Meeting 24 h Movement Guidelines and Health-Related Quality of Life in Youths during the COVID-19 Lockdown

Round 1

Reviewer 1 Report

The manuscript deals with a topic of great interest for today's society; the authors are to be congratulated for this initiative by carrying out the experience in two countries in Europe and America.

The following are some suggestions for improvement of the article.

 

1. Introduction

The authors briefly describe the notion of health and indicate that it is a subjective, individual state. However, the study has been carried out through the responses of the relatives of the persons analysed. The perception of the family members may not fully correspond to that of the participants themselves.

The concept of health considers different dimensions: Physical, mental, emotional and social. 

In the theoretical framework, it should have been better explained how each of these dimensions is presented in the case of children and adolescents. If there are studies that have generated evidence on each of these aspects in people aged 3 to 17 years.

In the theoretical framework, the relationship between the variables used in the methodology and results section should be better explained:

- Cultural Environment. Brazil and Spain (nationality). Each of these countries can give rise to very unequal geographical, cultural and economic realities. The environment to be considered should be better contextualised. And in this environment, it should be justified what is the usual situation of the notion of integral well-being of people of these ages.

- Social and economic environment. It should be considered that it is not the same to carry out the study in a rural area as in an urban area, in an area where people live outdoors as in enclosed spaces. This has not been mentioned in the theoretical framework.

- Sex and age. Sex is a variable that should be developed comprehensively, as is age. At some ages, differences may be more pronounced than at others. The authors carried out the study in a very varied range from 3 to 17 years of age. The results should have been grouped by age groups.

- Background or habits of physical activity and sport. We do not know what type of activity the participants studied were engaged in, to be able to compare before and after. This is another limitation of the study.

- Diet or anthropometric data. It should be developed too. 

 

2. Methodology.

The process followed to identify the questions should be explained. If it went through any expert judgement. In addition, the questions should have a direct relationship with the main concepts considered in the theoretical framework and the discussion.

 

3. Discussion

The first paragraph should recall the objectives of the study

To be coherent with the notion of well-being or integral health, the discussion should be based on the relationship of the different physical, mental, emotional and social dimensions with the variables developed in the theoretical framework.

 

 

Author Response

The response to Reviewer 1 is in the attached file. 

Author Response File: Author Response.docx

Reviewer 2 Report

This paper examines the association between meeting 24-h movement behaviour guidelines and HRQoL (Health related Quality of Life Measurement) during the COVID-19 lockdown among a sample of 3-17 years old children and adolescents in Spain and in Brazil. Data was obtained by administering online questionnaires through a snowball sampling strategy to collect parents or guardians about physical activity, screen time and sleep duration in the very first period of the pandemic. Parents’ nationality, socioeconomic status (assessed with the Family Affluence Scale—FAS-III), educational level, age and sex of their children, anthropometric data (height and weight) were also collected as covariates for the models employed. This study hence represents the first analysis of association between meeting 24-h movement behaviour guidelines and HRQoL in a young population during the COVID-19 pandemic.

There are some important doubtful points regarding this work, namely:

-       it is not specified whether during the period under consideration children and adolescents who went to school attended the lessons face-to-face or electronically or did not follow them at all and therefore if part of the time spent in front of the screen was dedicated to this occupation

-       though using models that are adjusted for nationality, only aggregated results are considered while it would be interesting to show also possibly different or homogeneous behaviors in the two Countries

-       only fully adjusted models are shown, while a preliminary assessment of the association of covariates with the endpoints should be checked

-       even though a comment on this issue is included in the Conclusions, further analyses and considerations could be added concerning cause and effect relationships of the factors considered  

Provided that these issues can be taken into consideration, some major and minor comments to consider are listed below.

Major comments

-       Lines 119-121: explain why two different sources are employed for ST guidelines

-       Line 150: use median and range or explain why mean and standard deviation have been used instead

-       Line 154-156: it is not clearly explained, since fulfilling none, one, two or three guidelines is treated separately

-       Table 1: there is no reason to report mean height and weight since subjects are of different very young or young age; maybe they could be reported for each category

-       Line 170 and Figure 1 caption: change “prevalence” in “distribution”

-       Line 177: specify the model used to obtain the results

-       Lines 177-178: do results refer to “just one” and “exactly two” as in Figure 2 captions or, as it is written above, to “at least one” and “at least two”? Of course the interpretation is much different in the different cases.

-       Line 185, Figure 2: Why p-values for intermediate differences are not reported? It would be an interesting result even though they were not significant.

-       Line 188: specify the model used to obtain the results

-       Figure 3: please explain in detail in the text why the OR’s in panel a) are all equal to 1.

Please order the levels of meeting 24-h movement behaviours guidelines in panel e) in the same way as for all the other panels.

-       Lines 189-191: explain why results for the association between meeting all the guidelines and problems in dif- 192 ferent dimensions of HRQoL are reported only in this case

-       Lines 202-203: It would be advisable to detail a quantitative comparison, not only a qualitative one

-       Line 220 and Lines 235-237: The order of cause-effect is not clear, it should at least be pointed out

Minor comments

-       Line 143: change “covariables” in “covariate”

-       Line 154: here and everywhere write “p < 0.05” and not “p<0.05”

-       Line 170 and Figure 1 caption: change “prevalence” in “distribution”

-       Line 192, Figure 3 caption: describe what is shown (OR’s and their CI’s).

-       Line 250: change “participants” in “subjects enrolled”

Author Response

The response to Reviewer 2 is in the attached file. 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

After reviewing the latest version and reading the authors' arguments, I am of the opinion that the current version of the manuscript could now be accepted.

Author Response

We would like to thank the reviewer for the opportunity to improve our manuscript. 

Reviewer 2 Report

Though the manuscript has been improved, a few remarks have still to be addressed to define its final version:

-        Line 155 p. 4: explain better what is meant, mean differences are not assessed according to the meeting of all three guidelines, but with respect to meeting a higher or lower number of guidelines

-        Table 1: mean weight and height are not meaningful in this framework since growing children and adolescents are being considered, for whom such features are intrinsically different among age classes

-        Figure 3: OR for mobility features that are all exactly equal to 1 are at least strange and not very credible hance they cannot be kept in this form, please verify and possibly modify the presentation concerning this point

-        Line 195 p. 6: modify 1-20-5.95 in 1.20-5.95

Author Response

The report has been uploaded.

Author Response File: Author Response.docx