Potential Benefits from Physical Exercise in Advanced Cancer Patients Undergoing Systemic Therapy? A Narrative Review of the Randomized Clinical Trials

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study maintains that it provides a scoping review (ScR) of the literature regarding the effects of physical exercise in advanced cancer patients who are undergoing therapy focusing on randomized controlled trials.

The author needs to make sure that, first, the rationale for conducting a ScR rather than a systematic review is clearly discussed.

Second, in the case that the conduct of a ScR is warranted, the methodology used needs to reflect all of the procedures (such as those at the screening, selection… phases) that are clearly explained in ScR guidelines that exist in the literature.

Author Response

I agree that the paper may not meet the criteria of a Scoping review, hence I have  preferred to change the title, replacing the word “Scoping” with “Narrative”

Reviewer 2 Report

Comments and Suggestions for Authors

Interesting, well-documented study that brings clarifications regarding the importance of physical exercise in cancer patients undergoing medical oncologic treatment.

I would like to suggest some clarifications:

Lines 170 – 176 (correlated to lines 207-211)  – Please explain in more detail how you got to these results.

Line 180 - Perhaps it should be explained why only publications from the last 2 years were considered.

In conclusion: I appreciate the study's strengths and also the recognition of its limits (lines 218-219, and 271-271).

Author Response

1. Lines 170 – 176 (correlated to lines 207-211)  – Please explain in more detail how you got to these results.

REPLY: I have added the following  sentences just after table 4 to better explain the findings of the tables 3 and 4:

“However, we were not able to find any data indicating that  duration of the exercise as well as administration of a nutritional supplementation can affect the results.  With reference to the duration of the exercise, both positive and negative results were achieved in quite similar time frames. The different methodology of exercise and the impact of different regimens of chemotherapy can account for the difficulty of assessing the more advantageous approach.”

 

2. Line 180 - Perhaps it should be explained why only publications from the last 2 years were considered.

REPLY: There is a misunderstanding: we considered all RCTs quoted in the reviews published in 2022  and early 2023,   assuming that these reviews being  the most recent are comprehensive of all literature, than  we scrutinized all RCT in the remaining 2023 and 2024.

Reviewer 3 Report

Comments and Suggestions for Authors

I am not sure what the purpose of this paper really is. it felt like a bit of a 'fishing expedition' with little clarity in the purpose, desired outcomes, method, and conclusions.

It is unclear as to what is considered 'advanced cancer'. Tables are not well presented and there is a lot of missing data from the studies reviewed.

Muscle function seems to be assessed in a myriad of ways and presented as a single 'measure'. 

There is no clear search structure described.

Tables are difficult to read and outcomes are too varied for relevant comparisons.

Comments on the Quality of English Language

The English needs work. It is not particularly well written and hard to read.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thanks to the author for changing the title and replacing “scoping review” with a “narrative review”. However, the body of the manuscript also needs to be revised and any reference to a “scoping review” needs to be eliminated.

Author Response

-I was uncertain whether to delete the references of the reviews which were the main source of the papers I reanalyzed because they are mentioned in the article and the readers, if they like it, can retrieve  them and see the difference (and the originality)  of the key message of my article as compared with previous analyses. 

Under this perspective, this represents a "plus" of my analysis when compared with the previous ones.   - Finally I added some sentences to better explain , as required, the inclusion criteria of all the papers I have analysed.

Reviewer 3 Report

Comments and Suggestions for Authors   I am happy for the revision to be accepted and published in its current form.

Author Response

Thank you for your feedback.