# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### Study Aim 2
#### 3.2.2 A Failure to Consider Midlife Women's Needs
It also appeared to help with avoiding feeling pressured to perform, with the above-quoted participant suggesting she was able to undertake all exercises and moves in the class, which then helped her feel included and aided in avoiding the feelings of failure or judgement which often followed the need to adapt or withdraw from high-impact exercises. The participant who had totally withdrawn from all modes of PA due to UI was particularly exuberant about the reverse instruction method undertaken:  
_\"I think that it helped that the instruction wasn't that 'we are going to do it this way and we will all be watching if you don't do it'. The instruction was, 'We will all be doing it this way, but if you want to be stupid knock yourself out!\"._  
Being judged by others featured heavily throughout the focus group session, particularly in relation to the participants' previous experiences of requiring alternative exercises during group classes to ensure they remained dry. Few studies explore women's fear of judgement in the PA environment and how it impacts PA engagement; however, a recent study by [PERSON] et al. [100] found that fear of judgement resulted in women changing exercise mode, withdrawing from all exercise entirely or choosing to exercise alone. The study also reported that the participants' fear of judgement was most often related to how their bodies were judged and perceived by others, especially while moving during exercise [100]. Whether UI exacerbates body image fears and fears of being judged in the group PA environment is beyond the scope of the current study; however, a study by [PERSON] et al. [101] found as UI severity increased, body image perceptions were more negative, suggesting if the reverse instruction method can reduce feelings of judgement by providing women with the opportunity to participate at a similar impact/intensity as everyone else, women may be encouraged to stay participatory in group PA for longer. Future researchers may wish to explore this idea further. After commenting on midlife women's need to undertake alternative lower-impact exercises and those needs being largely ignored by group exercise instructors, the conversation turned toward the inconsiderate timings of suitable low-intensity classes:  
_\"Everything is either for younger women, or for older women because they are low impact...they're all at 10:00 AM when I'm working!\"_  
As before, the assumption is that classes perceived as for younger women are entirely unsuitable to the needs of midlife women who experience UI during PA and, considering women in this study and others have reported seeking out lower-impact group PA to manage their leaking and remain participatory in group exercise, it is disheartening that these types of class appear only available during the working day, further exacerbating the idea that they are only for 'older women' and midlife women's needs do not matter. Another participant voiced her annoyance at the lack of consideration of midlife women's working patterns:  
_\"I'm 55, so potentially still got 12 years to my retirement date. What happens in that time, when I'm working full-time? You can go to the stuff at night but that's all the 'let's lift each other up' type of stuff.\"_  
Participants appeared to understand that their long-term health depends on being physically active, but when there are no suitable classes available to achieve their goals, they are understandably frustrated, which may provide insight into why 50% of women reduce their PA levels during this life stage [75]. As with men, there are more women aged 35-49 years in work than in any other age group [102], and it would therefore seem logical to consider many midlife women's work patterns when designing PA interventions aimed at increasing their PA participation, and yet there appears little thought given to the needs of this demographic.