# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### General Discussion
Whilst the efficacy of instructors being endorsed by a professional organisation due to attaining a particular level of training and understanding of UI was discussedin-depth, exactly what level of training should be included has not yet been explored and should be investigated in future studies. The final tasks relating to aim 2 were to explore participants' perceptions of access to a specialist women's pelvic health physiotherapist in the PA environment, as well as to give voice to additional support requirements needed to help participants manage UI in PA environments, and which participants felt had not been covered but would help them (re)engage in group PA. The physiotherapist who made herself available during the intervention and focus group had a particular set of skills, and with many participants raising these in the discussion, the researcher took the opportunity to investigate them further, namely the use of humour in promoting health advice in the PA environment. Whilst not planned, exploring humour yielded useful information for improving UI help-seeking and treatment. Of note is the acceptance of using humour in a 'pelvic-floor friendly' group PA class to aid in FFE instruction, and UI management during exercise to help women stay dry and active. Participants felt humour in this scenario could elevate enjoyment levels while breaking the stigma of UI through light-hearted discussion. However, using humour in this way had a narrow margin of acceptance. For example, participants would not accept a male instructor, no matter his level of UI knowledge or training, who used humour to promote UI advice or PFE instruction to midlife women. Having access to a pelvic floor physiotherapist in the PA environment was met with overwhelming positivity. Several of the participants had sought help for UI to varying degrees from medical service providers but felt access to a specialist in the PA environment would allow help to be expedited, particularly concerning performing PFEs correctly, which evidence shows few do. The literature overwhelmingly supports performing PFEs effectively and soon after UI onset improves health outcomes; yet, few women seek help, and those who do, often wait years of having symptoms. Providing specialist pelvic health support to women when UI first occurs in the PA setting may help women begin treatment earlier and stay physically active longer. Further research is needed to test this theory and its effectiveness, but positive findings could provide wide-ranging benefits to women with UI, and the health services supporting them. The final aim of the study was to explore how advertisements for exercise programmes targeting women with UI are perceived by women who experience UI when exercising and to make suggestions for future PA promotions. Particular attention was paid to changes that could improve the self-efficacy of women with UI and help avoid women withdrawing from this mode of exercise at UI onset or help encourage those already withdrawn to consider re-engaging. As with the focus group, many of the findings from this phase of the study were novel, but particularly salient was the need for group PA exercise content to be more open and available. Participants were unanimous in suggesting a lack of knowledge, which specific exercises were included in the exercise class design made assessing their risk of leaking impossible. Without this knowledge, none felt confident considering a class advertised in this way. This is the way group PA classes tend to currently be advertised, however, the lack of knowledge of the specific exercises to be undertaken could be overcome by group PA classes and, preferably, exercise instructors, attaining a professional 'pelvic floor friendly' endorsement, which needed to be clearly advertised and evidenced before women would contemplate taking part.