Dementia Support Through Football: A Scoping Review of Community-Based Interventions

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Excellent manuscript, methodologically robust, clearly reported with appropriate recommendations

Author Response

We would like to thank you for the constructive feedback on our manuscript ‘Dementia support through football: a scoping review of community‑based interventions’. We greatly appreciate the time and care taken by reviewers in evaluating our work.

We have carefully considered each comment and have revised our manuscript to address all points outlined. Below, we provide a point-by-point response to each reviewer comment, with our responses in bold.

We believe that the revisions have strengthened our review. We remain grateful for the opportunity to revise and resubmit our work.

Yours sincerely,

Alexander Hagan (on behalf of all authors)

Reviewer 1

Excellent manuscript, methodologically robust, clearly reported with appropriate recommendations

We would like to thank Reviewer 1 for their positive and kind feedback.

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript "Dementia support through football: a scoping review of community‑based interventions" is well written; however, the major concern is that the context expressed in the title is not adequately developed in the text.

Above all, cognitive, memory and mental tests, and also physical tests, to evaluate the effect of football exercise have not been considered. It is well known that aerobic exercise stimulates neuron activity and regeneration, so it becomes essential to know if such physical activity has induced some improvement in cognition and memory

Author Response

We would like to thank you for the constructive feedback on our manuscript ‘Dementia support through football: a scoping review of community‑based interventions’. We greatly appreciate the time and care taken by reviewers in evaluating our work.

We have carefully considered each comment and have revised our manuscript to address all points outlined. Below, we provide a point-by-point response to each reviewer comment, with our responses in bold.

We believe that the revisions have strengthened our review. We remain grateful for the opportunity to revise and resubmit our work.

Yours sincerely,

Alexander Hagan (on behalf of all authors)

The manuscript "Dementia support through football: a scoping review of community‑based interventions" is well written; however, the major concern is that the context expressed in the title is not adequately developed in the text.

Above all, cognitive, memory and mental tests, and also physical tests, to evaluate the effect of football exercise have not been considered. It is well known that aerobic exercise stimulates neuron activity and regeneration, so it becomes essential to know if such physical activity has induced some improvement in cognition and memory

We thank Reviewer 2 for their thoughtful comments.

However, the focus of the current review differs from the type of evaluation described. As outlined in the title, “Dementia support through football: a scoping review of community-based interventions” this review aimed to map and describe the range, context, and characteristics of football-based community initiatives that provide psychosocial support for people living with dementia and their families. The inclusion of cognitive, memory, and/or physiological data was not appropriate, as our review was not designed to evaluate intervention efficacy or physiological outcomes. Rather, the purpose of our review was to capture how current initiatives are structured, delivered, and experienced within community settings. These findings are under-represented in the literature but essential for understanding real-world implementation and accessibility beyond diagnosis.

That said, we have added a sentence to our discussion highlighting this important point (page 13, lines 302-306):

“While this review aims to highlight the range of community-based football initiatives supporting people living with dementia and their families, it did not assess intervention efficacy or include formal cognitive or physiological outcome measures. Such evaluations were beyond the remit of a scoping review but would represent a valuable direction for future work.”

Reviewer 3 Report

Comments and Suggestions for Authors

This is an interesting paper that serves to take stock of what would appear to be a very valuable initiative, particularly if evidence could be better adduced as to its likely benefits.

Some more commentary, even if relatively brief, on the methods would be appreciated. Presumably, before and after tests of mood etc were administered, but we were not told about this. We are told that the methods of the studies were often not rigorous, but I think the paper would have more value to potential future researchers if more granular attention was given to the methodological limitations, even if just in summary form.

I was not clear as to the scope of the eligibility criteria. In the example given as to the search strategy, 'soccer' and 'Alzheimer' was given. Later, we learn that a study was excluded on the basis that it related to 'American football'. I am therefore unsure what codes of football (e.g. rugby league? rugby union? Australian rules football?) might have been eligible or excluded. I suggest that the investigators make this clear. 

The table that includes details of the studies would in my view be much better presented in landscape format as the columns are necessarily quite narrow in portrait orientation and somewhat irritating to read in that format. 

Author Response

We would like to thank you for the constructive feedback on our manuscript ‘Dementia support through football: a scoping review of community‑based interventions’. We greatly appreciate the time and care taken by reviewers in evaluating our work.

We have carefully considered each comment and have revised our manuscript to address all points outlined. Below, we provide a point-by-point response to each reviewer comment, with our responses in bold.

We believe that the revisions have strengthened our review. We remain grateful for the opportunity to revise and resubmit our work.

Yours sincerely,

Alexander Hagan (on behalf of all authors)

This is an interesting paper that serves to take stock of what would appear to be a very valuable initiative, particularly if evidence could be better adduced as to its likely benefits.

We would like to thank Reviewer 3 for their valuable feedback.

Some more commentary, even if relatively brief, on the methods would be appreciated. Presumably, before and after tests of mood etc were administered, but we were not told about this. We are told that the methods of the studies were often not rigorous, but I think the paper would have more value to potential future researchers if more granular attention was given to the methodological limitations, even if just in summary form.

We agree that more granular attention to methodological limitations would be useful, and as such we have revised our Discussion accordingly (page 14, lines 306-315):

“Methodological quality across included studies was generally limited. Most studies drew upon small, convenience-based samples employing descriptive or qualitative designs, with few using standardised pre- and post-measures used to assess change over time. Details regarding intervention implementation, recruitment, and participant characteristics were often incompletely reported. These limitations restrict the comparability of findings across studies and highlight the need for more rigorous and transparent evaluation in this emerging field.”

I was not clear as to the scope of the eligibility criteria. In the example given as to the search strategy, 'soccer' and 'Alzheimer' was given. Later, we learn that a study was excluded on the basis that it related to 'American football'. I am therefore unsure what codes of football (e.g. rugby league? rugby union? Australian rules football?) might have been eligible or excluded. I suggest that the investigators make this clear. 

We thank the reviewer for this helpful comment. The search strategy was intentionally broad to maximise sensitivity and ensure that all potentially relevant studies relating to football were included. During the screening process, any articles that focused on sports other than football/soccer (inc., American football, rugby league, rugby union, or Australian rules football) were excluded. The rationale behind focusing specifically on football/soccer over other similar sports was based on the significant variation in structure, culture, and community, which forms the basis of this review.

We have added the following sentence to our Methods section to clarify this (page 4, lines 116-120):

“For the purposes of this review, the term “football” refers specifically to football (soccer). Studies detailing other forms of football (e.g., American football, rugby league, rugby union, or Australian rules football) were excluded during the screening process, as these represent distinct sports and community contexts.”

The table that includes details of the studies would in my view be much better presented in landscape format as the columns are necessarily quite narrow in portrait orientation and somewhat irritating to read in that format. 

We agree and have reformatted the manuscript accordingly.

Reviewer 4 Report

Comments and Suggestions for Authors

While the topic itself is important as any interventions for dementia are aimed at immproving mental health and quality of life, the way the information is presented in the current paper can be improved.

1. First you mixed in one analysis interventions that were directly related to fooball as a physical activity and those that just used images of football as material for intervention. For me these are too different intervention and the second one could use generally any pictures to address the same goals.
2. It would be interting to see more details on hor out of more that 1000 papers you ended up with only 11? What was so wrong with the rest?
3. The results section looks like design section with very little results and thir description. Maybe you could think of some deeper analysis of these results.
4. As in most articles analyzed the sample were small or pilot, it is hard built any conclusions on that, so I woul rather focus on limitations fo your study and would go into any generalizations.

Author Response

We would like to thank you for the constructive feedback on our manuscript ‘Dementia support through football: a scoping review of community‑based interventions’. We greatly appreciate the time and care taken by reviewers in evaluating our work.

We have carefully considered each comment and have revised our manuscript to address all points outlined. Below, we provide a point-by-point response to each reviewer comment, with our responses in bold.

We believe that the revisions have strengthened our review. We remain grateful for the opportunity to revise and resubmit our work.

Yours sincerely,

Alexander Hagan (on behalf of all authors)

While the topic itself is important as any interventions for dementia are aimed at immproving mental health and quality of life, the way the information is presented in the current paper can be improved.

1. First you mixed in one analysis interventions that were directly related to fooball as a physical activity and those that just used images of football as material for intervention. For me these are too different intervention and the second one could use generally any pictures to address the same goals.

We agree that the reviewed interventions varied in form, with some incorporating physical activity and others using football as a reminiscence theme. This variation aligns with the exploratory scope of the review, which aimed to capture the full spectrum of football-related community initiatives supporting people with dementia.

We have revised our discussion to highlight the distinction between physical and thematic engagement (page 13, lines 226-232):

“The current review draws upon both physical (i.e., walking football) and reminiscence-based interventions, reflecting the diverse methods in which football initiatives have been embedded within the community to support people living with dementia. While these approaches differ methodologically, they share a common reliance on the social and cultural significance of football in order to promote inclusion, identity, and wellbeing.”

1. It would be interting to see more details on hor out of more that 1000 papers you ended up with only 11? What was so wrong with the rest?

We thank the reviewer for this comment. The limited number of included articles reflects both the emerging nature of football-based dementia initiatives and the specificity of our inclusion criteria.

Our search strategy and eligibility criteria is detailed within the Methods section, in accordance with PRISMA guidelines (page 4, lines 98-129).

Over 1,500 records were initially identified through comprehensive and intentionally broad database searches, but most were excluded as they did not describe community-based football (soccer) interventions involving people living with dementia. The vast majority of studies that were excluded focused instead on chronic traumatic encephalopathy as causes of dementia in football and contact sports, which does not align with the scope of the current review.

1. The results section looks like design section with very little results and thir description. Maybe you could think of some deeper analysis of these results.

We thank the reviewer for their comment. The purpose of a scoping review is to map and describe the existing evidence base rather than to undertake any form of critical appraisal or meta-analysis. In line with PRISMA-ScR guidelines, the results section therefore focuses on the characteristics, delivery models, and reported outcomes of community-based football initiatives for people living with dementia, as presented in both the narrative synthesis and Table 1. Given the exploratory and largely qualitative nature of the included studies, deeper statistical analysis was neither feasible nor appropriate.

1. As in most articles analyzed the sample were small or pilot, it is hard built any conclusions on that, so I woul rather focus on limitations fo your study and would go into any generalizations.

We agree with the reviewer that the small, pilot nature of many included studies limits generalisability, a view shared by another reviewer. We have revised our manuscript to highlight the methodological limitations of included studies (page 14, lines 306-315):

“Methodological quality across included studies was generally limited. Most studies drew upon small, convenience-based samples employing descriptive or qualitative designs, with few using standardised pre- and post-measures used to assess change over time. Details regarding intervention implementation, recruitment, and participant characteristics were often incompletely reported. These limitations restrict the comparability of findings across studies and highlight the need for more rigorous and transparent evaluation in this emerging field.”

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

No more suggestions

Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for your comments