# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### Study Aim 2
#### Women's Group PA Behaviour  
Reasons to engage in Group PA  
The focus group began with participants being asked to consider factors which contribute to group PA being their preferred mode of exercise to gain insight into urinary incontinence and women's motivations for attending group PA classes. Participants unanimously cited enjoyment as their primary motive for participation. For one non-exercising participant in particular, the intervention reminded her of why she had \"loved', and now missed, attending group exercise classes:  
_\"You might not go and make your best friends in life, but you will go and have a good time with women having a laugh and embarrassing yourself like we just did. I had a blast! And I haven't had a blast like, I want to cry, I haven't had a blast like that in ages.\"_  
The link between enjoyment and motivation is well evidenced in the literature with many studies reporting higher rates of motivation to exercise and long-term PA adherence when individuals perceive the PA mode as enjoyable [31]. [PERSON] et al. [74] recorded a high number of participants in their study, who maintained a steady amount of exercise 6 months after their initial assessment, attributing it to high levels of perceived enjoyment measured; however, enjoyment alone may not be enough to encourage women to go back to group PA or to ensure that women continue with group PA after experiencing UI, and in the current study, the older participants appeared to equally value the social opportunity group PA provided, suggesting it may be a possible facilitator to enjoyment:  
_\"I think sometimes when you go into group things, it isn't really about what you're doing. It's about the people that you're with that makes it fun.\"_  
The importance of social opportunities for midlife women is rarely included in loneliness or social exclusion studies; however, we know that women in this life stage often report having little time to participate in PA due mainly to caregiving responsibilities [10], ignoring their own needs in favour of managing the needs of others [75]. [PERSON] et al. [38] suggest that such caregiving also leads to feelings of social exclusion rather than loneliness and that providing opportunities to socialise can help positively influence those feelings in midlife adults. Therefore, it seems appropriate to prioritise group-type exercise when promoting PA to women to maximise feelings of social inclusion and reduce psychological distress; however, given that social isolation can increase when women withdraw from group PA due to UI [54], successfully promoting social inclusion and enjoyment may be difficult without first understanding the exact factors that UI impacts and lead to women's group PA withdrawal. Reasons to Withdraw from Group PA  
Participants discussed their enjoyment of dance-based group PA, in particular, and this appeared to be the most common mode of group-based PA, with five out of the six participants preferring this specific method over any other form of exercise. Despite their strong preference, all except one of the participants were not currently participating in dance-based PA:  
_\"Absolutely anything with music and I love it...but I stopped because there was a lot of younger girls there and I just felt 'oh God! I'm going to wet myself!\" So, I ended up not going and I did other things, but I would like to be able to go back to that, or a modified version of that.\"_  
All six participants reported a fear of leaking in front of others to be the main reason for their withdrawal from group PA. Withdrawal from general PA due to the stigma, embarrassment, or fear of leaking in front of others is well-cited in the literature [6; 24; 76]; however, as this participant demonstrates, the threat of leaking in front of younger women seems to be particularly troublesome for the midlife women in this study. A multi-billion-dollar industry has developed around anti-ageing as society tells older women they are undesirable and ugly [77] and that youthfulness equals attractiveness [78].