Group Classes Might Actually Have the Edge When It Comes to Pelvic Floor Muscle Training
For years, the assumption has been that 1-on-1 physiotherapy is the gold standard for pelvic floor muscle training — and group classes are the compromise. A 2025 analysis of a landmark trial suggests the story is more complicated, and more interesting, than that.
When a patient asks whether they should do individual sessions or join a group class for their stress urinary incontinence (SUI), most clinicians have defaulted to recommending 1-on-1, and for understandable reasons. There's the opportunity for personalised assessment, real-time correction of technique, and the reassurance of one-to-one attention.
But a growing body of evidence, culminating in the Hay-Smith et al 2024 Cochrane Review and a striking secondary analysis by Cacciari et al 2025, is challenging that assumption — and the finding most worth sitting with is not about outcomes at 12 weeks. It's about how quickly those outcomes are reached.
The established picture: 1-on-1vs. Group
The Cochrane Review is clear that, by the end of a supervised programme, there is consistent evidence of little to no di!erence in urinary incontinence outcomes between women receiving 1-on-1 supervision and those in a group setting.
This has been the known finding for some time, and it's clinically reassuring — it tells us group-delivered pelvic floor rehabilitation is not a lesser treatment. But it's also slightly unsatisfying, because it doesn't tell us anything about the journey to that endpoint.
"Nearly every study I have ever presented shows that by 12 weeks, there is no difference between group and 1-on-1 training. But that is because they don't assess until the end of the study."
That observation — from presenter Taryn Hallam, drawing on the Cacciari et al 2025 data — is where the real story begins.
The new finding: group supervision accelerates early results
The Cacciari et al 2025 analysis looked at something most trials don't bother to track: not just whether women achieved a meaningful reduction in leakage by the end of a 12-week programme, but when they achieved it — and what predicted getting there faster.
The minimum clinically important difference (MCID) was defined as a ≥50% reduction in urinary incontinence episodes. Across the total cohort:
46.9% had achieved their goal by week 3 of the programme
70.7% had achieved their goal by weeks 4–6
88.5% had achieved their goal by weeks 7–12
These are genuinely encouraging numbers. But the question the researchers then asked was: which factors predict who gets there early versus late?
FACTORS THAT SIGNIFICANTLY INFLUENCED HOW QUICKLY WOMEN REACHED THEIR GOAL
Four factors were found to significantly influence the time needed to achieve a ≥50% reduction in incontinence episodes. Three were clinical and somewhat expected:
Longer symptom duration slowed progress
More severe SUI slowed progress
Interestingly, having a stronger baseline pelvic floor also slowed progress — potentially suggesting that women with more room to improve respond faster.
But the fourth factor was the one that caught attention:
Attending group vs 1-on-1 supervision — women in group settings achieved their 50% reduction milestone significantly earlier than those in individual sessions.
Women attending group supervision were 71% more likely to reach their goal at any given time point than those receiving 1-on-1 training. They got there faster.
Why might group supervision accelerate results?
The research doesn't directly answer this, but several mechanisms are plausible and worth considering clinically.
Social accountability. Attending a group class at a fixed time, with the same cohort of women, creates an implicit commitment structure. It may also create subtle peer accountability — a reason to show up, engage, and do the work.
Motivational environment. Observing others progressing may be normalising and encouraging, particularly for women who feel isolated by or ashamed of their symptoms.
Frequency of reinforcement. Group programmes may involve more frequent repetition of the same cueing, explanation, and feedback — creating stronger motor learning through repetition in a way that a single weekly 1-on-1 session may not.
A Note on What Group Means Here
The Cochrane Review notes that some suggestion exists that being seen in person at the start of training may help, to confirm a correct voluntary pelvic floor muscle contraction. This doesn't contradict the group finding; it suggests that an initial assessment or technique check, followed by group-based programme delivery, may be a sensible model.
WHAT THIS MEANS FOR HOW WE TALK ABOUT GROUP EXERCISE
For physiotherapy practices offering group pelvic floor or clinical pilates programmes, this finding matters — not just clinically, but in how the value of group work is communicated to patients.
The historical framing has often been something like: "Group is a good option if 1-on-1 doesn't suit you, and the research shows it gets similar outcomes by the end." That framing positions group as an acceptable trade-off.
The emerging framing, consistent with the current evidence, is different: "Group-supervised training appears to help women reach their goals faster — and by 12 weeks, outcomes are equivalent regardless of supervision type."
Therefore, group isn't the consolation option. For many women, it may be the better one.
There are, of course, still appropriate indications for 1-on-1 sessions, such as:
Complex presentations
Technique difficulties
Women who need a high level of individual assessment
Those who simply prefer private settings
But as a default clinical recommendation, the evidence no longer supports framing group supervision as second-best.
One remaining caveat: It's still PFMT, not Pilates
A separate result from the same Cochrane Review is worth holding alongside this finding. The evidence clearly shows that direct pelvic floor muscle training — voluntary, conscious contraction — is superior to indirect approaches, where activation is hoped for as overflow from other exercises.
This means group exercise only carries these benefits if the group programme is delivering explicit, supervised PFMT — not simply a Pilates or core class where pelvic floor muscle activation isn't consciously cued.
The coordination training approach — voluntary PFM contraction integrated simultaneously with other movements, like bridging or plank, shows some early evidence of added benefit, and the Cochrane Review flags it as an area for urgent future research. But the foundational ingredient remains the same: the patient must be voluntarily activating their pelvic floor, not just hoping it happens.
Clinical Application Summary
Use PFM coordination exercises (PFMT during bridge, plank, etc.)
Perform PFMT most days of the week rather than only a few days
Consider group-supervised delivery as a valid first-line option, not a fallback
Ensure group programmes include explicit cueing for voluntary PFM activation throughout.
Bottom Line
The evidence no longer supports the assumption that 1-on-1 pelvic floor training is automatically superior to group delivery. Women in group supervision appear to reach meaningful clinical outcomes faster — and by 12 weeks, both approaches achieve comparable results for most patients. The conversation around group exercise as clinical pelvic floor rehabilitation deserves an update.
How Ivoryrose Can Help
The research is clear — group-supervised pelvic floor training is not a second-best option. For many women, it may be the most effective path to results. And at Ivoryrose, group-based pelvic floor rehabilitation is something we've always taken seriously.
Our studio and gym classes are delivered by our women's health practitioners and trained instructors who understand pelvic floor dysfunction from the inside out. Explicit pelvic floor cueing is woven into our sessions, which means you're getting exactly the kind of supervised PFMT the research points to as effective.
For women who can't make it to the clinic in person, we also offer supervised PFMT via Zoom — so you can access the same quality of group-based pelvic floor rehabilitation from home. Our online sessions are available following an initial clearance appointment with one of our physiotherapists, ensuring the programme is appropriate for where you are in your recovery.
Whether you're newly postpartum, managing long-standing leakage, or simply ready to take your pelvic floor health seriously — there's a path here for you.
Ready to get started? Book an initial assessment with our physio team, or explore our class timetable to find a session that works for you.
Sources:
Hay-Smith EJC et al. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2024 Dec 20;12(12):CD009508.
Cacciari LP, Morin M, Mayrand MH, Dumoulin C. Incontinence in Older Women: When to Expect Meaningful Leakage Reduction from Pelvic Floor Muscle Training. Int Urogynecol J. 2025 Dec 17. doi: 10.1007/s00192-025-05486-3.