# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### General Discussion  
This study sought to understand the experiences of group PA by women with UI and to demonstrate whether a group exercise class designed to be 'pelvic-floor friendly' could help increase PA participation levels of women with UI. Using a combination of quantitative and qualitative methods, the findings suggest that by adjusting group PA class design elements to better meet the needs of women with UI during exercise, women could be encouraged to re-engage in group PA.  
By applying the HAPA-FUIQ measure, it was found that the study intervention created non-significant positive change in all HAPA constructs except ASE, and significant positive change in OEUI and AP. The intervention's influence on ASE was undetermined due to recruitment methods; however, intention (measured by BI) positively improved, albeit non-significantly, suggesting the intervention created positive change in women with UI's intention to participate in PA. Significant positive change in AP suggests the intervention positively influenced motivation to exercise, as planning where, when, and how to do PA is less likely without motivation. Regarding aim 1, a 'pelvic-floor friendly' group exercise intervention can influence the intent and motivation to participate in PA, of women with UI. Aim 2 explored the perceptions and feelings of women with UI to the design elements of the 'pelvic-floor friendly' group exercise intervention, including the addition of access to a women's specialist pelvic health physiotherapist, with emphasis on self-efficacy in PA. Little was known before the current study, about women with UI's group PA behaviours. Participants reported their primary motivators for attending group PA were enjoyment and the social opportunity exercising with others afforded. Many participants valued the chance to socialise due to their busy schedule, and the time-saving aspect of group PA was a key motivator. Understanding this may benefit PA promotion to women by emphasising the efficiency of group PA in raising PA levels. In accordance with the limited literature, it was found the main reasons women withdrew from group PA once they experienced UI was because of the embarrassment of leaking in front of others and worsening UI symptoms. It was somewhat of a surprise to also find that the volume of exercise adaptions required by women to help avoid leaking was cited as a factor for withdrawal. To the best of the researchers' knowledge, this is the first time this barrier to women's PA participation has been reported, however further research is needed to understand the specific exercises which negatively impact UI and which provide a suitable alternative. Exploring this further could lead to more effective alternative exercises being incorporated into group PA class design, potentially helping women remain active in their favoured PA class after UI onset, which in turn, may improve motivation and long-term PA adherence. It is acknowledged that some women continue to engage in group PA despite experiencing UI, and this study found feelings of obligation towards others in the group, as well as perceiving set classes as an excuse to make time for'self', were primary reasons for this behaviour. The latter was overwhelmingly cited as a motivator by midlife women with caring and work responsibilities. PA practitioners may be able to use the lure of 'time to self' to encourage busy midlife women to engage in PA long-term and by also facilitating the fostering of friendships within the group PA environment, perhaps the obligation to others that motivates those with long-term adherence, can also be utilised. Understanding why group PA was often withdrawn from once UI was experienced by midlife women was an important area to explore. It was clear there was a failure to consider midlife women's needs in promoting, planning, and designing of group PA. Participants felt most classes in their community catered toward younger women, meaning the exercises were high intensity and high impact, both presenting an unacceptable risk of leaking.