# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### Instructor Characteristics
In this instance, the lack of open dialogue over UI for both the male instructor and female participant fosters embarrassment in both: \"_Once we're away to start, it's like all the women run to the toilets, but it's male coaches and they don't know the first thing about any of these kinds of problems and it's almost like a taboo, nobody wants to speak about it because it's really embarrassing.\"_  
Despite women running en masse to use the toilet immediately before skipping begins, there is a general feeling that the male coaches have no awareness of the problem the move causes. A mass exodus of women to the toilets would seem unlikely to go unnoticed by any instructor but the participant alludes to the 'taboo' of UI, suggesting male instructors are possibly too embarrassed to explore the reasons behind the behaviour. [PERSON] et al. [107] found the PA instructor participants in their study reported feeling comfortable discussing UI with women exercisers but required training and support to do so. However, their study data were not sex-segregated and is, thus, unable to confirm whether male and female instructors were equally comfortable discussing UI, but for participants in the current study, having a PA instructor trained in recognising UI and that is able to provide advice and support to women in the PA environment may mitigate some of the discomfort urinary incontinent women feel: \"_I think if you had a well-educated middle-aged male, that would be ok, but they're just not.\"_  
Alongside instructor sex requiring consideration in group PA design, the quoted participant also refers to the instructor's age, implying having instructors of a similar age to group members, would elicit more confidence that male instructors understand the issues UI causes in exercising women. When asked to share their thoughts about a young instructor leading their group class, the feelings were mixed. If the young instructor was male, one participant explicitly stated, \"_I would think that they didn't know anything about it\"_ and was steadfastly unwilling to consider participating in a group PA class led by an instructor who was both male and young, believing they would have no understanding of the needs of a midlife woman with UI. In contrast, another participant assumed that any young male instructor was bound to have an awareness of UI, as long as the class was being advertised as 'pelvic-floor friendly': \"_I think that if you had a 20-year-old male doing a lesson that is being advertised as low-impact pelvic-floor friendly, I am expecting that he would expect a room full of women our age and I would expect that he would be knowing what to expect and I would expect that if there is a problem, he'll be fine with it.\"_  
As before, having a PA instructor who has had pelvic floor training appears to mitigate against the embarrassment of managing UI during PA and allows women to feel more confident in participating even where the instructor is both male and young. Whilst being male, young, and unknowledgeable appears to be the least preferred characteristics for a group PA instructor, young women are also deemed unsuitable unless a class is advertised as 'pelvic-floor friendly' and the female instructor's knowledge made clear: \"_Unless she let you know that she'd had that [pelvic floor] training and she made it clear in her introduction or the advertising of the class that she understood, in which case that's fine. She's a professional who has considered that aspect for other people.\"_Exercise instructors with knowledge of specific health conditions have been reported as important to exercisers in the literature. For example, a study exploring the factors influencing the exercise of adults with arthritis found participants recorded having an instructor with knowledge of arthritis and exercise was important for continued participation [47].