# 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
To the best of the researcher's knowledge, this is the first time the volume of adaptations required has been reported as a barrier to participation, as no corroborating literature could be found; however, exercise adaptation, in general, is a commonly reported strategy utilised to help avoid leaking during PA and to maintain PA participation by reducing the exercise intensity, impact or changing the exercise type [84]. The final reason for group withdrawal, which the women discussed was, worsening UI symptoms. As women age, UI can progressively worsen [85] leading women to worry about their long-term health outcomes:  
_\"It's progressively getting worse, and I think to myself now, it's going to get to a point where well, already I've not gone to workouts because there's skipping in the program and if this keeps getting worse, I'm not going to be able to do it anymore and that's really going to impact my mental health.\"_  
The participant talks as if worsening symptoms are almost inevitable, which corresponds with women's perceptions of UI and ageing previously reported in the literature. For example, [PERSON] et al. [83] found UI was viewed as a normal part of ageing by over two-thirds of Canadian women, and this assumption had not changed over the past decade,despite public health campaigns and increased treatment awareness, suggesting health education is either failing in its messaging or additional factors require addressing. Already, the participant is avoiding PA classes where particular exercises are programmed despite reporting a relatively low ICIQ-SF severity score, and, despite her younger age (36 years old), the participant indicates concern over worsening UI symptoms and the impact the resulting reduction in her preferred PA mode will have on her mental health. Given that women experience poorer mental health than men across their lifespan, including higher rates of depression and anxiety [86], the potential for the withdrawal from favoured modes of PA to exacerbate mental health decline is concerning and would seem worthy of further investigation. Reasons to Continue Engaging in Group PA  
Despite most intervention group members reporting UI as a reason they withdrew from group PA, and the motivations expressed for preferring this mode of exercise seemingly doing little to counteract that outcome, two participants continued regularly attending group PA classes. Both participants reported exceeding the current WHO physical activity guidelines, and the HAPA-FUIQ measurements indicate both are at least moderately motivated to be physically active; however, it should be noted that both also reported their UI bothered them \"a little\" and they reported the lowest UI severity in the group. A correlation between UI severity and PA participation levels has been reported in the literature [87], and it is therefore possible the presence of all these factors may indicate these participants are predisposed to continue their preferred mode of PA and less likely to find their UI unmanageable during exercise. Despite this, it seems important to understand, in women's own words, their perceptions of what drives them to continue participating in group PA, despite leaking urine whilst doing so. As previously discussed, the social aspect of group PA is particularly coveted by all women in the focus group and is a reason for group participation.