Impact of Aerobic and Strengthening Exercise on Quality of Life (QOL), Mental Health and Physical Performance of Elderly People Residing at Old Age Homes

Round 1

Reviewer 1 Report

The authors investigated the use of aerobic and strength training exercise on quality of life for elderly individuals within old age homes during COVID-19 restrictions. The authors found that aerobic and strength training improved mental health and quality of life in the elderly residing in old age homes. 

Overall comments: It was difficult to tell if this manuscript is intended to be descriptive in nature or to describe an intervention. The manuscript needs a more definitive direction. 

Line 50: QOL should be defined in the manuscript text not just the title. 

Line 118: Table 2 should be referred to somewhere in the text. 

Results section should have a line stating that all continuous data is reported as means and ±. Using this will improve the consistency of the manuscript. 

Table 3: data for 178 individuals is reported however only 39 participated in the intervention. A paired sample t-test was used to only look at those 39. Why include the rest of the prospective subject data? Additionally, table 3 could be reformatted for improved flow. The variable category could replace the column for number. 

Lines 136 - 141: This appears to be method related information and should be placed accordingly.

Lines 154- 157: This also appears to be method related information. 

Table 6: The column for number can be removed to simplify the table. 

Table 7: sample size and effect size should be included. 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

 

This study aims to assess the impact of aerobic and strengthening exercise on quality of life, mental health and physical performance of elderly people during covid-19 pandemic. The study is quite interesting and relevant due to the Covid 19. However, some important comments and raised issues should be addressed.

Abstract:

·       Line 18, add a dot after “most.”

Introduction:

·       Introduction is rather well written; however, the study rationale is unclear. You claim that: “There is limited scientific evidence reporting the experiences of elderly to date and QOL of elderly residing in old age home was not explored enough in Malaysia.” However, this paper is related to Covid 19 conditions. Therefore, the Introduction needs some literature review regarding the other countries’ exercise results in these conditions. Also, you need to provide what’s novel in your study compared to this. Otherwise, this study is related only to Malaysia, which is unsuitable for a wider audience.

·       Moreover, there is not a good lead-in to the study aims. What are the literature gaps that you are filling with this study?

·       Some corrections are also needed:

o   Please provide references for the sentence in lines 66-67 since you say, “Based on the data from the previous studies.”

o   Line 70, add a dot after reference 25.

 

Materials and Methods:

·       Was the protocol previously utilized? Please add a reference or elaborate further on why you chose this exercise protocol.

·       Why didn’t you include a control group for this experiment? For this type of study, the absence of the control group is a big downside. Please elaborate in detail on this. Also, add this to the study limitations paragraph.

·       Did you check for data normality? Since you used parametric techniques on the questionnaire data, adequate data normality test is necessary.

Results:

·       Table 6 should be replaced with the graph to visualize the results better.

Discussion:

·       Discussion is overall poorly written. You merely compare your results with other studies without providing some meaningful elaboration. Try more explaining and elaborating…try telling us the story while citing the essential references, rather than reporting and comparing the results. Ask why sometimes and elaborate on that. For example: “However, score difference before and after exercise was bigger in their findings (38.7 ± 5.6 and 33.7 ± 3.4) as compared to the current study (4.6 ± 2.9 and 2.8 ± 1.8)”. Why was that the case? 

·       Please add the study limitations paragraph.

Conclusion:

·       The authors should provide a more meaningful conclusion. In particular, what should practitioners do with these results? Add some specific recommendations.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

• "COVID-19 Pandemic" in the title is redundant and confusing, should be removed and only mentioned in the main text

• the characteristics of the group should concern only the 39 respondents who exercised - without the excluded people

• 139 people are people excluded from the study!

• lines 125-134 and table 3 are not the results, but the description of the research group and the excluded people - should be transferred

• lines 136-165 are also not direct results telling about the impact of exercise

• table 3: in my opinion "Race" and "Income" are irrelevant

• well-conducted discussion

• conclusion - the pandemic seems to be irrelevant

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

I would like to congratulate the authors on an excellent manuscript. I don't have any suggestions for improvements to make. The objectives are clear, the data treatment is adequate and the study design is satisfactory. The article is well written and direct. The conclusion is supported by the results and there is cohesion between the objectives, method, results, discussion and conclusion.

 

Congratulations

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Dear authors,

I am pleased with your answers and corrections. You did a great job. The only remaining concern is related to the statistics. Namely, if you found that distribution is not normal, which is usually for this kind of data, you should have performed non-parametric statistics. In this case, the Mann-Whitney U test, not T-test. Also, add in the Statistics paragraph that you have performed a data normality check.

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

table 3 is still in the results section - this is not the right place

Author Response

table 3 is still in the results section - this is not the right place

Response: Table 3 was removed from the results and explained in the Materials and Methods.