Review Reports - Challenges to Physical Activity Participation Among Older People Living with HIV: Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

please see the attached report.

Comments for author File: Comments.pdf

Author Response

Comment 1: Clearly acknowledge the limited inclusion of studies from sub-Saharan Africa, emphasizing its relevance for the generalisability of findings

[Response 1]: Thank you for pointing this out, we agree with this comment and have included this limitation in the results section on Page 1, lines 27-28.

[Comment 2]: In the introduction explicitly state the implications of identifying barriers to physical activity for public policy and community interventions that target OPLWH

[Response 2]: Thank you for pointing this out. We agree with this comment and have stated these implications of physical activity for public policy and programmes, Page 3, lines 107 to 108

[Comment 3]: In the methods section, clearly indicate reasons for the non-retrieval of certain studies (n=48) as stated in the PRISMA flow chart

[Response 3]: Thank you for pointing this out. The reason for the non-retrieval of articles has been explained in lines 200 to 201 on Page 6. Other reasons for non-retrieval had also been included on lines 202 to 204, Page 6.

[Comment 4]: Provide justification for the exclusion of grey literature, clarifying how this decision influences the scope and interpretation of findings

[Response 4]: Thank you for pointing this out: The reason for excluding grey literature and how it affects the study breadth and findings has been explained in lines 132 to 134 of Page 4.

[Comment 5]: In the results section, conditions such as diabetes and hypertension described by Bernard et al. 2021 are they directly or indirectly related to reduced physical activity?

[Response 5]: Bernard et al. 2020 note that OPLWH who had conditions such as diabetes, hypertension, and abdominal obesity had low physical activity performance. The authors do not state that these conditions directly or indirectly affect physical activity performance and further discuss that other studies like Green et al. (2014), Crane et al. (2019), and Guralink et al (1994) have also found that the presence of comorbidities is associated with poor physical activity.

[Comment 6]: Specify clearly the proportions of OLPWH with multimorbidity in Table 2 and discuss their impact on outcomes.

[Response 6]: Thank you for pointing this out, we agree with the comment. Table 2 has been corrected, pages 11-12 and the impact of the multimorbidity has been discussed in the outcomes, pages 13 and 14.

[Comment 7]: Consider adding a visual figure or a conceptual table to succinctly illustrate the relationships between the individual factors and the community/environmental factors

[Response 7]: Thank you for pointing this out. We agree with the comment, and a conceptual figure has been added that shows the relationship between the individual and community challenges. Page 17 lines 449 to 458.

[Comment 8]: Offer explicit, actionable, recommendations for community interventions to specifically mitigate HIV-related stigma

[Response 8]: Actionable recommendations have been offered on Page 18, lines 495 to 497.

[Comment 9]: highlight the necessity for further research to address regional differences, particularly comparing African contexts with findings from North America and Europe.

[Response 9]: Thank you for pointing this out. We have included the need for further research to compare findings from lines 482 to 485, page 18.

[Comment 10]: In the conclusion explicitly suggest actionable strategies or solutions to identified barriers especially stigma clearly reiterate the need for additional studies from sub-Saharan Africa.

[Response 10]: Thank you for pointing this out, the recommendations have been included in the conclusion, from line 533 to 537, page 19

Minor comments

[Comment 11]: Perform a thorough proofreading to correct minor grammatical errors and repetitive citations.

[Response 11]: Thank you for pointing this out. We agree with the comment; The manuscript has been proofread, and professional editing services have been sought.

[Comment 12]: Enhance readability in section 3.6, pages 13-16, by incorporating further subheadings

[Response 12]: Thank you for pointing this out. We agree with the comment. Additional subheadings have been included in section 3.6, pages 13 to 16.

References

[Comment 13]: Suggest adding further references on practical intervention strategies aimed at vulnerable populations living with HIV and AIDS

[Response 13]: Thank you for pointing this out. We agree with this comment. Additional references have been added that support the implementation of strategies to support vulnerable people on page 18, line 497, and in the reference list on page 25, lines 768-774.

Reviewer 2 Report

Comments and Suggestions for Authors

This manuscript addresses an important and timely topic, focusing on the challenges faced by older people living with HIV when engaging in physical activity. This work is generally well-organized, scientifically rigorous, and methodologically sound. The use of the Joanna Briggs Institute framework and alignment with the PRISMA guidelines enhances the credibility of the review. This study fills a notable gap in the literature, particularly by focusing specifically on OPLWH, a population often underrepresented in physical activity research.

However, I offer the following detailed suggestions to further strengthen the manuscript:

1. Clarity and Flow of Writing

Comment: Some sections are overly verbose or repetitive and would benefit from concise rephrasing to improve clarity.

Example:
Lines 32–36:

“Physical activity among older people living with Human Immunodeficiency Virus (HIV) is an essential self-care activity shown to have several benefits. Older People Living with HIV (OPLWH), in particular, benefit from physical activity as they are at risk of developing age-related chronic illnesses…”

Suggestion: The repetition of "benefit from physical activity" can be reduced by rephrasing the second sentence to avoid redundancy.

2. Structure and Organization

Comment: The thematic structure is clear, but transitions between sections, and especially from methods to results, could be improved for a smoother flow.

Example:
Line 171 ("3. Results"), in line 176:

“After removing duplicates and other articles that did not meet the inclusion and exclusion criteria, 1291 articles were screened...”

Suggestion: Add a bridging sentence at the start of the "Results" section to clarify how the methodology led to these results.

3. Literature Contextualization

Comment: The review acknowledges the underrepresentation of sub-Saharan Africa but could provide a more in-depth exploration of the reasons behind this underrepresentation.

Example:
Lines 455–459:

“Although most studies are from areas outside sub-Saharan Africa, this also illustrates the pertinence of the issue across different geographical settings…”

Suggestion: Consider adding a brief explanation of potential systemic barriers (e.g., funding, publication access, language) that limit research in African contexts.

4. Methodological Transparency

Comment: The process for resolving disagreements between reviewers is vague and can be elaborated upon.

Example:
Line 146:

“Two reviewers screened articles for selection and any disagreements were discussed.”

Suggestion: Specify how disagreements were resolved (e.g., through consensus, third-party adjudication).

5. Tables and Data Presentation

Comment: The tables are comprehensive, but visually dense.

Example:
Table 1 (Lines 234–235): The amount of text in the “Outcome to the scoping review” and “Overall Appraisal Decision” columns makes it difficult to scan.

Suggestion: Consider using bullet points or bolded keywords for key themes such as "Pain," "Stigma," or "Lack of motivation" to enhance usability.

6. Discussion and Implications

Comment: The discussion is insightful, but could go further in practical recommendations.

Example:
Lines 510–522:

“From this review, a critical literature gap requiring further research was identified of additional studies on experiences at the gym in sub-Saharan Africa…”

Suggestion: This could be followed by actionable recommendations such as: "Community-based intervention programs tailored to the needs of OPLWH should consider inclusive gym environments and anti-stigma education campaigns."

7. Limitations

Comment: The current limitations section is underdeveloped.

Example:
Lines 524–525:

“The review was limited by the inadequate representation of studies from sub-Saharan Africa…”

Suggestion: This section was expanded to include (1) language restriction to English, (2) exclusion of grey literature, and (3) potential bias due to database selection.

8. English Language and Style

Comment: The English is generally clear but contains several long, complex sentences that could be simplified.

Example:
Line 164:

“Data extraction also included findings relative to this review.”

Suggestion: Rephrase to: “Findings relevant to the review questions were also extracted.”

Author Response

[Comment1]: Some sections are overly verbose or repetitive and would benefit from concise rephrasing to improve clarity.

Example:
Lines 32–36:

Suggestion: The repetition of "benefit from physical activity" can be reduced by rephrasing the second sentence to avoid redundancy.

[Response 1]: Thank you for pointing this out, we agree with the comment, the document has been proofread, we have also used professional editorial services to refine the language. The first sentence has been changed on page 1, lines 33-34.

[Comment 2]:

Comment: The thematic structure is clear, but transitions between sections, and especially from methods to results, could be improved for a smoother flow.

Example:
Line 171 ("3. Results"), in line 176:

“After removing duplicates and other articles that did not meet the inclusion and exclusion criteria, 1291 articles were screened...”

Suggestion: Add a bridging sentence at the start of the "Results" section to clarify how the methodology led to these results.

[Response 2]: A transition sentence has been added between the results and the methods section. Line 169, page 5.

[Comment 3]:

Literature Contextualization

Comment: The review acknowledges the underrepresentation of sub-Saharan Africa but could provide a more in-depth exploration of the reasons behind this underrepresentation.

Example:
Lines 455–459:

“Although most studies are from areas outside sub-Saharan Africa, this also illustrates the pertinence of the issue across different geographical settings…”

Suggestion: Consider adding a brief explanation of potential systemic barriers (e.g., funding, publication access, language) that limit research in African contexts.

[Response 3]: Thank you for pointing this out, I agree with the comment. A possible explanation for low representation of studies in Southern Africa has been provided. Lines 469 to 471, page 17.

[Comment 4]:

Comment: The process for resolving disagreements between reviewers is vague and can be elaborated upon.

Example:
Line 146:

“Two reviewers screened articles for selection and any disagreements were discussed.”

Suggestion: Specify how disagreements were resolved (e.g., through consensus, third-party adjudication).

[Response 4]: Thank you for pointing this out, I agree with the comment. How disagreements were resolved has been addressed. Page 4, lines 140-141

[Comment 5]:

Comment: The tables are comprehensive, but visually dense.

Example:
Table 1 (Lines 234–235): The amount of text in the “Outcome to the scoping review” and “Overall Appraisal Decision” columns makes it difficult to scan.

Suggestion: Consider using bullet points or bolded keywords for key themes such as "Pain," "Stigma," or "Lack of motivation" to enhance usability

[Response 5]: Thank you for pointing this out. I agree with the comment, bullet points have been used to show themes, the column of overall appraisal decision has been removed to reduce the density of the tables, since all studies were included, this was added to the paragraph summarising the outcomes from the appraisal of studies. Pages 7-9

[Comment 6]:

Comment: The discussion is insightful but could go further in practical recommendations.

Example:
Lines 510–522:

“From this review, a critical literature gap requiring further research was identified of additional studies on experiences at the gym in sub-Saharan Africa…”

[Response 6:] Thank you for pointing this out. I agree with the comment, and amendments have been made to show actionable recommendations lines 495 to 495, page 18.

[Comment 7]:

Limitations

Comment: The current limitations section is underdeveloped.

Example:
Lines 524–525:

“The review was limited by the inadequate representation of studies from sub-Saharan Africa…”

Suggestion: This section was expanded to include (1) language restriction to English, (2) exclusion of grey literature, and (3) potential bias due to database selection.

[Response 7]: Thank you for pointing this out. We agree with the comment. We have added to the limitations section as suggested. Page 19, lines 541 to 544.

[Comment 8]:

English Language and Style

Comment: The English is generally clear but contains several long, complex sentences that could be simplified.

Example:
Line 164:

“Data extraction also included findings relative to this review.”

Suggestion: Rephrase to: “Findings relevant to the review questions were also extracted.”

[Response 8]: Thank you for pointing out this issue. The manuscript has been proofread, and the authors have sought professional editing services to improve the quality of writing. The sentence has been corrected, line 158, page 4.

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Editor

Thank you for selecting me as a reviewer

The title is very vague and it is not clear what it examines

The introduction is very scattered and long. The introduction could be written better and should be connected

What were the criteria and quality of the articles entering and leaving?

Information should be given about AIDS and the role of exercise in reducing or reducing it should be improved

The mechanisms of the effect of exercise on AIDS should be determined.

Author Response

[Comment 1]: The title is very vague and it is not clear what it examines

[Response 1]: Thank you for pointing this out. The title has been changed to make it clearer and concise. Page 1 line 2

[Comment 2]: The introduction is very scattered and long. The introduction could be written better and should be connected

[Response 2]: Thank you for pointing this out. We agree with the comment. The introduction has been proofread and written more concisely. The services of a professional editor have also been sought. Pages 1-3.

[Comment 3]: What were the criteria and quality of the articles entering and leaving?

[Response 3]: The eligibility criteria are stipulated on page 4, lines 128-134. The quality of the selected articles is also described on page 10, lines 227 to 234, and this is included as Additional file C.

[Comment 4]: Information should be given about AIDS and the role of exercise in reducing or reducing it should be improved.

[Response 4]: Thank you for pointing this out. We agree with the comment. Information on how physical activity impacts people living with HIV is outlined in the introduction. Page 2. Lines, 46 to 50.

[Comment 5]: The mechanisms of the effect of exercise on AIDS should be determined.

[Response 5]: Thank you for pointing this out; however, this study was limited to describing the challenges experienced by OPLWH in performing physical activity; it was beyond the scope of the study to determine the mechanisms of the effect of exercise on AIDS. We will consider conducting this as a study in the future.