Effects of Core Stabilization Exercise Programs on Changes in Erector Spinae Contractile Properties and Isokinetic Muscle Function of Adult Females with a Sedentary Lifestyle
Round 1
Reviewer 1 Report
General Comments
Thank you for giving me this reviewing opportunity. It appeared that this study was conducted well. Now, after reading the manuscript, I had a few thoughts.
- Please justify why only female population.
- In discussion, there are several parts stating “hypothesis,” but I did not see any hypothesis statement in abstract and introduction.
- In discussion and conclusion, it was stated “stiffness was reduced,” but it was not specified which metric is surrogate of the stiffness.
- There was no limitation sub-section in discussion.
- There were some blanks or questionable parts in tables.
I suggest revising this manuscript with the points above. Also, my other comments were attached below.
Specific Comments
<Abstract>
Line 21: velocity until 90%. Not sure what this 90% is based on. Is this based on Tensiomyography or isokinetic strength?
<Introduction>
Line 39: Not sure you need a word “functional.”
Line 79: I suggest changing the part “Accodingly,…” to “Therefore, the central purpose of this study is to…” I don’t think “present” is a good fit in here.
Line 83: Other studies… However, there is only one reference to support this sentence. Please revise accordingly.
One question: why “adult females”? Would be better if there are justifications/rationales of the reason in intro.
<Methods>
One request: Please state study design.
Table 1: I am not sure what “Title 2” and “Title 4” mean.
One suggestion: I would switch 2.3 and 2.4 orders. To me, it makes sense to introduce intervention (core stabilization exercise) first. Then, data analysis next.
Line 159: Questions about core stabilization exercise (currently 2.4). Did anybody demonstrate or supervise all exercises? If so, who instructed all exercises?
Also, did you measure adherence and compliance to this protocol?
Table 2: I might have missed, but would be better if intensity of back extension, hop bridge, isometric abdominal contraction, and trunk twist was written in the table 2.
Line 177: Not sure the meaning of “for Windows.”
<Results>
Table 3: What is “t” in Table 3?
I did not see any sub-heading of 4. Discussion.
Line 207, 225, 239: There were no hypothesis statement in intro. Thus, it is awkward to see, “we hypothesized…” and “our hypothesis…” in here.
Line 225: It is indeed statistically different in both Dm and Vc90, but how this applies clinically? For instance, Vc90 change value is only 0.01. Not sure how this change is feasible from clinical perspectives.
Line 232 and 236: stiffness reduction was written, but I am not sure this statement was written based on which part of the data, Tc? Dm? Or, Vc90? I suggest giving a little more information about this to make a connection between those variables and stiffness.
One request: please add limitation section.
Author Response
We appreciate the positive comments from the reviewers. This process results in a more comprehensive and significantly improved manuscript of this study. Thank you.
"Please see the attachment."
Author Response File: 
Author Response.docx
Reviewer 2 Report
Basic reporting
The article is quite interesting, but unfortunately has many flaws. The abstract is unclear, vague, and only after reading the details in the main text can you figure out what the abstract was about. The introduction lacks a clear rationale for conducting this research. The authors do not indicate what knowledge gap their research findings will fill. In the Methods, the authors did not specify when they conducted the initial and follow-up measurements. Furthermore, they write that one of the measurements they performed was the "isokinetic muscular functional test of the lumbar joint". This statement that comes up in the work (especially "lumbar join") is unclear. I guess it was really about isokinetic trunk muscle strength. Another shortcoming is the lack of interpretation of the measured parameters. The discussion is rather chaotic and lacks a more detailed interpretation of the results obtained. The authors mention fatigue or improved circulation as factors potentially affecting the measured parameters. It is difficult to take them into account if we do not know when the control measurements were performed. The authors make no attempt to explain why extensor strength improved and flexors did not. This may be due to exercise selection or measurement tools. The core stabilization exercises mainly involve the transversus abdominis muscle, while the isokinetic lumbar flexion test mainly involves the rectus abdominis muscle. The isokinetic testing could have been supplemented with isometric strength testing, or some simple functional test, such as the time to hold the plank position. The authors found a slight increase in relative strength (with no increase in peak torque) at 90/sec, which may indicate a reduction in participants' body weight during the experiment. No information was provided that body weight was re-measured after completion of the 7-week exercise program.
It would also be useful to indicate the application values of the results.
Comments for the Author
Title:
In the title, I would clarify which muscles are meant.
Abstract:
Lines 17, 22, 25. What do you mean by “lumbar joint”?
Keywords:
Keywords must not duplicate the paper title. If you use different keywords, it will increase the discoverability and visibility of your paper.
Introduction:
Line 61. What do you mean by “muscle contractile thickness”?
Line 84. See the note for line 17.
Materials and Methods
Line 90. In the aim of the study you pointed that you studied adult females with sedentary work pattern, but in line 90 you stated that the participants performed at least 7 hours of sedentary work per week. Seven hours a week spent at work in sitting position is not a long time.
Line 90. Replace "patients" with "subjects" or "participants".
Table 1. If possible, add information on work experience with sedentary work pattern.
Lines 109-110. You write: Measurements were performed after enough rest to ensure that the erector spinae muscle was maintained in a relaxed state”. Was the rest time the same for all participants and specifically designated (e.g. 10 minutes), or was the rest period until you noticed a decrease in muscle tone, e.g. by palpating a muscle?
Line 127. See the note for line 17.
Line 128. Add information on what the exercises were focused on during the warm-up.
Lines 137-139. What was the rest time between testing the two velocities? Did you select the maximum value from 5 or 15 repetitions for further analysis?
Line 151. What does the symbol Td mean in the formula?
Lines 166-169. Use the singular when naming exercises. (also in Table 2: Bird dogs). The description of the exercises should be more detailed as there are many variations of the exercises.
Table 2. Instead of "form roller" it should be "foam roller". Regarding stretching, it should be Static & Dynamic. Add an intensity description to each exercise.
Lines 176-180. Did you calculate the sample size and effect size? Have you checked the normality of the data distribution?
Results:
In the text and tables, change p=0.000 to p<0.001.
Table 3. Add the units in which the variables are expressed.
Refer to the appropriate tables when describing the results.
Lines 193-194. Delete “there were”.
Table 4. Referring to relative peak torque as BW (body weight) is confusing. It is still a peak torque, just with the participant's body weight taken into account. It is better to refer to it as PT (%) or PT (% BW).
Discussion:
The heading "Discussion" is missing.
Lines 209-211. The sentence is unclear. Please correct.
Line 211, 241. What did you mean by "motor receptors".
Line 263. How did you measure muscle endurance?
Author Response
We appreciate the positive comments from the reviewers. This process results in a more comprehensive and significantly improved manuscript of this study. Thank you.
"Please see the attachment."
Author Response File: Author Response.docx
Reviewer 3 Report
Check the titles of the tables (tittle 1 tittle 4).
Self-myofascial release (Form roller)
Stretching (Static & Dynamics)
These sections should be explained in depth, and indicate what they consisted of.
Likewise, in the rest of the exercises, the magnitude and density of the load used should appear described.
Include a section on practical applications and limitations of the study. The conclusions in isolation, despite being well developed, are poor.
After this minor revision, the manuscript should be ready for acceptance. Congratulations on the job!
Author Response
We appreciate the positive comments from the reviewers. This process results in a more comprehensive and significantly improved manuscript of this study. Thank you.
"Please see the attachment."
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
Comments for the Author
Although the article has been greatly improved, there are still a few minor issues that need to be corrected. The authors should indicate exactly when the measurements were performed, especially the follow-up measurements. Without this information, we cannot be sure that the interpretation of the results undertaken in the discussion is reasonable. You write in lines 248-251 that “erector spinae stiffness was reduced in participants through a continued increase in the intramuscular temperature through repeated exercise and self-fascial relaxation using a foam roller. As a result, there was a post-exercise increase in the Dm”. So, the question is how long after the workout does the elevated muscle temperature last and when was the follow-up measurement taken.
Introduction:
Line 55. Replace "woman" with "women".
Lines 82-95. The added paragraph is quite unclear. Is it better when Tc takes lower values or higher values? In line 82 you write that "muscle fatigue tends to decrease Tc" and that you assume that after the applied training program Tc will increase (lines 84-85).In contrast, in the discussion (lines 236-237) you write that "Consistent with this evidence, we observed no significant post-exercise change in Tc of the erector spinae muscle". Except that the evidence mentioned says nothing about the effect of fatigue on Tc, but about the relationship between Tc value and muscle fiber type. This is quite inconsistent.
Line 84. What do you mean by saying: "...trunk stabilization Tc..."?
Line 88. What do you mean by saying: "...trunk stabilization Dm..."?
Lines 91-92. You write “…the rate of muscle contraction in this study was the evaluated variable, Vc90, is likely to increase”. The sentence does not sound right. It should be corrected.
Materials and Methods
Line 179. 0.91-0.99. Add the unit in which the range of values is expressed.
Line 181. 0.70-0.98. Add the unit in which the range of values is expressed.
Table 3. The unit of parameter Vc90 is incorrect. Instead of (ms/mm), it should be (mm/ms).
Conclusions
Lines 311-312. The added sentence about the research design should be in the Materials and Methods section, not in the conclusions.
Author Response
We appreciate the positive comments from the reviewers.
This process results in a more comprehensive and significantly improved manuscript of this study. Thank you.
"Please see the attachment."
Author Response File: 
Author Response.pdf
