Title: Physical activity and health-related quality of life among high-risk women for type 2
diabetes in the early years after pregnancy.
Version: 0 Date: 27 Jan 2022
Reviewer's report:
Abstract
Line 29: clarify you are estimating the moderating effects of current obesity
Line 43: Is sleep a domain of the 15D? Did you examine correlations between sleep and domains
other than sleep?
Introduction
Lines 82-84: I recommend revising the aims since your results report overall and domain specific
quality quality of life. Your aims here should reflect what you intend to report for your main
and secondary findings.  I also recommend revising your aims in he abstract for consistency
with the main body here.
Could you say a bit more about your rationale for these potential modifiers? Why would
associations be different in people who are both high-risk, defined using criteria?
Methods
Lines 87: The description of the sample should be revised for consistency with the aim.
Specifically, the aims states you will examine associations in women 4-6 years after pregnancy.
However, here it says 5 years postpartum.
Line 96: Minor grammatical, invidualized should be individualized
Line 103 – Please confirm your study sample included participants in both groups and that your
analysis will combine the group
Line 111: Clarify if you collected data on specific chronic diseases such as T2DM. I would
expect a substantial number of participants had T2DM given their risk status. It would be helpful
to report that information
Lines 119-123: Can you say a bit more about the SenseWear Armband for people unfamiliar?
How is this device work? Generally, how does it measure physical activity? Does it measure
accelerations across multiple planes similar to other actigraphy-based devices? I think it also
measures temperature as well. You can also summarize findings from validation studies to
demonstrates its capabilities at measures your exposures of interest
Line 122: The met levels for MVPA and VPA are the same. Is MVPA defined >3 METs?
Line 130: What is meant by coverage?
Lines 130-132: How did you estimate intensity-specific PA levels? Were these also weighted
averages? Why weighted-averages for total PA only?
Line 137: Can yo provide more information about the 15D? Specifically, what domains of
quality of life are measured? I see some mentioned in the results but a comprehensive summary
here would be helpful
Line 141: Are there thresholds for low, middle, or high quality of life? In this sample, the average
values were close to 1. Does that mean everyone had high quality of life? It would be helpful
if you can provide more context
Lines 147-149: Would people with both conditions be considered the highest risk group? Did
you perform analysis in that group? It could be interesting to see how PA is associated with
quality of life in that group as well.
Please provide a rationale for not including interaction terms to identify modification. You
should also discuss your rationale for correlations opposed to more common (OLS) methods
for modification.
Lines 159-166: Report whether there were notable differences between invited people enrolled
vs. not enrolled and people with and without valid data on exposures and outcomes of interest
Line 166 and table 1: What percentage of the sample was in the original intervention and control
groups respectively?
Line 186: The methods section does mention any analysis by randomization assignment. You
should revise the data analysis second to include randomization group as a covariate in your
analysis
Line 190: How are you defining very week? You should revise your data analysis section to
describe your thresholds for defining the strength of the associations.
Line 199: Results are presented out of order, table 1 results should be presented together
Line 223: Isn’t sleep a domain of the 15D? Did you examine correlations with other domains?
All tables should include p-values and not just NS
Table 2, not sure what the ** is referencing
Table 3, Include the correlations and not just NS. P-values do not provide all the information
readers require to make sense of the results
Discussion
Line 251: The authors summarize results here but did not introduce them in the results section.
The results section needs to be revised to include all results
Line 262: The authors should provide more information about the effect size of the associations
reported in other studies. Its hard for the reader to compare results
Line 290: Consider making comparisons by whether or not they met recommendations for PA?
I seems like people were typically pretty active and had good quality of life, which may explain
the results
Line 311: When discussing associations of PA and vitality, the authors should acknowledge a
potential bi-directional association, physical activity improving vitality
General comment: i'm not sure what this manuscript adds to the prior literature. The discussion
mainly discusses agreement with prior studies without telling us what we learned that's novel