Effects on Children’s Physical and Mental Well-Being of a Physical-Activity-Based School Intervention Program: A Randomized Study

Round 1

Reviewer 1 Report (New Reviewer)

General Comments

This is an interesting and original study, assessing the effectiveness of physically active breaks of a total of 10 minutes a day, introduced during curricular lessons, together with a 10-minute physical activity intervention during the daily school recess period on obesity prevention, fitness, cognitive function, and psychological well-being in school-age children. A total 310 children (55% girls) aged between 8 to 10 years participated in this study. Over a 6-month period the participants were randomly assigned to either the intervention group (n=157) or control group (n=153).  A 5-minute physically active breaks during lessons were repeated 2 times in the morning for a total duration of 10 minutes a day. The results indicated after a 6-months period in intervention group a significant decrease in body mass index, waist circumference, waist-height ratio and relative body fat mass, and a significant increase in measured physical fitness tests, concentration performance and well-being levels. The Authors concluded that integrating physical activity allows a reduction of the body mass index in children, increases the levels of physical well-being, confirming the evidence of the connections between physical fitness, cognitive functioning, academic performance, and mood improvement.

The manuscript is generally well written. However, the design of this paper should be slightly improved before publishing.

1.The Authors should clarify the aim in the end of the 1. Introduction (Lines 92-94) – a 15-minute physical activity … - because in Absracts and 2. Methods are indicating that a total duration of the physically active breaks was 10 min.

2. In my opinion, it is obligatory to present in Abstract information about the age range and sex (% girls) of the participants. The Authors presented only a number of participants in intervention and control groups without age and sex. Without this information is impossible to understand the developmental (pubertal) stages of the participants. The narrow age range (2 years) can be one limiting factor of this study.

3. I suggest to replace the text from the beginning of the Discussion (Lines 329-346) to Introduction or delete because this is a literature overview rather than the analysis of the main results of this study.

4. In my opinion, it is obligatory to add more limiting factors of the study at the end of  the Discussion chapter. The most important of them seems to be that since the study has been performed only on children aged 8 to 10 years (mostly prepubertal children, whereas pubertal stages were not measured), its results cannot probably be transferred to the general population of schoolchildren with a different age and habitual physical activity (whereas habitual physical activity of the participants was not measured in this study), and this should definitely be mentioned. 

 

 Specific Comments

 Abstract

Page 1: Please add information about the age range and sex of the subjects (see General Comments).

 

1.Introduction

Page 2, Lines 92-94: Please clarify the aim of this study (see General Comments).

 

3. Results

Page 6: Table 2. Please prolongs the upper line till full-length on Table 2

Page 8: Table 3. Please place a full-length upper line on Table 3 (this Table should begin with upper line)

Page 10: Table 4. Please place a full-length upper line on Table 4 (this Table should  begin with upper line)

 

4. Discussion

 

Page 11, Lines329-36: Please replace the text from the beginning of the Discussion to Introduction or delete  (see General Comments)

Page 13: Please add more limiting factors of the study at the end of  the Discussion chapter (see General Discussion).

 

Author Response

REF 1

1.The Authors should clarify the aim in the end of the 1. Introduction (Lines 92-94) – a 15-minute physical activity … - because in Absracts and 2. Methods are indicating that a total duration of the physically active breaks was 10 min.

Reply 1. The Referee is right; this typing error in Introduction section (Lines 103) has been amended

2. In my opinion, it is obligatory to present in Abstract information about the age range and sex (% girls) of the participants. The Authors presented only a number of participants in intervention and control groups without age and sex. Without this information is impossible to understand the developmental (pubertal) stages of the participants. The narrow age range (2 years) can be one limiting factor of this study.

Reply 2. These info have been added in the Abstract (lines 14-15)

3. I suggest to replace the text from the beginning of the Discussion (Lines 329-346) to Introduction or delete because this is a literature overview rather than the analysis of the main results of this study.

Reply 3. We thank the referee for the suggestion which, however, we share only in part. We have greatly condensed the part indicated by reducing it by 75% and we have placed it at the beginning of the discussion, as an introductory "hat" of the same (Lines 346-351)

4. In my opinion, it is obligatory to add more limiting factors of the study at the end of the Discussion chapter. The most important of them seems to be that since the study has been performed only on children aged 8 to 10 years (mostly prepubertal children, whereas pubertal stages were not measured), its results cannot probably be transferred to the general population of schoolchildren with a different age and habitual physical activity (whereas habitual physical activity of the participants was not measured in this study), and this should definitely be mentioned. 

Reply 4. We thank the referee for this further note which we fully agree with. Therefore, we have added the following sentence in the section ending the conclusions and limitations (Lines 433-436): 

„We have to consider that this study was conducted on children aged 8 to 10 years for whom pubertal stages were not measured and results cannot probably be transferred to the general population of schoolchildren with different age; furthermore, of the participants in this study we did not assess habitual physical activity.”

 Specific Comments

 Abstract

Page 1: Please add information about the age range and sex of the subjects (see General Comments).

We done

1.Introduction

Page 2, Lines 92-94: Please clarify the aim of this study (see General Comments).

We have added the following sentences at the end of the introduction (Lines 97-100):

“The hypothesis that we wanted to test is that a systematic and structured intervention of physical activity conducted daily at school outside the canonical hours set for this can have recognizable and measurable effects on physiology and psychosocial well-being. Consequently, this study was designed in order to describe the changes in body composition, physical fitness, cognitive performances, and psychosocial well-being, in school children, after 6-month PA intervention consisting of physically active breaks of a duration of 10 minutes a day, introduced during curricular lessons, together with a 10-minute physical activity intervention during the daily school recess period.”

3. Results

Page 6: Table 2. Please prolongs the upper line till full-length on Table 2

Page 8: Table 3. Please place a full-length upper line on Table 3 (this Table should begin with upper line)

Page 10: Table 4. Please place a full-length upper line on Table 4 (this Table should  begin with upper line)

We place a full-length upper line on Tables

4. Discussion

Page 11, Lines329-36: Please replace the text from the beginning of the Discussion to Introduction or delete  (see General Comments)

We done.

Page 13: Please add more limiting factors of the study at the end of  the Discussion chapter (see General Discussion).

Page 13: Please add more limiting factors of the study at the end of  the Discussion chapter (see General Discussion).

Accordingly, we have added the following further limitation (Lines 434-437 and Lines 442-445)

We have to consider that this study was conducted on children aged 8 to 10 years for whom pubertal stages were not measured and results cannot probably be transferred to the general population of schoolchildren with different age; furthermore, of the participants in this study we did not assess habitual physical activity.

“Yet another potential limitation of this study is the difficulty of controlling for variations in daily physical activity that was performed by study participants outside of school hours. However, greater attention was paid by the respective coaches of all those children who regularly played sports”

Reviewer 2 Report (New Reviewer)

ijerph-2159090_review

Title: Effects on children’s physical and mental well-being of a physical activity-based school intervention program: a randomized study

Comments for Authors

Dear authors,

I have carefully read your paper, which investigated the effects of a school physical activity program applied over a period of six months on obesity prevention, fitness, psychological health and cognitive performances in healthy children.

In your results observed a decrement in body mass index, waist circumference and waist-to-height ratio, less relative body fat mass, better performances in physical fitness, significant differences  in cognitive performances, enhancement of psychological wellbeing, in intervention group compared with control group. Therefore, it appears that the integration of a physical activity program of these characteristics seems to help to improve BMI, levels of physical well-being, cognitive functioning, academic performance and mood. I agree with you authors that more interventions of this type should be created and implemented in schools to promote regular exercise.

In general, the manuscript is well-written. The text is understandable and organized. However, I found some issues in introduction, methods, results, discussion and conclusion sections that should be addressed to improve the paper, in my opinion.

Specific comments:

Introduction

-       Page 2, lines 54-58. This paragraph does not contain any references; please add the references that are necessary to support this information.

-       Page 2, lines 92-94. The introduction is detailed and offers enough information; however you have not specified the hypothesis of your study. I suggest that you briefly add this information before mentioning the objective of your intervention.

-       Page 2, line 94. You mentioned in this line that “PA intervention consisting of a 15-minute PA performed…” The duration of the intervention that you indicate here (15 minutes) does not coincide with that indicated in the abstract or in the methods section (10 minutes), please check this information and unify it in all sections.

Methods

- Page 3, lines 107-108: You mentioned that the University’s Research Ethics Committee approved the study. Please add de code or reference number to support this information.

- Page 3, line 111. You obtained the participants from primary schools of three cities in the province of Lecce, Italy. What cities are these? How many schools have participated from each of the cities? Please complete this information

- Page 3, line 116: You mention that the participants must be able to refrain from all physical activity outside the parameters of the study protocol during the test days. What are these parameters specifically? For example, should a student who regularly performs intense physical activity stop doing it during the duration of the study? How do you control the physical activity that each student performs outside the school centre during the entire duration of the study? I consider that this is a very important parameter that could condition your results.

- Page 3, line 117: You mentioned that this was a double blinded study. I assume that you blinded the participants, although by the nature of the intervention the participants could easily tell if they belonged to the experimental or control group. Also who was blinded? Please add this information which is crucial for your manuscript

- Page 3, Figure 1: In this figure it appears that 9 people from the experimental group and six from the control group were excluded from the analysis. Why were they excluded? Please add this information

- Page 4, lines 132-149: You mentioned that before the start of the project, all the teachers of the intervention schools received training, also that all the intervention sessions were facilitated by an activity leader who was a certified physical education teacher. Active breaks were introduced during Italian, English, Mathematics and Science classes and it was the teacher who chose when to propose to the class to take an active break. Therefore, I understand that the teachers of each of the subjects (previously trained) were in charge of implementing the physical activities, is this so?

How long did you carry out the intervention? Was it 6 months? Was the intervention performed daily? How much total time of additional physical activity do you estimate was performed by the participants in the experimental group?

- Page 4. You describe the intervention that the experimental group received. You must also indicate what was done for the control group. This information is very important for your study. At the beginning of this paragraph you mention that “before to the start of the project, all teachers and children of the intervention schools received on-site training to deliver them with general information on nature and significance intervention, through 3 lessons held by a certified physical education teacher”.

Therefore I understand that the control group participants received these three sessions, was any additional intervention performed? Please add this information. Even if the components of the control group did not receive any intervention you should also indicate.

- Page 5, line 155: Please, could you add information about the period of time and places in which the data were recorded? How long did it take to complete the entire assessment? Who made the measurements? Were they the same evaluators for all the schools in all the cities?

- Page 5, lines 156-159: Please add information about the tools used to assess the weight, height and waist circumference of study participants

- Page 5, line 172: Please, add references for the Sit and reach test.

Results

- You show your results in detail and the figures help to interpret them.

About Tables 2, 3 and 4, I suggest that you use uniform terminology in these three tables and throughout the text to name the two study groups. I therefore recommend changing "participant group" to "intervention group"

Discussion

-       Page 12-13: You adequately mention the main limitations of the study. As I have previously commented in the methodology section, I consider that the physical activity carried out daily by each student should have been recorded both inside and outside the centre during the entire duration of the study. In my opinion, this is a very important parameter that could condition your results. I suggest that you mention it as a limitation of your study if you have not taken it into account.

Conclusions

-       Page 13. Taking into account the limitations mentioned the results of your study should thus be interpreted with caution.  Therefore and consequently I suggest you to the reformulate your conclusions in a more carefully way such as: “Our results suggest that ….”

I hope that my comments could help to improve the paper.

Author Response

REF 2

In general, the manuscript is well-written. The text is understandable and organized. However, I found some issues in introduction, methods, results, discussion and conclusion sections that should be addressed to improve the paper, in my opinion.

Specific comments:

Introduction

-       Page 2, lines 54-58. This paragraph does not contain any references; please add the references that are necessary to support this information.

Reply: We agree with the referee and have added the appropriate reference n° [9].

-       Page 2, lines 92-94. The introduction is detailed and offers enough information; however you have not specified the hypothesis of your study. I suggest that you briefly add this information before mentioning the objective of your intervention.

Reply: The referee is right; the starting hypothesis has not been made explicit. In the new version of the paper, we have added the following sentences at the end of the introduction (Lines 97-100):

“The hypothesis that we wanted to test is that a systematic and structured intervention of physical activity conducted daily at school outside the canonical hours set for this can have recognizable and measurable effects on physiology and psychosocial well-being. Consequently, this study was designed in order to describe the changes in body composition, physical fitness, cognitive performances, and psychosocial well-being, in school children, after 6-month PA intervention consisting of physically active breaks of a duration of 10 minutes a day, introduced during curricular lessons, together with a 10-minute physical activity intervention during the daily school recess period.”

-       Page 2, line 94. You mentioned in this line that “PA intervention consisting of a 15-minute PA performed…” The duration of the intervention that you indicate here (15 minutes) does not coincide with that indicated in the abstract or in the methods section (10 minutes), please check this information and unify it in all sections.

Reply. The Referee is right; this typing error in Introduction section has been amended

Methods

- Page 3, lines 107-108: You mentioned that the University’s Research Ethics Committee approved the study. Please add de code or reference number to support this information.

Reply – we added the following:

“The University’s Research Ethics Committee approved the study (N.1/2021).” (Lines 119-120)

- Page 3, line 111. You obtained the participants from primary schools of three cities in the province of Lecce, Italy. What cities are these? How many schools have participated from each of the cities? Please complete this information

Reply – The municipalities considered were similar with similar socio-economic status and all above 24,000 inhabitants, with a total population of over 83,000 inhabitants. We selected 14 classes belonging to 5 different schools located in these three cities.

This info has been added in Lines 114-115.

- Page 3, line 116: You mention that the participants must be able to refrain from all physical activity outside the parameters of the study protocol during the test days. What are these parameters specifically? For example, should a student who regularly performs intense physical activity stop doing it during the duration of the study? How do you control the physical activity that each student performs outside the school centre during the entire duration of the study? I consider that this is a very important parameter that could condition your results.

Reply - The parameters were new sporting competitions or changes in physical activities that were already practiced before the study. For those children in both control and intervention groups who already played sports outside of school, collaboration was requested from their respective coaches so as not to vary the workload.

We added the following sentence in the revised manuscript (Lines 129-132):

“More specifically, the participants did not undertake new sports competitions or modifications to physical activities already practiced before this study and for those who already practiced sports outside of school, the collaboration of their respective coaches was requested in order not to vary the workload.”

- Page 3, line 117: You mentioned that this was a double blinded study. I assume that you blinded the participants, although by the nature of the intervention the participants could easily tell if they belonged to the experimental or control group. Also who was blinded? Please add this information which is crucial for your manuscript

Reply - The referee is right to ask the question because we have not been clear in explaining the method. Obviously, the participants knew very well whether they were in the intervention group or in the control group. There were two "blind" subjects: the evaluators who carried out the anthropometric measurements and the tests on the one hand and the statistical data analysts on the other.

Consequently, we changed the text as follows (Lines 135-138)

A randomized controlled trial study design shown in Figure 1 was used; for its execution we employed two "blind" subjects: the evaluators who carried out the anthropometric measurements and the tests on the one hand and the statistical data analysts on the other.

- Page 3, Figure 1: In this figure it appears that 9 people from the experimental group and six from the control group were excluded from the analysis. Why were they excluded? Please add this information

Reply – We have added the following text to the revised manuscript (Lines 133-135)

Children were excluded from the data analysis if they did not complete the tests, or did not complete the questionnaire, due to accidents, injuries, or illness. Accordingly, 15 students were excluded from the final data analysis.

- Page 4, lines 132-149: You mentioned that before the start of the project, all the teachers of the intervention schools received training, also that all the intervention sessions were facilitated by an activity leader who was a certified physical education teacher. Active breaks were introduced during Italian, English, Mathematics and Science classes and it was the teacher who chose when to propose to the class to take an active break. Therefore, I understand that the teachers of each of the subjects (previously trained) were in charge of implementing the physical activities, is this so?

Reply – yes, it is

How long did you carry out the intervention? Was it 6 months? Was the intervention performed daily? How much total time of additional physical activity do you estimate was performed by the participants in the experimental group?

Reply - The intervention lasted 6 months, it was daily and therefore for a total of 120 days; 20 min of PA were performed every day for a total of 40 hours.

 

- Page 4. You describe the intervention that the experimental group received. You must also indicate what was done for the control group. This information is very important for your study. At the beginning of this paragraph you mention that “before to the start of the project, all teachers and children of the intervention schools received on-site training to deliver them with general information on nature and significance intervention, through 3 lessons held by a certified physical education teacher”.

Therefore I understand that the control group participants received these three sessions, was any additional intervention performed? Please add this information. Even if the components of the control group did not receive any intervention you should also indicate.

Reply – Indeed, the control group did not receive any intervention and this has been specified on page 4 (Lines 159-160)

- Page 5, line 155: Please, could you add information about the period of time and places in which the data were recorded? How long did it take to complete the entire assessment? Who made the measurements? Were they the same evaluators for all the schools in all the cities?

Reply - Data were recorded in the gyms, in the morning at nine and it took three mornings to complete the evaluation. The measurements were carried out by the same evaluators in "blind" mode in all schools and in all cities

 

These info have been added (Lines 182-184)

 

- Page 5, lines 156-159: Please add information about the tools used to assess the weight, height and waist circumference of study participants

These info have been added (Lines 184-185)

- Page 5, line 172: Please, add references for the Sit and reach test.

Reply: We agree with the referee and have added the appropriate reference n° [34].

Results

- You show your results in detail and the figures help to interpret them.

About Tables 2, 3 and 4, I suggest that you use uniform terminology in these three tables and throughout the text to name the two study groups. I therefore recommend changing "participant group" to "intervention group"

Reply - done

Discussion

-       Page 12-13: You adequately mention the main limitations of the study. As I have previously commented in the methodology section, I consider that the physical activity carried out daily by each student should have been recorded both inside and outside the centre during the entire duration of the study. In my opinion, this is a very important parameter that could condition your results. I suggest that you mention it as a limitation of your study if you have not taken it into account.

Reply - As reported before, the physical activity done outside the school was controlled by the coaches for all those children who regularly engaged in sporting activities

Accordingly, we have added the following further limitation (Lines 442-445)

“Yet another potential limitation of this study is the difficulty of controlling for variations in daily physical activity that was performed by study participants outside of school hours. However, greater attention was paid by the respective coaches of all those children who regularly played sports”

Conclusions

-       Page 13. Taking into account the limitations mentioned the results of your study should thus be interpreted with caution.  Therefore and consequently I suggest you to the reformulate your conclusions in a more carefully way such as: “Our results suggest that ….”

Reply – Done (Line 453)

Reviewer 3 Report (New Reviewer)

-Introduction:

The effects on children's physical and mental well-being of a physical activity-based school intervention program is an essential and well-recognized issue in the educational field. The importance of this study has been widely recognized, so it is suggested that the researcher needs clearly explain the importance and special features of the study design in the conclusion of the Introduction and also explain the need for this study, which can make this study a unique research position.

 

-Participants and Procedures: The background description of the regular primary schools' sample is insufficient to know from the text how many schools eventually participated in the study and whether these schools did a good job of controlling the background related to the study during the study period (e.g., during the study, whether there were any competitions, etc.). Therefore, the researcher is asked to provide a detailed overview of the implementation of existing physical activities and to explain further how many schools were eventually selected for this study. (L126)

 

- Randomization:

What was the baseline assessment implemented in the study? What are the steps? Please explain clearly

 

-Training Intervention:

The physical activities in this study were 10 minutes (including Warm-up, Training, and Cool-down); please explain why only 10 minutes were planned for the activities, especially 5 minutes for Training. In addition, only the names of the training activities are presented, and it is not easy to understand the appropriateness of the arrangement of these activities. Please also add the content of these activities as training activities and those parts that can effectively promote physical activity.

 

 

-Discussion

The researcher suggested (L415) that although other unmeasured factors may have contributed to the observed effects, the study's background and limitations are not transparent enough, so the researcher is asked to add the study's limitations.

 

Author Response

REF 3

Introduction: The effects on children's physical and mental well-being of a physical activity-based school intervention program is an essential and well-recognized issue in the educational field. The importance of this study has been widely recognized, so it is suggested that the researcher needs clearly explain the importance and special features of the study design in the conclusion of the Introduction and also explain the need for this study, which can make this study a unique research position.

Reply - it is known that there is a close physiological link between physical activity and general well-being in children and from this it follows that it is quite important to dedicate time to physical education and sport in schools. However, it is also clear that school time is dedicated to various things with the result of not having enough time to devote to physical education and sport. Thus, here we wanted to investigate the usefulness of an additional method concerning the performance of physical activity carried out during recess and also for a very short time during curricular lessons dedicated to other disciplines.

Consequently, we have added, at the end of the Introduction section, the following text (Line 93-104)

“As detailed above, school time is mainly dedicated to the learning of a series of curricular notions with the result of not having enough time to devote to physical education and sport. Thus, here we wanted to investigate the usefulness of an additional method concerning both the performance of physical activity carried out during recess and also for a short time during curricular lessons dedicated to other disciplines. Therefore, the hypothesis that we wanted to test is that a systematic and structured intervention of physical activity conducted daily at school outside the canonical hours set for this can have recognizable and measurable effects on physiology and psychosocial well-being. Consequently, this study was designed in order to describe the changes in body composition, physical fitness, cognitive performances, and psychosocial well-being, in school children, after 6-month PA intervention consisting of physically active breaks of a total duration of 10 minutes a day, introduced during curricular lessons, together with a 10-minute physical activity intervention during the daily school recess period.”

-Participants and Procedures: The background description of the regular primary schools' sample is insufficient to know from the text how many schools eventually participated in the study and whether these schools did a good job of controlling the background related to the study during the study period (e.g., during the study, whether there were any competitions, etc.). Therefore, the researcher is asked to provide a detailed overview of the implementation of existing physical activities and to explain further how many schools were eventually selected for this study. (L126)

Reply - 14 classes belonging to 5 different schools located in the three cities were selected. During the study period, none of the classes took part in competitive sports and participants were asked not to engage in any other than usual physical activity outside of school. Furthermore, for those children both in the control and intervention groups who already practiced sports outside of school, the collaboration of their respective coaches was requested so as not to vary the workload.

This info has been added in Line 114.

- Randomization: What was the baseline assessment implemented in the study? What are the steps? Please explain clearly

Reply – We have added the following info to the revised manuscript (Lines 147-151)

“The baseline assessment consisted mainly of the participants' anamnesis, i.e., information about surgeries, immunizations, allergies, illnesses, and results of physical exams and tests. Furthermore, information was collected on sports activities, including those of a competitive nature, which were carried out by the participants, outside school hours. This evaluation was made through a questionnaire addressed to the parents followed, only, if necessary, by a subsequent interview.”

-Training Intervention: The physical activities in this study were 10 minutes (including Warm-up, Training, and Cool-down); please explain why only 10 minutes were planned for the activities, especially 5 minutes for Training. In addition, only the names of the training activities are presented, and it is not easy to understand the appropriateness of the arrangement of these activities. Please also add the content of these activities as training activities and those parts that can effectively promote physical activity.

Reply - As these additional physical activities were done during recess and during the curricular lectures, they necessarily had to be short. The right compromise allowed us to use 10 of the 15 minutes dedicated to recess and 10 of the 60 minutes dedicated to curricular lessons.

 -Discussion: The researcher suggested (L415) that although other unmeasured factors may have contributed to the observed effects, the study's background and limitations are not transparent enough, so the researcher is asked to add the study's limitations.

Reply - We were encouraged by all referees to better explain the limitations of the study. For this reason, we have added the following text in the revised manuscript referring to the limitations present in the study (Lines 429-448)

“Although other unmeasured factors may have contributed to the observed effects (this may be a limitation of the study), the results established that increased physical activity positively contributed to the physical and mental well-being of the participating children, suggesting that physical activity represents a modifiable means to protect well-being by promoting resilience under different conditions. We have to consider that this study was conducted on children aged 8 to 10 years for whom pubertal stages were not measured and results cannot probably be transferred to the general population of schoolchildren with different age; furthermore, of the participants in this study we did not assess habitual physical activity. Another limitation could be the sample size and the loss of follow-up which could compromise the generalizability of the results, since the recruited participants were representative of a target population with considerable individual variability. For example, the influences of socio-economic conditions were not evaluated in the present study. In addition, future studies that take into account variables such as study time or rest, as well as nutrition or the use of new technologies, which could affect associations, would be recommended. Additionally, only specific physical fitness dimensions have been assessed. Yet another potential limitation of this study is the difficulty of controlling for variations in daily physical activity that was performed by study participants outside of school hours. However, greater attention was paid by the respective coaches of all those children who regularly played sports. Future research, therefore, should consider an assessment of different dimensions of fitness (e.g., cardiorespiratory fitness, muscular fitness, motor-cognitive fitness), which could provide a more comprehensive insight into the relationships between physical fitness, cognitive functioning, and psychological wellbeing.”

Round 2

Reviewer 2 Report (New Reviewer)

ijerph-2159090_review_R2

Title: Effects on children’s physical and mental well-being of a physical activity-based school intervention program: a randomized study

Comments for Authors

Dear authors,

I was glad to have the opportunity to review the new version of your manuscript, which investigated the effects of a school physical activity program applied over a period of six months on obesity prevention, fitness, psychological health and cognitive performances in healthy children.

In my opinion, you have responded positively to the suggestions for improvement made, you have expanded the information required in the introduction and methods sections, you have made the modifications indicated in the results section, and reformulated the hypothesis and conclusions.

I believe that all these modifications have improved the quality of this manuscript.

Therefore, I congratulate you on your great effort and the work you have done.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

This study examined effects of a physical activity-based school intervention program on physical and mental well-being of children. However, results of mental well-being appear not to be presented. In addition, the intervention is not clear. Although the authors stated that “few interventions have considered a school-based program that provide a strategy of change in physical activity habits across the classroom curriculum” in the Introduction section, it is not clear what a strategy is. I do still not understand this strategy after I read the Methods section. I am wondering why the intervention can improve physical and mental well-being? According to Table 1, the intervention looks like physical activity. I agree that physical activity can promote health. However, the relationship between physical activity and health has been well established. I would like to know what this study contributes to the literature?

 

The manuscript needs general editing throughout to improve readability.

 

Reviewer 2 Report

Dear Authors,

This study aimed to investigate the effects of a PA intervention in primary schoolchildren. Although I recognize the Authors’ effort in this research project, in my opinion there are some issues that undermine the possibility of its publication in the present version.

My major concerns regard the intervention and the analisys/presentation of results. The PA strategy is non appropriately described, no clear information on total amount of PA per day or week is given, so the intervention is not repeatable. Secondly, the analysis is not appropriate to the design, consequently the results presentation appears non-formally correct (why considering a control group if it is not used as reference population?). Moreover, a general confusion in the overall paper is noted (the CONSORT is not complete; some confusion in the definition of the student population: aged 8-10 in the CONSORT then, in the text, 9-11 or secondary school level student; it is not clear how it was possible to randomize the students, it would be better to randomize the classrooms; a measure of fidelity is missing; other confused details in analysis and writing).

Although I recognize Your effort in this manuscript, there are some changes that would need attention and revising before being considered for publication.