# 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  
Exercising with Women of a Similar Age  
Next, participants were asked about any differences they had observed between previously attended group classes and the intervention class recently undertaken--none of the design changes made in the intervention class were explicitly mentioned by the researcher. Several women were aware of being in the intervention with women of similar age to themselves and that this was unusual as so many classes they thought they would enjoy were seen to be mainly advertised to younger women. These classes were then interpreted as being both high-intensity and high-impact and beyond what the women felt their pelvic floor could cope with. When discussing the high-intensity levels, there was a general feeling of the midlife group member's needs being ignored, particularly by group instructors who rarely seemed to consider the specific adjustments midlife women might need when programming high-impact exercises, though one participant thought instructors might be aware midlife women are more likely to be unable to undertake some exercises, they chose to ignore their needs in favour of the younger members of the class:  
_\"Part of their brain is maybe aware that if they're got perhaps slightly older women in the class, they should be more careful, but actually that all just get swept aside in the 'well, I've got lots of 19/20-year-olds, so we'll just cater to those people and the older people will just have to pretend they've got bad knees'._  
Most women seemed to feel that they were simply left to find a way to cope with UI themselves during group PA. Almost all the women felt they had tried to maintain their participation in group PA by adapting exercises in the class to avoid the risk of leaking;however, few in the focus group felt they had the knowledge to do this without worrying if their adaptations were safe. With no support being given from the class instructors, the women felt they had no choice but to \"pretend they've got bad knees\" to save their embarrassment at not being able to do certain exercises due to the impact on their pelvic floor. One participant felt that not being able to undertake the same exercises as the younger women in their exercise class was embarrassing, even if their inability is disguised through feigning injury:  
_\"Normally you will see all these younger people and you're the only one that is walking, and you know, it's like everybody can see you as if you wore fluorescent clothes!\"_  
Feeling as if you stand out due to leaking, whether you are seen to be wet or not, is a common feeling for women with UI and often leads women to try and hide their symptoms to avoid stigma [55,94]. When a stigmatised condition is revealed to others, it can result in the rejection of the individual from that social setting [95] and worry over the risk of discovery of an as-yet-undiscovered stigmatised condition, such as UI, can lead to psychological distress [94,96]. For women trying to hide their UI in a group PA setting, worry over others finding out about their UI can result in a loss of enjoyment and, ultimately, withdrawal from group PA.  
Rather than withdrawing from group PA altogether, several women tried to remain participatory by seeking out classes aimed at older women, as these were assumed to be of lower intensity and, therefore, lower impact, and subsequently, more pelvic-floor friendly:  
_\"I find that I'm going along to 'old lady' classes because I know I'm not going to affront myself, but then you come out of there and you're like, 'well, it's been nice and you've had a nice chat and had a bit of exercise', but you can't do anything hardcore, really.\"_  
As discussed previously, there is an assumption that exercising with older ladies is'safer' if you expect to leak during the class and as such, the risk of being stigmatised because of UI is lower. However, several women felt that attending lower-intensity classes aimed at older women also reduced their enjoyment somewhat.