Evaluation of Whole-Body Vibration Exercise on Neuromuscular Activation Through Electromyographic Pattern of Vastus Lateralis Muscle and on Range of Motion of Knees in Metabolic Syndrome: A Quasi-Randomized Cross-Over Controlled Trial
, Laisa Liane Paineiras-Domingos 1,2,3, Ygor Teixeira-Silva 1,2, Thais Amadeu 1, Adriana Pereira da Silva LÃrio 2, Arlete Francisca-Santos 2, Luiz Felipe Ferreira De Souza 2, Mario José dos Santos Pereira 2, Maria Eduarda Souza Melo-Oliveira 2,4, Alexandre Gonçalves de Meirelles 2,4, Glória Maria Guimarães-Lourenço 2,4, Aline Reis-Silva 2,4, Eloá Moreira-Marconi 2,5, Marcia Cristina Moura-Fernandes 2,5, Vinicius Layter Xavier 6, Alessandra da Rocha Pinheiro Mulder 7, Ana Cristina Rodrigues Lacerda 8, Vanessa Amaral Mendonça 8, José Alexandre Bachur 9, Redha Taiar 10,*, Alessandro Sartorio 11, Danúbia da Cunha de Sá-Caputo 1,2,3 and Mario Bernardo-Filho 2add
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Round 1
Reviewer 1 Report
Dear authors:
It has been a pleasure to review your paper about “Evaluation of whole-body vibration exercise on neuromuscular activation through electromyographic pattern of vastus lateralis muscle and on range of motion of the knees in metabolic syndrome individuals: a quasi-randomized and cross-over controlled trial.” but I have observed a few of methodology doubts that it’s necessary to change before to accept it
You can see below the recommendation
In section method
How did you calculate the sample size, can you improve it in the text? It’s not very clear
How did you do the randomization? Can you clarify in the text
Regarding the outcomes, Can you include the information about the intra-rater reliability of experienced raters?
Can you include a paragraph with the clinical implication of the results?
Author Response
Dear reviewer, thank you for your considerations. Below are the answers to your considerations.
1- How did you calculate the sample size, can you improve it in the text? It’s not very clear
Answer: The text has been rewritten from: For a statistical power of 95 %, sample size of 13 subjects was calculated to be required based on the sample size determinants in health studies by the Laboratório de Epidemiologia e Estatística (Lee), Faculdade de Medicina, USP, São Paulo, Brazil (Brazil).
To: The sample size calculation was calculated based on a study by Sá-Caputo et.al 2014, involving individuals with MetS submitted to WBV exercise based on the determinants of sample size in health studies by the Laboratório de Epidemiologia e Estatística (Lee), Faculdade de Medicina, USP, São Paulo, Brazil using the site: http://www.lee.dante.br/p Pesquisa.html. For a statistical power of 95%, the sample size of 13 individuals was calculated.
2- How did you do the randomization? Can you clarify in the text
Answer: The text has been rewritten from: This study was a quasi-randomized and cross-over controlled trial, approved by the Research Ethics Committee of the Hospital Universitário Pedro Ernesto (HUPE),Universidade do Estado do Rio de Janeiro (UERJ) with the number CAAE 54981315.6.0000.5259, and registred in the Registro Brasileiro de Ensaios clínicos - ReBEC: RBR 2bghmh.
To: This study was a quasi-randomized and cross-over controlled trial. Individuals were allocated in order of arrival by researcher. This work was approved by the Research Ethics Committee of the Hospital Universitário Pedro Ernesto (HUPE),Universidade do Estado do Rio de Janeiro (UERJ) with the number CAAE 54981315.6.0000.5259, and registred in the Registro Brasileiro de Ensaios clínicos - ReBEC: RBR 2bghmh.
3- Regarding the outcomes, Can you include the information about the intra-rater reliability of experienced raters?
.Answer: all procedures were performed by health professionals previously trained by experienced rates to perform this protocol. Intra-rater reliability did not performed.
4- Can you include a paragraph with the clinical implication of the results?
Answer: Some limitations of this study should be pointed out, such as the relatively small number of participants, but the statistical power was 95 %. Moreover, although we evaluated both lower limbs, we did not register which lower limb was the dominant one. Nevertheless, there is a strength of this work that is the improvement of the increase of the neuromuscular activity and this finding would have a positive clinical implication improving the daily activities in individuals with MetS.
Best regards.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The authors concentrated on neuromuscular effects of whole body vibration exercises in obese patients with diagnosis of metabolic syndrome (MetS).
The study aim and methodology are very interesting. Motor limitations in obese subjects are indisputable and all safe and effective procedures improving their joint mobility and flexibility are crucial.
There are some limitations and inconsistencies:
1) The authors informed (lines 136-137) that "After two-months
washout, the subjects were enrolled to the other group [41]." Could you explain this statement?
2) Could you add a figure/figures presenting the whole body vibration exercise and the vibrating platform?
3) The authors compared %RMS in the first session (Table 5), in the last session (Table 6) and cumulative effects (Table 7) between two groups (CG and TG). Could you compare the range of the motion (ROM) of the right and left knees, especially:
a) before the first session
b) after the last session
c) cumulative effects
between two studied groups?
4) Could you check your statement (lines 207-208) that: "an improvement of 7.4 and 14.4 on the ROM was observed in the TG on the left and right knees, respectively"? (in my calculation: 7,5 and 13,5, respectively)
5) The authors informed (lines 182-183) that "The %RMS to the cumulative effect was calculated dividing the value of the RMS before the last session and the first session multiplied by 100". Could you check these results (Table 7)? Calculations of mean values are very different from the results in the table. For example: cumulative effects of %RMS on the right VL muscle in the CG group was 101,74 (vs. 99.38), whereas on the left VL muscle in the TG group was 111.9 (vs. 100.6).
6) Please use "Instruction for Authors" for all references.
Author Response
Dear reviewer, thank you for your considerations. Below are the answers to your considerations.
1) The authors informed (lines 136-137) that "After two-months
washout, the subjects were enrolled to the other group [41]." Could you explain this statement?
Answer: We added the complementary information: “ the period of time between the two intervention”
2) Could you add a figure/figures presenting the whole body vibration exercise and the vibrating platform?
Answer We added two figures. Figure 1 with the line 154-155, individual seated in a chair and figure 2 in line 164-165, with indivudual in squat position.
3) The authors compared %RMS in the first session (Table 5), in the last session (Table 6) and cumulative effects (Table 7) between two groups (CG and TG). Could you compare the range of the motion (ROM) of the right and left knees, especially:
a) before the first session
b) after the last session
c) cumulative effects
between two studied groups?
Answer We added the complementary information in the lines, 183-188; 223-226; 232-235 and 242-245 about this consideration.
4) Could you check your statement (lines 207-208) that: "an improvement of 7.4 and 14.4 on the ROM was observed in the TG on the left and right knees, respectively"? (in my calculation: 7,5 and 13,5, respectively)
Answer: It was corrected.
5) The authors informed (lines 182-183) that "The %RMS to the cumulative effect was calculated dividing the value of the RMS before the last session and the first session multiplied by 100". Could you check these results (Table 7)? Calculations of mean values are very different from the results in the table. For example: cumulative effects of %RMS on the right VL muscle in the CG group was 101,74 (vs. 99.38), whereas on the left VL muscle in the TG group was 111.9 (vs. 100.6).
Answer: About this consideration we conected the value concerning the VL left in TG from 100.60 to 110.60 in the table 7. It was typo.
6) Please use "Instruction for Authors" for all references.
Answer: It was corrected
Best regards!
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Thank you for attempting to address some of my concerns.
Please compare the range of the motion (ROM) of the right and left kenes (i.e.
before the first session after the last session cumulative effectsbetween two studied groups (between CG and TG).
All seven tables do not have any changes.
Author Response
Open Review
(x) I would not like to sign my review report
( ) I would like to sign my review report
English language and style
( ) Extensive editing of English language and style required
( ) Moderate English changes required
(x) English language and style are fine/minor spell check required
( ) I don't feel qualified to judge about the English language and style
-Does the introduction provide sufficient background and include all relevant references?
Can be improved. We improved the introduction.
-Is the research design appropriate?
Can be improved. We improved the research design.
-Are the methods adequately described?
Can be improved. We improved the methods.
-Are the results clearly presented?
Must be improved. We improved the results.
-Are the conclusions supported by the results?
Can be improved. We improved the conclusion.
Comments and Suggestions for Authors
Thank you for attempting to address some of my concerns.
Please compare the range of the motion (ROM) of the right and left kenes (i.e. before the first session after the last session cumulative effects between two studied groups (between CG and TG).
All seven tables do not have any changes.
We added the solicited information.
Author Response File: 
Author Response.docx
