# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### Instructor Characteristics  
The focus group participants next discussed what they needed from PA instructors to help them remain active in group PA. The need for PA instructors to possess certain characteristics was seen as a priority by all, and of note, the women commented on instructors having little awareness of UI, its symptoms or how it impacts PA. The participants were, however, quick to point out that instructors did not necessarily have to have personal experience with UI to support them in class:  
_\"...it's always good to know that they understand, and they are going through the same thing. I don't think they have to have it.\"_  
However, several of the women commented on UI still being considered 'taboo', and it is rarely mentioned in the PA environment. Of note, male instructors were seen to be embarrassed when the women in one of the participant's CrossFit(r) classes would discuss leaking during some of their exercises:  
_\"When the male instructors overhear the women chatting about it or laughing about it or whatever, they are so embarrassed, you can see it. So how could you be open? How can they adapt to the class if they know nothing about it themselves?\"_  
This participant feels the women in her group class must moderately discuss UI in their male instructor's presence due to the instructor's embarrassment. Being forced to hide UI from others can contribute to the reinforcement of stereotypes and help perpetuate the stigma which surrounds UI [95]; however, public education and raising awareness of UI through health promotion can reduce the stigma of UI [106]. In the PA environment, this could mean having instructors who can instigate or contribute to a discussion regarding UI or at least facilitate women in carrying out their own discussion, rather than becoming embarrassed. The participant views their instructor's embarrassment as a sign that they lack knowledge of UI, and this does little to help her feel confident that any exercise adaptions the instructor provides will consider her needs. Almost all participants felt they could not discuss UI in class, even if they required support or guidance to continue participating, due to the lack of discussion around UI in that environment; however, one participant who previously reported attending low-intensity classes full of older women in order to remain active in group PA also felt that environment gave her some confidence, should she need to tell the instructor she was having difficulty continuing due to UI:  
_\"I'd say, of the classes that I go to regularly, locally, it's usually women of our sort of age that are running them because I just feel like, even if I had to say something to them, it wouldn't be like, shock news, do you know what I mean.\"_  
Despite women often feeling they are alone in experiencing UI [54], the participant perceives a female instructor of a similar age will have some awareness of UI and would be more comfortable in discussing symptoms than a male instructor would be. Indeed, for all participants, the instructor's sex matters and having a male instructor appeared to be a barrier to participation:\"If there's a class with skipping and it's a female instructor, I would be inclined to go to the class. I wouldn't even give it a second thought. If it's male instructors on that day, and there's skipping, I'll be like 'Mmmm'. It would be a deliberation for me.\"_  
Skipping is the exercise which, for this participant, almost always induces leaking. Where skipping is programmed into a session, extra thought is given to whether she will attend or not, but only if the instructor is male.