# 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
Many women develop body dissatisfaction as they grow older as a result, but while most studies in this area agree that body dissatisfaction is higher in women than in men, the evidence regarding ageing being an influential factor is mixed. For example, in studies looking at body dissatisfaction across the life course, older women have been reported as being more likely to dislike their body, particularly when experiencing poor health [79], and in studies including midlife women, they have been found to have higher body dissatisfaction, higher ageing anxiety and are more likely to participate in anti-ageing behaviours as a result [80]. However, others have reported ageing has little effect, with body dissatisfaction remaining stable across the lifespan [81]. Regardless of whether ageing increases body dissatisfaction, when the midlife woman experiences UI, body dissatisfaction may be intensified in the presence of younger women due to the negative stereotypes and stigma often associated with UI. For example, UI is often perceived as shameful and embarrassing, and of note is the assertion that UI represents the \"beginning of old age\" [82]. This stereotyping of UI as an 'old lady' condition may contribute to midlife women's fears of leaking in front of younger women during group PA due to the assumption younger women will view them as disgusting, old or incapable. However, perhaps somewhat surprisingly, it appears it is not only younger women whom midlife women fear leaking in front of in a group PA setting:  
_\"... it was brilliant, the social element, and even though it was full of women older than me when I started leaking, I stopped... and I can't exercise. I can't do anything. Can't do more than walk.\"_  
A fear of leaking in front of older women was mentioned explicitly by this participant only; however, the researcher observed other women nodding in agreement, though they declined to comment when prompted. Using the term \"even though\", suggests the participant feels UI is an older woman's condition and that it may be expected or more acceptable to experience UI in that age group--a view reflected in the literature [82, 83]. One may then expect midlife women who exercise in groups with older women to be more likely to continue group PA participation after experiencing UI during PA; however, the participant clearly states this was not the outcome of her experience, and she withdrew from group participation, and, indeed, all forms of PA except for walking. During pre-intervention testing, the participant reported her UI as bothering her the most out of all participants in the intervention group, and it may be that despite exercising with older women, she feels unable to manage her UI during any form of PA; this relationship between UI severity and PA levels is discussed later in this section. While two participants stated they withdrew from group PA immediately after experiencing UI, the remainder discussed the different strategies, whether successful or not, that they employed to try and maintain their PA participation. Exercise adaptations appeared as a common strategy, where exercisers can choose to undertake an alternative, often lower-impact exercise to the class norm, to help avoid predicted pain, discomfort, or, in this case, leaking urine. While exercise adaptations were appreciated by all participants, it appeared the number of adaptations required negatively impacted motivation to continue attending group classes:  
_\"It does put you off going. I would like to go to high-impact style classes... but I can't do that anymore because it would be too embarrassing, because I would have to adapt too many of the exercises.\"_  
Despite motivation and self-efficacy for exercise being high, and this participant exceeding current WHO PA guidelines, withdrawal from group PA still occurred, due to feeling embarrassed by the number of adaptations needed to avoid leaking during class.