Effects of Diet Control and Telemedicine-Based Resistance Exercise Intervention on Patients with Obesity and Knee Osteoarthritis: A Randomized Control Trial
Round 1
Reviewer 1 Report
The present study aimed to verify the effects of diet control and telemedicine-based resistance exercise intervention on patients with obesity and knee osteoarthritis using a randomized control trial.
The reviewer judges that this study is a very interesting topic in the field of sports medicine and science, and this research background, logical basis, research design, data processing, and discussion were well written.
However, this manuscript has the following major problems in order to be published in high-level journals such as IJERPH: In particular, although the subjects participating in the present study were patients with obesity and knee osteoarthritis, body composition, blood lipid profiles, and TUG test were only measured as dependent variables. In other words, it is judged that new and scientific dependent variables that can prove the clinical and physiological improvement effect of obesity and knee osteoarthritis should be added.
Author Response
Dear reviewer,
Thank you very much for the comments and suggestions. Please read the attached response letter.
All the best,
Nai-Jen Chang
Author Response File: 
Author Response.pdf
Reviewer 2 Report
This study is very interesting. However, a few more modifications need to be made. Please revise it after checking the comment.
- Insert results that show statistical significance into the abstract.
- The author described the following in the introduction. “Previous studies have examined patients with obesity and knee OA and compared 77 the effects of weight loss–only, exercise-only, and weight loss–exercise interventions.” What is the reference to support this? Do not simply present the reference, but enlarge this part based on prior research.
- And this part also needs to sufficient references. “However, the literature has not examined the feasibility of achieving weight loss, improving blood biochemical values, and enhancing functional performance through the provision of nutritional advice and elastic band resistance exercise instructions by a dietitian and implementation of follow-up using telemedicine to track participants’ progress, particularly with respect to the aforementioned population with comorbid obesity and knee OA.”
- I hope that you will correct the above comments well. Only then will we be able to understand the need for this study.
- Do you have a picture of a person doing band exercise? If you have one, please put it in.
- Body Composition Analyzer (Model IOI 353M, Jawon, Seoul, South Korea). Please modify this.
- automatic height-measuring equipment (HW-3070, Taiwan), Please correct this part the same as the part above.
Author Response
Dear reviewer,
Thank you very much for the comments and suggestions. Please read the attached response letter.
All the best,
Nai-Jen Chang
Author Response File: Author Response.pdf
Reviewer 3 Report
Dear authors,
Congratulations for your manuscript. The theme is very interesting and sounding for clinical practice. However, I have some major concerns about statistical procedures and how you report the results. Please, see my comments in the attached file.
Comments for author File: Comments.pdf
Author Response
Dear reviewer,
Thank you very much for the comments and suggestions. Please read the attached response letter.
All the best,
Nai-Jen Chang
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
As this reviewer mentioned in the first review, this study lacks originality to be published in the high quality journal IJERPH (IF 3.39), and the effectiveness of telemedicine-based resistance exercise interventions in patients with obesity and knee osteoarthritis was not reviewed based on new, scientifically dependent variables. In addition, this reviewer judges that the fact that the intervention-related dependent variable was excluded even though resistance exercise was applied to the subjects contained major problems in the initial study design.
Author Response
Dear reviewer,
Thank you for the reviewing the revised article again. We are sorry to hear from your comments. As your big concern, we have endeavored to add more information into the limitations. As, “Second, other intervention-related dependent variables were not assessed. Changes in physical activity levels through wearable technology (e.g, daily walking steps, speed), performance-based measures of physical function, and quality of life for this population were not tracked, and physical or occupational activities unrelated to the study could have introduced bias into the results. The OA participants were also not precisely assessed to intra-articular joint condition (e.g, cartilaginous wear) by magnetic resonance imaging [58] and biomechanics changes (e.g., gait, joint loading) [59]. Third, potential placebo effect is not accounted for, since there is no sham exercises. Fourth, the severe OA participants (ie., K&L grade > 3) were excluded. The generalizability of the results to all patients with obesity and knee OA is low.”
For the concerns of advanced technology usage, we also added the sentences. As, total body DXA scan is suggested to adopt for the precise measurement of the body composition, but the safety of repeated measurements, the cost, and technical expertise are limited [61]”
We appreciate your comments to make our further studies better.
All the best,
Nai-Jen Chang
Reviewer 3 Report
Dear authors,
Thank you for your effort in all my concerns. I'm pleased to recommend the acceptance of the manuscript now.
Author Response
Dear reviewer,
Thank you very much for the positive feedback.
All the best,
Nai-Jen Chang
