Exercise Preferences in Young Adults with Cancer—The YOUEX Study

Round 1

Reviewer 1 Report

Dear authors,

the manuscript has an interesting and highly applicable "core" even if minor revisions are necessary.

1. Introduction. Your introduction is mainly focused on presenting the importance and the role of physical activity for cancer survivors health. Therefore your introduction fails in the introduction of the chosen exercise programs and modalities. Why did you choose those exercise programs and modalities? Please provide this modification and rebalance the introduction working on the length of its different sections.

2. Material and methods. 

Line 93. You wrote "Exclusion criteria were the lack of sports clearance from the attending oncologist"... sports or physical exercise?

Lines 109-140. You described the workouts protocols and, at the end, you wrote "the exercise recommendations in all study modules were guided by the present exercise guidelines of the ACSM, aiming to reach at least 150 minutes moderate PA per week" . Your goal is to reach just the aerobic prescription but you also trained other aspects (e.g. strength, sensorimotor training) not having the same volume across the workouts (M1-M3). Why? Please better explain this aspect in the discussion and in the study limitation. Are the workouts really balanced? Could you really conclude that the effects of the workouts are linked with the typology and not with the content of the workouts and with their weekly frequencies? There is too much variability among the workouts in terms of contents, weekly frequency and suggested independent physical activity. In addition, your online supervised workout (i.e. M1) was conducted just once a week combined with the suggestion to train in autonomy for 1-2 times per week... These aspects are very important to properly read and comment the results, therefore you should better comment the effect of the workouts characteristics on the observed results (this aspect is linked with the suggested improvement of the introduction)... or you should insert this aspect in the study limitation. 

What about the sample size? Did you calculate the a priori power?

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for submitting the article. The reviewer presents some points and concerns that must be verified/discussed before the possible publication of the article.

1 - On Materials and Methods
Could you describe more details about the training prescription? For example, was there an evolution of the training load during the training period?

2 - On Materials and Methods
While feasibility and acceptance are important for exercise adherence, adaptations in health are obviously also important. Were there physical measurements regarding the adaptations caused by the exercise?

3 - On Materials and Methods
Lines 159-160 - Could you cite the studies, please?

4 - On Results
- Line 211 - typo.

5 - On Results
- Line 228 - What happened to the volunteers who were previously enrolled in module 3 between November 2020 to March 2021? This should be clearly presented in the text.

6 - On Discussion
As already presented as a limitation, the lack of randomization and a control group weakens the findings and interpretations. Additionally, a crossover study could rule out other limitations, as the volunteers would experience all three exercise modules. In this context, the authors are invited to briefly insert in the discussion the possible benefits of the chosen design (voluntary choice at baseline and after 6 weeks) and the reason for non-randomization.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

This study is novel and helps to formulate further research questions for this clinical population in the future. The major issue is that the PA levels are all subjective and there was no attempt to monitor them. This is especially problematic since you have no idea of the adherence of the participants to each module. Please address this issue in the Methods and Discussion. There are also numerous English grammar issues throughout the manuscript as well as not using passive tense when describing findings. Below are further comments.

 

Line 20: Please spell out YOUEX before abbreviating.

In the Abstract there should be a full stop to end the sentence before the Methods, Results, and Conclusion.

Line 33: Abbreviations cannot be used for keywords. Therefore remove “AYA” or spell it out.

Lines 45-48: You should comment that the ACSM exercise recommendations may be non-specific for cancer patients since these guidelines are the same as for apparently healthy adults.

Line 62: Please delete “e.g.” and replace it with “…according to the various factors such as physical and mental health……”

Line 88: “…protocol was approved by…”

Line 96: “..flyers..”

Line 107: “…procedure as follows:”

Lines 122-140: Please explain how 150 minutes of MVPA was achieved. Any resistance training should be excluded from the targeted MVPA. It should just be aerobic exercise when targeting the 150 min/wk. The exercise programs for all groups/modules should be volume matched. Did participants keep a training diary? Were there taught how to monitor exercise intensity?

Line 154: “…other modules were not selected was collected…”

Line 159: “…but internally…”

Line 189: “One-hundred and four…”

Line 199: “There were no smokers…”

Line 211: “…and T2..”

Lines 220-222: You cannot make a comparison to ACSM since the guidelines are based on structured exercise and not sports/recreational activities that are included in the scoring of the Godin-Shephard Leisure-Time Questionnaire.

Line 230: “..was the flexibility…”

Line 235: “Sixteen percent of YA…”

Line 267: “..indicated a significant…”

Line 276: “…pandemic influenced…”-

Lines 304-307: In the Introduction, you mentioned the issue of no specific exercise guidelines for YA. So how can you conclude that the YA is not achieving an acceptable level of PA? Additionally, you are using the ACSM recommendations and comparing the results of the Godin-Shephard Leisure-Time Questionnaire – which I already mentioned is problematic.

You need to describe how you counted resistance training when calculating PA levels. This is important since the ACSM treats aerobic exercise separately from resistance training when recommending target thresholds.

Line 339: “…advice by exercise trainers.”

Line 384: “….training interventions on treatment related…”

Line 387: “…had not been individual enough.”

Line 402: “..only asked..”

Line 406: “..after we had started the patient recruitment.”

Line 419: “…programs in YA are yet to be evaluated and should…”

Lines 420-421: This sentence needs to be revised since it is poorly worded.

Line 423: “..long-term adherence of YA)..”

Line 431: “..alternative to existing exercise options.”

 

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 4 Report

This is an exceptional paper which must be published. I only suggest to remove the 100% from the table 3. 

Author Response

Thank you for your positive feedback! We revised table 3 as suggested.

Round 2

Reviewer 3 Report

Well done on addressing my comments and improving the quality of your manuscript.