Physical Activity Habits of Latvian Nursing Students: A Cross-Sectional Study

Round 1

Reviewer 1 Report

1. Instead of  “promote the PA of nurses”, consider using “promote PA among nurses”.

2. In the Introduction section, the authors mentioned that a longitudinal cohort study had been initiated. The authors may consider introducing the plan of using longitudinal data in the future. 

3. In the Methods section, the authors stated, “Most participants were young (18-24 years old) single female students without children living in households where the average monthly income for the family member is EUR 500 - 1200.” However, the results do not support this argument. Table 1 shows the results of each demographic characteristic one by one. So the authors can only say there were more younger students than older students, more single than married, and more females than males, etc. But it does not mean that most participants have all these characteristics simultaneously.

4. “According to the WHO recommendations [27], adults should have at least 150–300 or more minutes of moderate-intensity aerobic activities per day, or 75–150 or more minutes of high-intensity aerobic activities per day” 

This is not correct. According to WHO, adults aged 18–64 years should do at least 150–300 minutes of moderate-intensity aerobic physical activity; or at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week. So it should be “per week” instead of “per day”

https://www.who.int/news-room/fact-sheets/detail/physical-activity

5. The cross-sectional analysis is a limitation of this study, especially considering the fact that longitudinal data is potentially available.

6. The results of this paper lack clear policy implications.

Author Response

Thank you for the opportunity to revise our manuscript “Physical activity habits of Latvian nursing students”. The suggestions offered by reviewer have been immensely helpful and we appreciate insightful comments on revising our manuscript.

We included reviewer’ comments immediately after this letter and responded to them individually, indicating exactly how we addressed each concern or problem and describing the changes we have made. The revisions have been approved by all authors. The changes are highlighted within the document by using the track changes mode in MS Word or coloured. The English language of our manuscript was edited by native speaker.

Sincerely,

Maksims Zolovs

………

Reviewer 1

Comment 1: Instead of “promote the PA of nurses”, consider using “promote PA among nurses”.

Response: The suggestion was taken into consideration.

Comment 2: In the Introduction section, the authors mentioned that a longitudinal cohort study had been initiated. The authors may consider introducing the plan of using longitudinal data in the future.

Response: Every year, using the same research instrument, the same nursing students will be surveyed with the aim of determining and analyzing the PA habits among Latvian nursing students to provide a reliable research base for policy makers and interested parties. Currently only data of the cross-sectional investigation are available, but in future longitudinal study will look at physical activity changes of the 1. study year students over whole study period in universities.

Comment 3: In the Methods section, the authors stated, “Most participants were young (18-24 years old) single female students without children living in households where the average monthly income for the family member is EUR 500 - 1200.” However, the results do not support this argument. Table 1 shows the results of each demographic characteristic one by one. So, the authors can only say there were more younger students than older students, more single than married, and more females than males, etc. But it does not mean that most participants have all these characteristics simultaneously.

Response: The statement about demographic characteristics of participants has been corrected.

Comment 4: “According to the WHO recommendations [27], adults should have at least 150–300 or more minutes of moderate-intensity aerobic activities per day, or 75–150 or more minutes of high-intensity aerobic activities per day”

This is not correct. According to WHO, adults aged 18–64 years should do at least 150–300 minutes of moderate-intensity aerobic physical activity; or at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week. So it should be “per week” instead of “per day”

https://www.who.int/news-room/fact-sheets/detail/physical-activity

Response: The mistake has been corrected

Comment 5: The cross-sectional analysis is a limitation of this study, especially considering the fact that longitudinal data is potentially available.

Response: This is the first publication where data were analysed based on the first study. Currently there are no available other data, the new data from the same respondents are being collected now during this Autumn.

Comment 6: The results of this paper lack clear policy implications.

Response: As nurses are the main point of contact with patients in primary health care in Latvia and their task is to promote health, they must also lead by example. Since no such studies have been conducted in Latvia before, we will present the results to the management of the nursing programs of all 3 participating universities and the Latvian Nursing Association.

Reviewer 2 Report

Thanks for submitting your paper. i found it interesting and can be an important contributor to knowledge known on the topic. There are several observations I am making regarding improving the paper:

Make you commentary more focused on what is known internationally therefore what your results suggest as compared to worldwide studies on PA and nurses.

If your project is longitudinal would it not have been better to have started with the 1st year of students on the BSc course and follow them through. Thus you are choosing a sample that cannot be compared each year or a paired study.

Please be clear as to what you mean by working full time or in later years-what does this mean? What does part time vs full time mean in terms of the sample-present this in a table.  You also need to clarify the Theory and Practice elements of the course and then relate this, rather than full time work-do you mean when in placement. Then compare students who are in University doing a theory block?

You describe various strengths. Then present a major flaw in your data collection instrument. I recommend you start with the flaws and what you intend to do about it-can you do any further testing to add rigour to the IPAQ-SF? 

The abstract needs reworking it does not match the conclusion. You need to mention COVID for example and how it may have impacted on your study. The abstract should reflect your study overall and it at present does not.

Author Response

Thank you for the opportunity to revise our manuscript “Physical activity habits of Latvian nursing students”. The suggestions offered by reviewer have been immensely helpful and we appreciate insightful comments on revising our manuscript.

We included reviewer’ comments immediately after this letter and responded to them individually, indicating exactly how we addressed each concern or problem and describing the changes we have made. The revisions have been approved by all authors. The changes are highlighted within the document by using the track changes mode in MS Word or coloured. The English language of our manuscript was edited by native speaker.

Sincerely,

Maksims Zolovs

Reviewer 2

Comment 1: Make you commentary more focused on what is known internationally therefore what your results suggest as compared to worldwide studies on PA and nurses.

Response: Comparison of the data from our study and studies conducted in other countries on PAs and nurses has been added to the Discussion section. We hope to find an opportunity to use other research tools in the future, similar to the global research trends. Currently we are grateful to Latvian nursing students for the responsiveness to participate in the study.

Comment 2: If your project is longitudinal would it not have been better to have started with the 1st year of students on the BSc course and follow them through. Thus, you are choosing a sample that cannot be compared each year or a paired study.

Response: The current study is the first part of the longitudinal study. The survey will be repeated to the same students later during next 3 years.

Comment 3: Please be clear as to what you mean by working full time or in later years-what does this mean? What does part time vs full time mean in terms of the sample-present this in a table. 

Response: We corrected and specified the full-time as working 40 hours/week and part-time as working less than 40 hours/week. We have changed full-time work to full-time job to make it clear that some students are engaged in paid job additionally to studies in the university.

“in later years” – They were students of higher study years (2., 3., 4.) than 1. study year students.

Comment 4: You also need to clarify the Theory and Practice elements of the course and then relate this, rather than full time work-do you mean when in placement. Then compare students who are in University doing a theory block?

Response: There were students who were engaged in the paid work additionally to studies compared to those who did not work during the study period. All students of the same semester had the same curriculum, thus physical activity in the week of investigation should not be different due to curricular activities.

Comment 5: You describe various strengths. Then present a major flaw in your data collection instrument. I recommend you start with the flaws and what you intend to do about it-can you do any further testing to add rigour to the IPAQ-SF?

Response: The order of the ‘flaws’ and ‘strengths’ have been corrected.

Comment 6: The abstract needs reworking it does not match the conclusion. You need to mention COVID for example and how it may have impacted on your study. The abstract should reflect your study overall and it at present does not.

Response: Thank you for the suggestion, the Abstract has been corrected accordingly.

Round 2

Reviewer 1 Report

The revision addresses most of the concerns. The authors should acknowledge the limitation of the cross-sectional design in the limiations.

Author Response

Thank you for comments. We have added following text in the discussion: "Since the study is cross-sectional, we cannot determine the exact cause-effect relationships. We are looking forward to seeing longitudinal data in the next few years to determine student physical activity changes over the study period."

Reviewer 2 Report

I am happy that the authors have answered my suggestions. However the ethical considerations-was the study granted permission to be undertaken by which University Ethics Committee?

Author Response

Thank you for comments. The study was approved by the Ethics Committee of Riga Stradiņš University (Approval Number 22-2/446/2021). Added to the text.