# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion  
### Study Aim 1  
The study's first aim was to determine whether a 'pelvic-floor friendly' group exercise class could influence the motivation or intent of women with UI to encourage women's (re)engagement in PA. To do this, PA behaviours were measured pre- and post-intervention using the UI-modified and HAPA questionnaire, with the average HAPA construct subscale scores calculated for both the intervention and control group at baseline and follow-up (Table 3). Non-significant improvements in all HAPA constructs were observed in the intervention group post-intervention, except for the constructs of Outcome Expectancy-UI (OEUI) and action planning (AP), which resulted in significant positive changes. Intriguingly, action self-efficacy (ASE) scores for the intervention group significantly decreased from baseline to follow-up; although not significantly different, the ASE scores were also higher at baseline for the control group. These ironic effects may have come about due to the participants having unusually high baseline scores, particularly the intervention group. The groups may not have fully understood the constructs being measured until they learned about what they were (i.e., in the intervention). As noted below, action planning was found to be significantly different at follow-up for the intervention group. According to the tenets of HAPA, action self-efficacy contributes to action planning, and this would  
Figure 2: Deductive and inductive themes. Note. PA = physical activity; UI = urinary incontinence; PFE = pelvic floor exercises. further suggest that the baseline action self-efficacy scores were ironic [71]. The control group showed minor changes in all constructs, but none were statistically significant, and there were no significant differences between groups. Outcome expectancies are predominantly viewed as important in the motivation stage of HAPA where individuals consider the pros and cons of participating in PA [62]. Our addition of the OEUI construct specifically added for predicting PA behaviours in women who experience UI is equally important in the motivation stage where participants anticipate the specific consequence of leaking urine if they were to undertake PA When comparing the pre-intervention scores for both constructs in the present study, it was noted that the OE of PA participation in both the intervention and control groups was viewed more negatively when the participants were asked to consider UI, specifically as an outcome of undertaking PA, as they were for OEUI. Previous research suggests that women omit considerations of UI symptoms during PA (even when UI is severe) unless they are explicitly requested to do so, and this behaviour may account for the more negative results recorded in OEUI when compared to OE. This view is corroborated when analysing individual responses where all participants (except one) from both groups responded with a maximum score (\({}^{7}\)) to at least one of the items measuring OEUI at baseline, whilst only two participants in total included a maximum score for items measuring general OE. Post-intervention, the positive change in OEUI was significant within the intervention group only, suggesting the factors implemented in the intervention, which aimed to reduce the chance of experiencing UI during PA participation, may have positively influenced the perceived outcomes of being physically active where leaking urine is a possibility for women. Simply, participating in the group PA intervention may have provided the female participants with some degree of confidence, and it is possible to undertake PA without the risk of leaking; thus, the post-intervention measure of OEUI yielded a significant improvement in the intervention group. According to the principles of HAPA, while outcome expectancies are important, they do not work in isolation to predict behavioural intention; ASE also has an influential role.