Round 1

Reviewer 1 Report

General

Wagoner and colleagues present a well written manuscript describing the 1-yr intermediary results of the EXCEL Study, which aims to support oncology patients via exercise programs especially in rural and remote communities across Canada. The authors utilized the RE-AIM framework (i.e., Reach, Effectiveness, Adoption, Implementation, and Maintenance which together are thought to determine public health impact).

 

Wagoner and colleagues report very high adherence and completion rates, feasibility and successfully implemented networks between patients, health care professionals and qualified exercise professionals. Readers do not get any substantial information regarding the effectiveness of the intervention (e.g., changes in physical fitness, socio-economic burden or benefits). 

 

Critique

From my point of view, three things should be criticized. 

 

1st, the rather lengthy discussion. 

 

2nd, the impression that some of the intentions planned for the future, such as "ongoing integrated knowledge translation efforts" and "feedback from stakeholder groups", do not result from the reported data, but were probably planned a priori, completely independently of the results. I do not want to criticise the importance and correctness of these plans, but according to my scientific understanding, they do not belong in the paper. Even in such a methodological paper, the conclusion should be data-based. 

 

3rd, I am missing data on the socio-economic aspects, at least the costs of the intervention per patient should be summarized and ideally compared to the costs of a non-digital exercise intervention.

 

Minor

Before recommending the acceptance of the paper, I have a few minor comments that I respectfully request the authors to include in their reflections: 

 

Abstract

 

L20: Please specify the barriers you have in mind here, similar to L 46 (geographic isolation etc.). We know there are several barriers hindering peoble to participate in rehab and exercise programs. 

 

L24: I think you should either briefly explain the RE-AIM concept in the abstract, or avoid the term.

 

L35: See above, the “conclusion” is not data supported.

 

L38: Please avoid repeating keywords from the title

 

Introduction

 

L42: You might want to add the information that cardiovascular fitness is linked to mortality / survival probability with or without treatment (e.g., https://www.mdpi.com/2072-6694/13/8/1771)

 

L57: A strong argument for remote rehabilitation etc. are potential socio-economic benefits. Please consider naming this aspect here.

 

Materials

 

L104: I apologise for not being familiar with the Canadian system, however, as a reader, I wonder if the definition of "underserved rural/remote communities (population <100,000 people)" is generally acceptable. 100,000 people would make a small but complete city in Central Europe. Please consider to base your definition on population density. On Wikipedia I found “a population density of less than 150 people per square kilometer” defining rural areas in Canada. https://en.wikipedia.org/wiki/Rural_area#Canada

 

 

Results

Fine. Thank you. 

 

Discussion

 

I feel the discussion is overlong and would politely ask you to consider the possibility of compressing it. 

Author Response

Please see attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Please see attached file

Comments for author File: Comments.pdf

Author Response

Please see attachment. 

Author Response File: Author Response.docx