi-spas, with a primary focus on cosmetic surgery, are adding spa business as an additional profit center. Health club are also trying to capture a piece of the pie by adding spa practices. The rationale in this market is that time-crunched patrons can benefit from the one-stop-shopping approached to fitness and wellness but the health club operator also uses the spa as an enticement to join the fitness centre.
As the day and destination spa markets become saturated, it will become imperative for survival that each operator differentiate itself from the competition. The necessity for market segmentation to ensure clear communication with consumers will be a key to success in the maturing spa market. Another component of success will be a branding strategy that the consumer can immediately identify with respect to spa performance and the consumers personal comfort travel (Rutherford & O’Fallon 2011).
Health Issues and Spa Demand. Increasingly, spa goers are looking to create prolonged wellness that integrates and renews body, mind and spirit. To that end, Eastern and Western lifestyle issues related to medicine, philosophy, and spiritual are becoming a mainstay of many spa/wellness experiences. To best deliver this, the wellness spa (located at day, destination, or resort environment) supports guest’ needs by creating an experience, not just a series of treatments. All the guest amenities, treatments, and programs must be seamlessly integrated into a personally tailored guest experience.
This experience should be targeted toward couples, parents with children, and teenagers. In the early 1990, spa were considered a natural outgrowth of fitness facilities and focused primarily on treatments related to body wellness. As market sophistication evolved, the body mind connection attracted consumer focus. In the beginning of the twenty- first century, spas and marketers are overtly addressing body, mind, and spirit connections in order to respond to emerging market sensibilities (Rutherford & O’Fallon 2011).
Spas as an Operating Department. Historically, spa operations were treated by management similarly to other revenue departments, like catering and restaurants. These departments were simply perceived as an amenity needed to attract guest to the hotel. As long as the department broke even, or didn’t lose too much money, their ability to increase occupancy was deemed sufficient justification for their existence. However, in the late 1990’s, hotel spa followed the path of other operating departments and were transformed from support to profit centres. This trend is strong and continues today (Rutherford & O’Fallon 2011).
Spa Trends: On site industry trends Anti-aging treatments and products are driving much of spa menu and retail development. This calls for devoting a treatments room to outpatient medical procedures. Programming and spa menu items include sun damage treatments, chemical skin for renewals, and other rejuvenation techniques that build on repeat procedures. Commensurately, spas are developing retail product lines so that clients can take the spa experience home and continue the wellness regime. Global Industry trends Trends in day, destinations and amenity spas influence each other.
According to Susan Ellis (2004), president of Spa Finder, a spa marketing company, after the rise of the medical spa and broadening spa participations by men and teens, spa use is expected to become more popular in the future. Spa Finder’s trends to watch for are: those personal elements that make the spa experience special will find their way into the design of personal living spaces in private homes; private, gated living communities will develop around central spa facilities, much like golf and sly-in communities.
Managing visitor’s expectation and experience. Visitor’s expectation of a wellness centre or spa will differ greatly according to which country they come from, their language and their experience of wellness facilities generally. For example, the British or Americans would have a very different understanding of what they would expect to find in spa (i. e. luxury, pampering, and beauty) from a Central or Eastern European (i. e. healing waters, physical health checks, and medical treatments). Information provision and marketing is therefore extremely important in managing visitor expectation.
In some cultures, nudity in spa is the norm or even a requirement in some areas (e. g. suanas and steam rooms). This is true of Austria, Germany and some spas in CEE and Scandinavia. However, for some visitors (e. g. American, British, Asians, and Southern Europeans) this can be unexpected and even embarrassing. In some cultures (e. g. Finland and Japan) men are separate from women when using sauna or spa facilities. In other cultures, mixed nudity is accepted. Some nationalities are used to doing activities in groups and are not used to enforced silence (e. . Southern European). This can create a certain amount of tension in countries, where spas and wellness centers are seen as quiet, restful, sometimes even spiritual spaces (especially in sauna and steam rooms) Help may also be needed to guide visitors around spas, as it could be their first visit or rituals and traditions may differ from those in their home country. Language may be a barrier where there is little or no translation, especially in countries where language can seem completely unfamiliar (e. g. Finland, Japan, and China).
Visitors sometimes have problems knowing which entrance to use if there is more than one, which ticket to buy when there are many options, and might not understand the cloakroom system (e. g. in Hungary, where a cloakroom attendant usually has to be approached for a locker and key) or the new technology (e. g. in Austria when the locker system can be operate using a wristband). Knowing just how long to stay in medical, mineral or thermal waters is not clear to the inexperienced. Even if 20min is the recommended time, bathers need to know how long to rest or whether they should go to a cool shower after.
Just a small information panel outside a bath, sauna or steam room can be enough to inform visitors, what the recommended length of time should be. (Smith & Puczko 2009). Atmosphere Creating a relaxing, clean, and pleasant environment is a paramount importance for all wellness facilities, but most especially for spas and spa or wellness hotels, which may also need a touch of luxury (spiritual or holistic tourist may accept more basic facilities). The use of design, colour, lightning, and location of furniture, degree of natural light, greenery, views, music or scents can all contribute to creating a harmonious atmosphere.
Certainly, most of these qualities are determined during the planning process. The management may face difficulties when the services and/ or the surrounding environment do not support or accompany each other. These mismatches certainly result in sub-optimal satisfaction and consequently lower the optimal revenue level 9 (Puczko & Smith 2009). Spa Tourism Spa tourism is arguably the best known form of wellness tourism and is sometimes treated as being synonymous with wellness tourism.
ISPA (2007) defines spa as ‘places devoted to enhancing overall well-being through a variety of professional services that encourage the renewal of mind, body and spirit’. ISPA also defines the key elements of the spa experience: relax; reflect; revitalize; and rejoice. It is difficult to distinguish between spas and more general forms of wellness (e. g. holistic retreats); however, it also shows clearly the diversity of the spa sector. There are now numerous sub-sectors within spa tourism and it is no longer enough simply to use the label ‘spa’ and assume that tourist will know what to expect.
Perceptions differ greatly, for example, tourist in Central and Eastern Europe are very similar with the concept of historic medical spas, whereas other visitors (e. g. from the United States or United Kingdom) with expect something similar to a beauty salon. Spa are now of a highly complex and diverse nature. This diverse nature starts with the name and its likely meanings. Bath, bano, bad, therme/ terme, grotto, spa, kupele, furdo – all mean a thermal water-based spa, in various languages. The translation of the name from the original language often uses the term ‘spa’, but these establishments are not really always spa.
Spas may differ widely in terms of what they offer, that is their services or treatment supply, and however, they have one thing in common, which is the aspiration to improve health and well-being. Most spas have some form of water-based treatments; however there is a difference between mineral, thermal, and healing waters: mineral waters; it has at least the set amount of dissolved mineral content which is minimum 500mg/1 or 1000mg/1; thermal waters: natural waters that are at least 30 C or 32 C at source (this can vary country by country); healing waters; the healing affects have to be proven, that is evidence-based.
The International Spa Association (ISPA, 2007) has defined the ‘ten domains of SPA’ or segments of the industry as: the waters; food, nourishment, diet, and nutrition; movement, exercise, and fitness; touch, massage, and body work; mind/body/spirit; aesthetics, skin care, natural beauty agents; physical space, climatology, global ecology; social/cultural arts and values, spa culture; management, marketing and operations; time, rhythm, and cycles.
Not every spa contains every domain. The rejuvenation of the spa concept has generated several attempts to categorize spas. Since the modern concept of spas were established in the United States, one of the most comprehensive categorizations comes from the International Spa Associations (ISPA, 2007 and the Spafinder Magazine, 2007): club spa; day spa; spa hotel; holistic spa; medical spa; bath; resort spa; sport spa and structured spa.