Title: Group-based physical activity interventions for postpartum women with children aged
0-5 years old: A systematic review of randomized controlled trials
Version: 4 Date: 06 Nov 2021
Reviewer's report:
Topic: Group-based physical activity interventions for postpartum women with children aged
0-5 years old: A systematic review of randomized controlled trials
I'd would like to express my appreciation for inviting me to review this peer-reviewed work. The
authors have made major changes to the content, and the work now reads much more clearly
than when I first read it. I commend the authors for making improvements to their re-submitted
manuscript. However, there are still significant areas of ambiguity, which I hope the authors
can address fully. I have three main reservations about the paper that the team should address
before proceeding with it: 1) database search and search string used, 2) adherence to PRISMA
2020 guidelines, and 3) inclusion of both effect sizes to and p-values. The following are my
specific observations:
Abstract
• Page 2: Spelling error for PsychInfo.
Introduction
• Page 5: “Two postpartum studies” should be replaced with “Two studies that investigated
postpartum women”. Authors must conduct a more thorough proofreading.
• I appreciate the synthesizing of the existing reviews as per previous comments.
Methods:
• Page 8: I'm puzzled as to why PRISMA 2020 was not utilised. I believe that adhering to the
most recent standard will undoubtedly improve the quality of the reporting style.
• Page 8-9: The team stated that the search was modeled by Gilinsky's 2015 review. I took a
brief look at the review. They searched Medline, PsycINFO, and CINAHL, and I'm delighted
you included EMBASE in your search. Given that all of the papers included are RCTs, I highly
advise the authors to explore the CENTRAL (Cochrane) databases. Additionally, they were
more explicit in their reference list search via PubMed forward and backward citations.
• Page 9: Kindly write your justifications for restricting to 20 years and identify the Gilinsky
2015 review to which your team referred.
• Page 9: Possibility of specifying a database for the search string? or, if you are using PRISMA
2020, the complete search query for all databases. Is there a particular reason why only free
terms were used? (Like EMTREE should be used as the index term for EMBASE).
For example, if its PubMed, please organize it like "Postpartum Period"[Mesh] OR
Postpartum[Title/Abstract]…” so that it may be repeated and transparency is established.
Results
• Abstract, aims and page 16: I remain skeptical that psychological well-being, BMI, fat mass,
weariness, stress, mood, and coping all qualify as "health behavioral outcomes." Your team may
wish to consider using broader terminology to encompass all of these objectives.
• Result sections and Table 2: P-values, from the biostatistician's perspective, can only quantify
statistical significance and are unable to convey the clinical significance of a result. If data are
available, please include the effect size (e.g. Cohen d, eta-squared, mean difference, RR/OR)
in addition to the p-value. It would be preferable to indicate the direction and magnitude of the
association. I took a brief look at the full-text and saw that the majority of the studies did include
the effect sizes. Consistency is insufficient justification for displaying the p-value alone.
Discussion:
• This section will require significant change once the aforementioned issues are resolved.
• It is preferable to include a section discussing the quality assessment.
• Limitations: “It is also important to acknowledge that as the search strategy was conducted by
searching for terms in the titles and abstracts fields. As such, poorly reported studies or studies
that had physical activity as a secondary outcome may not have been included in this systematic
review.” – This section was added recently. While acknowledging it is commendable, I would
still prefer that you include the index phrase in the first place.
Table 2:
• While I agree that this is just six, the tabular presentation is still somewhat bulky and difficult
to digest. A excellent table should be capable of efficiently communicating critical messages at
a glance. The first column's header should read “Study. Country”