Pilot and Feasibility Study of an Individualized Telehealth Exercise Program for People with Cystic Fibrosis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, 

See some comments to improve your paper.

Introduction:

• if is possible, remove the line 74-75.
• if is possible add some information in introduction about studies that analyse exercise (type) and age or gender results

Methods

• if is possible, add more information about the exercise program. How did you check the correct posicion to the exercise or give feedback?
• the participants perform all the same exercises per session? Can you describe a litle more?

Discussion

• the discussion in very centered in the number of the participants. But if it is possible, add more information about the results achieved in the clinical parameters.
• Also, if is possible, above the recomendations for aerobic and strength exercise, what do you think about the diferent capacities (functional and strength) and all perform the same number of repetitions? Why 12 repetitions? Maybe considering recent studies about fitness capacity and performance in clinical populations could help to introduce something interesting.
• PLease add the limitations of the study, in addition to the number of participants

Author Response

Reviewer 1:

Dear authors, 

See some comments to improve your paper.

Introduction:

• if is possible, remove the line 74-75.

Answer: we removed these lines in the revised manuscript.

• if is possible add some information in introduction about studies that analyse exercise (type) and age or gender results

Answer: we included this information in the revised introduction.

Methods

• if is possible, add more information about the exercise program. How did you check the correct position to the exercise or give feedback?
• the participants perform all the same exercises per session? Can you describe a little more?

Answer: We revised the Methods section (lines 143-154) adding this information.

Discussion

• the discussion in very centered in the number of the participants. But if it is possible, add more information about the results achieved in the clinical parameters.

Answer: we have extended the revised discussion to include the discussion of the clinical parameters (Lines 402-437).

• Also, if is possible, above the recommendations for aerobic and strength exercise, what do you think about the different capacities (functional and strength) and all perform the same number of repetitions? Why 12 repetitions? Maybe considering recent studies about fitness capacity and performance in clinical populations could help to introduce something interesting.

Answer: The discussion was revised to include those discussion points.

• Please add the limitations of the study, in addition to the number of participants

Answer: A paragraph was included discussing the limitations.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The article proves important for the patients in question, with online exercises being an excellent option. I'm unsure if this type of exercise is still being used after the pandemic; however, we must consider that it was a widely used practice during that period, which was also the period of the study. Therefore, the article becomes relevant.

Title: OK, no changes.

Abstract: I can't count the words in the PDF, but it seems long. I believe it can be revised, and some irrelevant information can be removed.

Introduction: It's clear that exercise is recommended for pwCF, however, I felt the lack of studies and systematic reviews that showed this. I did a quick search on PubMed and found several studies. I strongly suggest including a paragraph discussing the current state of the response to physical exercise.

Thus, the suggestion of online exercise is reinforced; we have studies, but not on online exercises. Methods:

"Live two-way video conference training". Were these video calls scheduled? Individual? With the trainer guiding during the training? More information is needed in the training description.

The training is described; the question is whether the patient received guidance on how to arrive at the intensity parameters. I suggest adding this information (aerobic training).

I found the requested information in the measurements section; I suggest repositioning it. Because this information is not an "Outcome Measure".

I confess that I didn't understand what the % columns in Table 2 are. Perhaps it's my lack of knowledge, but a legend is necessary. Item 3.2 ok; 3.3 ok; 3.4 ok. I suggest splitting Figure 5, because graph A shows too much information and is difficult to read.

Discussion: On line 274 you say it's comparable to other studies; you need to cite which studies those are.

You need to include studies in this discussion; there are many claims without a solid basis.
You are being repetitive regarding recruitment; this information can be summarized.
You brought up several studies on page 9; I suggest exploring each of them further in the discussion.

Conclusions: Okay, but you need to pay attention to why your study "didn't work." I suggest including this paragraph even before the conclusions, as a way of outlining the study's limitations.

Author Response

Reviewer 2:

 

The article proves important for the patients in question, with online exercises being an excellent option. I'm unsure if this type of exercise is still being used after the pandemic; however, we must consider that it was a widely used practice during that period, which was also the period of the study. Therefore, the article becomes relevant.

Title: OK, no changes.

Abstract: I can't count the words in the PDF, but it seems long. I believe it can be revised, and some irrelevant information can be removed.

Answer: The abstract was shortened to exclude some irrelevant information.

Introduction: It's clear that exercise is recommended for pwCF, however, I felt the lack of studies and systematic reviews that showed this. I did a quick search on PubMed and found several studies. I strongly suggest including a paragraph discussing the current state of the response to physical exercise.

Thus, the suggestion of online exercise is reinforced; we have studies, but not on online exercises.

Answer: We have included an additional paragraph in the introduction.

Methods:

"Live two-way video conference training". Were these video calls scheduled? Individual? With the trainer guiding during the training? More information is needed in the training description.

The training is described; the question is whether the patient received guidance on how to arrive at the intensity parameters. I suggest adding this information (aerobic training).

I found the requested information in the measurements section; I suggest repositioning it. Because this information is not an "Outcome Measure".

Answer: The information was added in the revised Methods section and taken out of the “Outcome Measure”.

I confess that I didn't understand what the % columns in Table 2 are. Perhaps it's my lack of knowledge, but a legend is necessary. Item 3.2 ok; 3.3 ok; 3.4 ok. I suggest splitting Figure 5, because graph A shows too much information and is difficult to read.

Answer: We apologize for the confusion and added a legend for Table 2. We also split Figure 5 into two figures (Fig. 5 and Fig. 6a,b).

Discussion: On line 274 you say it's comparable to other studies; you need to cite which studies those are.

Answer: we added a reference that discussed those studies.

You need to include studies in this discussion; there are many claims without a solid basis.
You are being repetitive regarding recruitment; this information can be summarized.
You brought up several studies on page 9; I suggest exploring each of them further in the discussion.

Answer: We attempted to streamline the discussion and added rationales based on published studies.

Conclusions: Okay, but you need to pay attention to why your study "didn't work." I suggest including this paragraph even before the conclusions, as a way of outlining the study's limitations.

Answer: We appreciate the Reviewer’s suggestion and included an additional paragraph in the revised manuscript “Study Limitations”.

Author Response File: Author Response.pdf