Aerobic Upper-Limb Exercise-Induced Hypoalgesia: Does It Work?
Round 1
Reviewer 1 Report
First of all, congratulations to the authors. An excellent research.
The research article titled "Aerobic upper limb exercise-induced hypoalgesia-Does it work?" has a very high quality design.
The introductory part is adequately explained. The method section is pretty clear. The analyzes are correct. The data is well discussed.
The research design and writing are impeccable.
I think it offers important information for practical practitioners.
It is only necessary to increase the quality of the figures. I think it is ready to be published after the approval of the editors and reviewers.
Author Response
Re: Revision of the manuscript entitled “Aerobic upper limb exercise-induced hypoalgesia-Does it work?”.
We thank you and the reviewers for the opportunity to revise and resubmit our manuscript. We appreciate the reviewers' kind words and truly believe that this paper has clinical importance. We addressed the reviewers’ comments and revised the manuscript accordingly.
Please find below a point-by-point reply to the reviewers' comments. All changes were highlighted in the text
Review 1
First of all, congratulations to the authors. An excellent research.
The research article titled "Aerobic upper limb exercise-induced hypoalgesia-Does it work?" has a very high quality design.
The introductory part is adequately explained. The method section is pretty clear. The analyzes are correct. The data is well discussed.
The research design and writing are impeccable. I think it offers important information for practical practitioners.
It is only necessary to increase the quality of the figures. I think it is ready to be published after the approval of the editors and reviewers.
Answer #1: Thank you for your supportive remarks. The figures’ quality was improved
Reviewer 2 Report
Please see attached.
Comments for author File: 
Comments.pdf
Author Response
Re: Revision of the manuscript entitled “Aerobic upper limb exercise-induced hypoalgesia-Does it work?”.
We thank the reviewers for the opportunity to revise and resubmit our manuscript. We appreciate the reviewers' kind words and truly believe that this paper has clinical importance. We addressed the reviewers’ comments and revised the manuscript accordingly.
Please find below a point-by-point reply to the reviewers' comments. All changes were highlighted in the text
Reviewer 2
The focus of this study is to assess effects of upper limb aerobic training on pain sensitivity in healthy individuals. Methods are clear and described in detail. Introduction and results can be improved, however. Some suggestions and comments are presented below.
Introduction
Comment #1: Rationale reported in the introduction does not support the hypothesis. Introduction: clearly explains that physiological and metabolic responses following upper limb exercises are different from lower limb exercises. Hypothesis should not be to expect EIH like lower extremity exercises rather just to explore if EIH is observed following upper extremity exercises.
Answer #1: Changes were done as suggested. Please see lines 70-73: “Considering the differences between aerobic activity in the upper limbs compared to the lower limbs, we aimed to explore if EIH is observed following upper extremity exercise which may serve as a tool to improve physical function and to reduce pain in those who are limited to perform an exercise with lower limbs”
Comment #2: Rationale for this study will be strengthened if author add information about importance or need of upper limb exercises in certain populations like paraplegia or multiple sclerosis.
Answer #2: This information was added to the text (lines 33-35): “However, in some clinical conditions (e.g. paraplegia, lower limb amputation, post-surgery or injuries), when exercise with lower extremities is limited, upper limb exercise is recommended in order to improve functioning or fitness”.
Methods
Comment #3 It is understandable that experiments cannot be repeated. However, it would have been interesting to see effects of upper vs lower limb exercises on pain threshold and intensity within the same sample. Also, looking into local effects along with remote effects would have been more useful.
Answer #3: In this study, we aimed to test the central hypoalgesic effect. However, we agree with the reviewer that additional examination of the local effect would have given a broader picture as mentioned in the limitations section (lines 398-402).
In addition, comparing the EIH effects between upper and lower limbs, on the same cohort, is of interest and should be tested in future studies. The reviewer’s suggestion was added to the text. (lines 404-406.)
Results
Comment #4 For participant characteristics, also add that most participants were overweight.
Answer #4: The information about the participant BMI categories was added to the text (lines 210-211).
Comment #5: Table 1 needs clarification in the title and foot notes. What does p-value represent?
Answer #5: The table’s title includes this information i.e. Exercise variables and statistical differences between THR and BORG protocols. We added a description also in the footnotes. (lines 225-227)
