Review for 10.1186/s12876-024-03533-z (2024)

Title: Impact of exercise on outcomes among Chinese patients with Crohn's disease: A mixed
methods study based on social media and the real world
Version: 2 Date: 02 Nov 2024
Reviewer:  Yuquan Chen
Reviewer's report:
The manuscript titled "Impact of Exercise on Outcomes among Chinese Patients with Crohn's
Disease: A Mixed Methods Study Based on Social Media and the Real World" presents a
comprehensive exploration of the physical and mental health benefits of exercise for Chinese
patients with Crohn’s Disease (CD). Employing both social media data analysis and a cross-
sectional survey, the study offers valuable insights. However, the manuscript requires substantial
revisions to improve clarity, methodology, and consistency in data presentation.
Firstly, the manuscript lacks consistency in the terminology used for "physical activity" (PA)
and "exercise." Although these terms are sometimes used interchangeably, they have different
implications, with PA referring to general movement and exercise indicating structured activity.
Clear and consistent use of these terms is essential to avoid reader confusion, particularly
in sections that discuss quantitative data and conclusions. Additionally, the qualitative
methodology section requires clearer definitions, particularly regarding terms such as "themes"
and "clusters." The study would benefit from a more transparent explanation of how Latent
Dirichlet Allocation (LDA) results from social media posts were validated or compared with
interview findings, as this would strengthen the rigor of the mixed-methods approach.
In the data collection process, there is insufficient detail on the criteria for filtering social media
posts. To ensure representativeness, the study should provide specific inclusion and exclusion
criteria and elaborate on the keywords used to scrape data from the Crohn's disease discussion
forums. In the quantitative analysis, the statistical approach lacks sufficient transparency. While
the manuscript states that multiple linear regression was employed to control for confounding
factors, it does not clarify the rationale behind the choice of variables, such as age, BMI, and
lifestyle factors, included in the model. This clarification would enhance the credibility of the
findings on exercise’s impact on mental health in CD patients.
Furthermore, the qualitative interview sampling approach raises potential issues of selection
bias, as participants were recruited solely from a single hospital. This limitation should be clearly
acknowledged, with a discussion on how this may affect the generalizability of the findings to
other Chinese CD populations. Suggestions for future studies that include multiple centers would
enhance the relevance of the study. Similarly, the measurement of physical activity through self-
reported questionnaires, such as the Global Physical Activity Questionnaire (GPAQ), presents
another limitation. Self-reported data is prone to recall bias, and the use of wearable devices
could yield more accurate PA data. This potential source of bias is particularly relevant given
the study’s emphasis on the relationship between PA levels and patient-reported outcomes.
The study discusses the effects of varying exercise intensities but fails to provide detailed results
in this regard. Specific data on the impact of moderate and high-intensity PA is necessary to
substantiate claims about the positive or negative effects of different PA intensities on mental
and physical health outcomes. Further statistical analysis and presentation of intensity-based
differences would lend support to the study’s conclusions. Additionally, while the qualitative
findings are stated to have informed the quantitative analysis, the manuscript lacks a cohesive
integration of these insights. A more detailed discussion of how qualitative themes, such as
psychological benefits and social support needs, shaped the quantitative phase would better
reflect the study’s mixed-methods design.
Finally, the manuscript briefly mentions ethical considerations for using social media data,
but it is unclear if consent or permissions were obtained from the platform or users. A
more comprehensive description of the ethical protocols for social media data usage would
demonstrate the study’s commitment to ethical standards. In summary, while the study provides
valuable insights into the effects of exercise among Chinese CD patients, major revisions are
required to improve methodological clarity, enhance data interpretation, and ensure a cohesive
connection between qualitative and quantitative findings.