# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### Study Aim 3
#### 3.3.1 Women's Group PA Behaviour (Additional Understanding)  
Reasons to engage in Group PA  
Like the findings from the focus group, the social aspect of group PA was the major motivating factor for survey participants engaging in group PA:  
_\"I like being able to participate and spend social time with my friends while improving my health at the same time.\" In addition, some women felt motivated by seeing others push themselves: \"I love the motivation and seeing everyone else push to do better. I dislike the embarrassing aspects of leaking.\"_  
However, the negative impacts of UI on group PA engagement were much more obvious in the online survey than in the focus group with several participants commenting, as the participant above, that they were embarrassed due to leaking and worrying about other class members judging them. As previously discussed, embarrassment due to UI is commonly reported in the literature but women can feel judged due to a range of factors in the PA environment. In the focus group, judgement due to leaking and body image was discussed, but participants also worried about being judged for prioritising themselves and not their families, a phenomenon confirmed by the literature [100]. The guilt that can form when women feel they are prioritising their own health needs over that of their family may be a difficult obstacle for PA promotion to overcome, especially where midlife women with multiple caring responsibilities are being targeted. Being able to offer women a time-effective option that meets many of their health and well-being needs, may help women reconcile these feelings of guilt and judgement. The Impact of UI on Women's Willingness to Engage in Group PA  
Only one woman out of the 15 participants felt her willingness to participate in group PA was not affected by UI. In corroboration with focus group findings, many of the control group women's responses centred around avoiding specific exercises or modes of PA:  
_\"Didn't affect it for Pilates but it's one of the things stopping me from doing a boot camp or HIIT class as I know I'd have to go to the toilet if there were any running/jumping moves.\"_  
This supports the need to devise specialist PA interventions, which avoid the kind of exercises which may result in women experiencing UI, as already discussed earlier. However, for the first time in this study, pad use was reported as a specific reason to withdraw from group PA:  
_\"I avoid indoor classes where it might be obvious or visible that I'm wearing a pad. I'm willing to join a running group which feels more discreet.\"_  
The participant infers that indoor group PA classes force participants into closer proximity with each other and this makes her uncomfortable due to worrying that other group members will be able to see that she is wearing a pad to manage leaks. As a result, the participant has changed her preferred mode of PA and chosen an outdoor group which allows for increased personal space between group members. Such a group also allows for clothing to be worn around the waist or at a longer length which can help hide bulky pads, something which would look odd and draw attention in an indoor group class. It has long been established that women in the general population have reported that tight-fitting clothing, which is often associated with exercise, is a barrier to PA [118], particularly for those who do not fit the slim Western ideal body type. To manage low body confidence and to avoid the gaze of others, women will often choose to wear black clothing to blend in and disguise parts of the body they find especially uncomfortable to show [119]. The few contemporary UI studies looking at women's PA participation, which have included exercise clothing in their findings surmise that women may be more likely to continue engaging in PA despite UI symptoms if clothing is loose and dark, as these help to make light urine leaks and pad-use less noticeable [24; 120].