Review for 10.1186/s12876-022-02147-7 (2022)

Title: Effects of a 12-week home-based exercise training program on aerobic capacity, muscle
mass, liver and spleen stiffness, and quality of life in cirrhotic patients: A randomized controlled
clinical trial
Version: 1 Date: 05 Oct 2021
Reviewer's report:
The authors examine the effects of a 12-week home-based exercise training program on
aerobic capacity, muscle mass, liver and spleen stiffness, and quality of life in cirrhotic
patients. Reviewer also think that the topic that home-based exercise may be of interest to the
field, because globally we need distance socially now. This manuscript provides an important
contribution to the field of exercise therapy for several diseases. However, reviewer has concerns
about the tendency of this study toward overinterpretation of the results, and the use of
appropriate controls.
1.   The authors used the term ‘’HIIT” for their exercise training program. However, it seems
that this is not applicable because the intensity in HIIT in many cases are higher than current
study (e.g. Gibala et al., J Physiol, 2012). The authors should rephrase it.
2.   The authors used a Garmin watch for measuring heart rate and activity levels. If there are
any references or author’s data tested the validity of Garmin watch for these parameters, the
authors should describe that information.
3.   How did authors evaluate the maximum heart rate? The authors should state in method
section.
4.   In baseline, why there are differences in mean muscle mass between HoBET and control
group? If the authors focused on the muscle mass as a secondary aim at least, it will be required
that these parameters should be comparable in each group.
5.   If the P is > 0.05, there is no change. Please do not suggest a direction of change when P
> 0.05 throughout manuscript. Therefore, the authors need rewriting about the results such as
aerobic capacity, and thigh muscle mass. Accompanied with this change, the conclusion and
discussion also may change partially.
6.   Especially in the results of Thigh muscle mass, the authors should rewrite, such as from
“non-significantly increased” to “unchanged”. And, does last sentence “In contrast…” indicates
data from the thigh circumference and feather index? If so, the authors should describe carefully.
7.   Why mean duration of exercise was unchanged in both HoBET and control group? Normally,
it should be higher in the HoBET group because exercised group. Is it a number that excludes
the duration of HIIT program? If so, the authors should explain that in Method section. This is
confusing reviewer.
8.   It is of serious concern that the subjects in the control group in the present study were
exercising. Even though this is clinical trial, that should be control appropriately. Although the
authors described this limitation in discussion section, this concern makes the interpretation of
the current study difficult.
Therefore, the authors tried to analysis for the comparison between adherence and non-
adherence groups. Sum of number of these 2 groups are 40, as well the number of initial analyses
in HoBET vs Control groups. This means, are there any patients with HoBET-non-adherence
to exercise or Control-adherence to exercise groups? Is this correct? If so, the analysis in Table
5 is inappropriate and should not including the manuscript. Because, originally Control group
did not performed exercise with HoBET regimen. The authors also described as “it depending
on individual preference”. If this manuscript needs that analysis, the authors must do analysis
only within the HoBET group.
9.   Although reviewer considered above analysis is not applicable, if including manuscript, the
detail should describe in Method section (such as how divided into adherence or non-adherence
group).