# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### Instructor Characteristics
#### 3.2.3 Additional Support to Help Women Manage UI During PA
It is beyond the scope of this study to ascertain in which situations and on which topics individuals find the use of humour acceptable, however in terms of group PA classes billed as 'pelvic-floor friendly' it would seem women-only group exercise classes run by female instructors would benefit from a less clinical and more light-hearted discussion of UI management, during PA.  
To explore the limits of using humour in the PA environment, the participants were asked to think about the way PFE instruction was delivered within the intervention exercise class and how they would perceive a situation where similar humour was used in a more clinical setting within the PA environment; for example, during a one-to-one pelvic floor functional assessment as part of a gym membership joining routine, either with a qualified pelvic health physiotherapist or a specifically trained exercise professional:  
_\"I think it probably would be comfortable because I think there's always a worry that you're going to be judged. So, the more relaxed the person is that you go and see, you're probably less worried about being judged.\"_  
For this participant, the less formal language used in the intervention in such a clinical setting would lessen the anxiety and fear the participant has of being judged. As previously mentioned, a fear of being judged because of UI symptoms contributes to the stigma of UI and often acts as a barrier to women help-seeking [54; 96]. If the more common clinical language increases fears of judgement, this may in part explain why women wait so long to seek help for their UI, and thus, using more relaxed language may encourage earlier medical help-seeking. The final theme discussed was regarding exercise classes, instructors or venues being certified as 'pelvic-floor friendly'. Certification was something the participants referred to throughout the focus group session. Many of the women would not consider re-engaging in group PA classes due to vagueness in the advertising of the class content which meant they could not judge their risk of leaking and proposed \"being certified\" as a solution. Several participants felt the wording of any certification was important and discussed the merits of group exercise classes being described as 'low impact' versus 'pelvic-floor friendly':  
_\"I think pelvic-floor friendly would be better as it's quite specific, so low impact... it sounds like it could be kind of anything and I don't really know what it's going to be, so I might still not feel comfortable going. Whereas if it very specifically says, then I might think, 'oh, actually, that's probably going to be okay', so I'll go, give it a shot.\"_  
Participants were acutely aware that 'low impact' exercises were not always successful in limiting UI incidence; for example, one of the groups reported side-steps, which are a common alternative for jumping jacks, still carried a risk of leaking. Due to this, the consensus was that 'pelvic-floor friendly' was a more precise descriptor and while not UI specific, the participants felt it was safe to assume it meant their needs, as women who leak during PA, would be considered in the class design and delivery. However, two of the group were concerned about \"outing\" themselves in front of other gym/leisure centre members as urinary incontinent by attending group PA described as 'Pelvic-floor friendly' and as such, postulated an alternative:  
_\"If they had a symbol that meant 'pelvic-floor friendly', I mean, it's something that could be rolled out. If they just had a symbol stating it rather than just at the beginning of the class, like going [funny voice] 'if you've got any issues...\"_Using a symbol in group PA class advertising, which women could recognise as meaning 'pelvic-floor friendly', would allow women with UI to easily identify the group PA classes most likely to meet their needs and help those who are concerned about being observed by others outside the class who may judge or stigmatisse them.