Effects of Protein-Rich Nutritional Composition Supplementation on Sarcopenia Indices and Physical Activity during Resistance Exercise Training in Older Women with Knee Osteoarthritis
, Yi-Hung Liao 3, Tsan-Hon Liou 2,4, Ching-Ya Hsieh 3, Yu-Chi Kuo 3,5,† and Hung-Chou Chen 2,4,*,†
Round 1
Reviewer 1 Report
The study aims to examine the effects of Protein supplementation + Resistance exercise training on sarcopenia index, physical activity, and global functional outcomes in older adults (females) with knee osteoarthritis.
The study is interesting, robust, and well-conducted by the authors.
Some aspects will be pointed out for the better understanding of the reader, or to clarify doubts of the reviewer.
In general, a formal revision of the text is recommended to avoid typographical errors (for example, end of line 184, 216, 227, 555, 556 ...)
1. The abstract and the introduction section are solid enough and provide the necessary information required to understand the study carried out.
2. The design is correct, but the authors must explain why in line 157 the resistance in kilos of one of the bands is not explained. The authors speak of 6 bands but only 5 resistors (perhaps it is an oversight).
3. It is recommended that the authors clarify whether the duration of 3 seconds of movement involved the concentric and eccentric phase, since it is described as a "slow movement", but in older adults it could not be considered as "slow".
4. Section 2.7 is entitled "Dietary Intake and Physical Activity", but there is no reference to physical activity. The authors are advised to take this aspect into consideration.
5. It is recommended to homogenize Table 2 (font, lines ...)
6. Idem Table 4.
Author Response
The study aims to examine the effects of Protein supplementation + Resistance exercise training on sarcopenia index, physical activity, and global functional outcomes in older adults (females) with knee osteoarthritis.
The study is interesting, robust, and well-conducted by the authors.
Some aspects will be pointed out for the better understanding of the reader, or to clarify doubts of the reviewer.
In general, a formal revision of the text is recommended to avoid typographical errors (for example, end of line 184, 216, 227, 555, 556 ...)
Response
Thank you for your comprehensive review and constructive comments. We corrected typographical errors at end of lines.
- The abstract and the introduction section are solid enough and provide the necessary information required to understand the study carried out.
- The design is correct, but the authors must explain why in line 157 the resistance in kilos of one of the bands is not explained. The authors speak of 6 bands but only 5 resistors (perhaps it is an oversight).
Response
We revised the statement as follows:
Page 3. Lines 133–134.
“When the bands were stretched 150% of the resting length, loading weights corresponded to 0.83 kg, 1.10 kg, 1.24 kg, 1.70 kg, 2.18 kg, and 2.58 kg for the yellow, red, green, blue, black, and silver bands, respectively [56].”
- It is recommended that the authors clarify whether the duration of 3 seconds of movement involved the concentric and eccentric phase, since it is described as a "slow movement", but in older adults it could not be considered as "slow".
Response
We revised the statement as follows:
Page 4. Lines 157–159.
“Three sets, involving 10 to 20 repetitions of gentle concentric and eccentric contractions (3-s duration per each con-traction) through the full range of the motion and a rest interval of 30 s between sets, were performed for each action.”
- Section 2.7 is entitled "Dietary Intake and Physical Activity", but there is no reference to physical activity. The authors are advised to take this aspect into consideration.
Response
We revised the title of Section 2.7 as “Dietary Intake”. Physical Activity is identified as one of the secondary outcome measures and is mentioned in Section 2.9.
- It is recommended to homogenize Table 2 (font, lines ...)
Response
Table 2 is homogenized.
- Idem Table 4.
Response
Table 4 is revised.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Effects of Protein Supplementation on Sarcopenia Indices and Physical Activity during Resistance Exercise Training in Older Women with Knee Osteoarthritis
This manuscript described that Protein supplementation(PS) augmented the effects of resistance exercise training(RET) on sarcopenia indices, PA, and global function in older women with KOA. This manuscript described just the clinical outcome of older women with knee osteoarthritis supplied with protein supplementation. The OA patients who provided with good protein nutrients with excise, the clinical outcome will better compared with the control group. Everybody just assumed this study's results.
Comments
- “16” This manuscript shows that"Older adults with knee osteoarthritis (KOA) are at high risk of sarcopenia. The authors need to explain why focus on older women, not a man or both?
- Is there any justification or standard of old age?
- 2.7. Dietary Intake and Physical Activity
The patients did not adopt the same food intake standards, and further data analysis is needed to ensure the standard consistency between the control and experimental groups.
- There is no information of nutriments component on the protein supplementation.
Author Response
This manuscript described that Protein supplementation (PS) augmented the effects of resistance exercise training (RET) on sarcopenia indices, PA, and global function in older women with KOA. This manuscript described just the clinical outcome of older women with knee osteoarthritis supplied with protein supplementation. The OA patients who provided with good protein nutrients with excise, the clinical outcome will better compared with the control group. Everybody just assumed this study's results.
Comments
“16” This manuscript shows that "Older adults with knee osteoarthritis (KOA) are at high risk of sarcopenia. The authors need to explain why focus on older women, not a man or both?
Response
Thank you for your comprehensive review and constructive comments. According the reviewer’s comments, we made statements to clarify the sex-specific design as follows:
Page 3, Lines 109–115.
“In the present study, the sex-specific design was conducted for older female participants based on the following reasons. First, sex-specific adaptations in response to RET have been identified for older people KOA [55]. In addition, the criteria for classification of sarcopenia status differ between men and women in elder [17, 56] and KOA [57] populations. Moreover, older female patients have significant lower muscle mass [58] and strength [59] than their male peers. Therefore, pooling the measured data of the two sexes into one group to analyze sarcopenia indices is difficult and we considered a sex-specific study design to reduce such biases caused by sex differences in the analysis of intervention outcomes.”
Is there any justification or standard of old age?
Response
The statement regarding inclusion criteria of participant’s age was revised as follows:
Page 3, Line 102.
“Female patients who aged ≥ 60 years and had primary KOA, ...”
2.7. Dietary Intake and Physical Activity
The patients did not adopt the same food intake standards, and further data analysis is needed to ensure the standard consistency between the control and experimental groups.
Response
Following the reviewer’s constructive comments, further data analysis was performed to ensure the standard consistency between study groups. The revised results were stated in Section 2.7 and were presented in Table 2.
We also served this point as one of study limitations as follows:
Page 13, Lines 473–477.
“In addition, the total energy intake and the proportions of macronutrients of habitual diet were not standardized for both groups over the study period. Therefore, the muscle mass outcome after intervention cannot be fully attributed from effects of PS+RET in the present study. Further studies are warranted to identify pure efficacy of PS+RET by conducting diet control (including total caloric intake and its proportions of nutrients) during the study period.”
There is no information of nutriments component on the protein supplementation.
Response
We added a supplementary table (Table S3) to present the nutrient component of the protein supplementation.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
This revised manuscript address all my concerns and much improved the quality. Minor comments are below.
It will be better revised the title using ~protein rich nutritional composition supplementation~or ~protein rich nutritional composition diet~, or ~protein rich diet~.
Check typographic errors
Should add precise conclusions in this study in the abstract.
Author Response
This revised manuscript addresses all my concerns and much improved the quality. Minor comments are below.
It will be better revised the title using ~protein rich nutritional composition supplementation~or ~protein rich nutritional composition diet~, or ~protein rich diet~.
Response
Following the reviewer’s constructive comment, we revised the title as follows:
“Effects of Protein Rich Nutritional Composition Supplementation on Sarcopenia Indices and Physical Activity during Resistance Exercise Training in Older Women with Knee Osteoarthritis”
Check typographic errors
Response
All typographic errors were corrected.
Should add precise conclusions in this study in the abstract.
Response
We added precise conclusions in the abstract as follows:
“In conclusion, PS exerted augmentative effects on sarcopenic indices, physical activity, and perceived global WOMAC score in older women with KOA through 12 weeks of RET.”
Author Response File: Author Response.pdf
