Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The sample size is quite small which is quite common in such studies.  Despite this a significant effect is detected in several of the responses.  The analysis for each response is a paired t-test which is appropriate but a more detailed analysis could be used that accounts for patient baseline characteristics and disease severity.  A larger sample size would be desirable for a modelling approach to have sufficient power.  This could be considered by the authors if a larger definitive trial is to be undertaken as useful estimates can be gleaned from this paper to calculate the required sample size.  The paper would benefit from a case profile plot showing the values of reach response pre and post and a boxplot of the improvement in each response.  The summary statistics should include the mean difference and more importantly the standard deviation of the difference (Post-Pre) for each response as these will be useful for others using this paper to design similar future studies.

Author Response

Dear Reviewer,

We appreciate the opportunity to implement the changes proposed, thereby improving our manuscript. The modifications have been marked in green for easier review. Additionally, we have included graphs, which we believe enhance the interpretation of the results.

Best regards,

Sandra Fonseca

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper does not add anything important to the subject. First, there are too few participants thus leading to non significance of the results. The main problem in the theory of beneficial effect of exercise is that randomized prospective studies are difficult , or impossible, to perform. The "effects" of exercise may be due to participants' selection or a placebo effect.

This paper can be considered for publication if the number of participants increases significantly and a control group will be designated.

Author Response

Dear Reviewer,

We appreciate the opportunity to implement the changes proposed, thereby improving our manuscript. The modifications have been marked in green for easier review. Additionally, we have included graphs, which we believe enhance the interpretation of the results.

Best regards,

Sandra Fonseca

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Authors present a work addressing: ‘.The Impact of Physical Exercise on Quality of Life, Self-Esteem,  and Depression in Breast Cancer Survivors’. The aim of the study was to analyze the effect of a physical exercise program on quality of life, self-esteem and depression in breast cancer survivors. The general conclusion demonstrates that healthcare professionals should promote physical exercise to improve health outcomes before, during, and after treatment. However, I will consider endorsement of paper after some major issues have been addressed:

Major:
1. What is the novelty of this study? and how your outcomes can help further studies in this area. Please add a brief explanation of the novelty of this study in the introduction section.
2. Based on the reference list, the novelty of the study can be doubted, as only 3 (6.66 %) (3 out of 45) references are from the last 5 years, while 33 (73.3 %) references are published before 2015.
3. In the introduction, the authors should add information about the biological and histopathological characteristics of breast cancer.
4. Please provide clinical data of patients in tabular form, including tumor staging, grade, tumor size, lymph node status, biological cancer characteristics, etc.
6. In Tables 1 and 2, decimal values ​​should be presented after a dot, not a comma.
7. I believe that conclusions should be written in a speculative manner, because solid conclusions cannot be drawn based on a study group of 13 breast cancer patients.
8. Please in discussion section add paragraph related to how we can applicate your results into practice?, why your work is valuable in the field? and how can we generalize the results?
9. The authors should expand on the study limitations and add future perspectives in the study.

Comments on the Quality of English Language

Moderate editing of English language required.

Author Response

Dear Reviewer,

We appreciate the opportunity to implement the changes proposed, thereby improving our manuscript. The modifications have been marked in green for easier review. Additionally, we have included graphs, which we believe enhance the interpretation of the results.

Best regards,

Sandra Fonseca

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have implemented my suggestions, thus I suggest to publish the manuscript in its current form.