Reviewer's report
Title:Factors influencing adherence to regular exercise in middle-aged women: a
qualitative study to inform clinical nursing practice
Version:1Date:21 November 2013
Reviewer: Kristina Karvinen
Reviewer's report:
This manuscript reports on a qualitative study of enablers and barriers that
influence physical activity adherence in a sample of 58 middle-aged women. The
study has several major and minor concerns that should be addressed.
Major Compulsory Revisions:
It is unclear exactly who these women were. The manuscript makes reference to
this study being part of a larger study but does not elaborate on this. How was
this sample chosen/recruited from the larger study? Was this an exercise
intervention that the women were enrolled in? If so, what was the exercise
protocol? Similarly, how active were they? All that was stated in the manuscript
was that they “on average participated in regular exercise”. There should be
somewhere some data on the volume of physical activity (e.g., weekly
moderate-to-vigorous PA minutes). Were some of them not currently active?
Was there a minimum volume of activity participants had to be participating in to
be included? This seemingly is a very important given the purpose of the study
was to assess barriers/enablers of adherence to physical activity.
It is not entirely clear how nurses could use the findings from this study to inform
practice. Although a couple of paragraphs are dedicated to implications for
nursing, it is vague and doesn’t actually give explicit directions based on the data
that nurses could take when working with this age group of women. More specific
guidelines would be more helpful.
Several concerns surround the data analysis that should be addressed. Why did
the authors choose to interview 58 women when saturation was reached after 10
interviews? What is the trustworthiness of the data? Did the authors consider the
inter-rater reliability of the analyses by the two authors? The authors state that
there was a structured interview guide, yet only two questions were provided.
What were other questions? What is meant by the sub-analysis (page 6)? How
did the authors determine that the pilot test was successful and that they could
continue with the study?
Additional information should be included surrounding characteristics of the
sample, most importantly concerning details about physical activity participation
(see above). Also, the household financial situation descriptive data is very
strange. What do these mean? How did the authors determine which category a
participant fell in?
The last paragraph on page 4 (and continued on to page 5) seems odd. The
authors state that barriers to exercise in middle-aged women are well known.
Then they go on to state that little is known about effective interventions to
enhance adherence. Yet, this study is not about exploring effective interventions
to enhance adherence, but seems to be more about assessing barriers/enablers
to physical activity. This paragraph needs reworking to better build a rationale
and show how this study is different and meaningful.
Page 13, first paragraph: The authors state “This sub-theme corresponds with
the concept of exercise self-efficacy” – yet the previous sentence does not
describe self-efficacy. Suggest changing.
Page 13, first paragraph: In the last couple of sentences the authors describe a
sub-theme and reference Jeng. More information is required from this reference
as it is unclear what the Jeng themes are and how they relate to the subtheme.
Page 9, second paragraph: the authors refer to a theme of intrinsic motivation,
yet the sub-themes are not related to the common use of this term (i.e., in this
context exercising for the sake of exercise itself). “Perceived health benefits” for
example, would not be considered intrinsic motivation, but rather extrinsic
motivation. From what source did the authors get their definition of “intrinsic
motivation”?
The final concern is about the uniqueness of the study. It would be helpful if the
novelty of this study was better argued in the rationale. A plethora of research to
date has examined barriers and other factors that influence physical activity
participation in women, as acknowledged by the authors themselves. A better
rationale needs to be developed as to why this study is important and different.
Minor Essential Revisions
The paper should be read over carefully to check for correct sentence structure
and flow. There are many sentences that are not properly composed (e.g., the
first sentence of the Introduction).
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.