Title: Comparative Effectiveness of Exercise Interventions for Primary Dysmenorrhea: A
Systematic Review and Network Meta-Analysis
Version: 2 Date: 25 Oct 2024
Reviewer:  María Jesús Benzo Iglesias
Reviewer's report:
Thank you for the opportunity to review this article. The topic you address is highly relevant,
as primary dysmenorrhea affects many women, and they are not always aware of rehabilitation
methods to reduce it. Additionally, the focus on Network Meta-Analysis is very interesting
because it allows conclusions to be drawn about the type, dose, duration, frequency, and volume
of exercise. I would like to raise some questions in order to clarify and possibly improve the
quality of the existing manuscript, so it can be published and made available to the scientific
community.
Abstract
The abstract lacks clarity regarding the primary outcomes measured. This should be clarified to
provide a concise overview of the study's objectives and findings.
Line 10: the ‘objective’ section would be better called ‘background’.
Line 18: should read ‘were’ instead of ‘was’.
The abstract overuses abbreviations like "PD," "RCTs," "NMA," and abbreviations for each
exercise type (e.g., MBE, SE, AE). Minimizing these abbreviations makes the abstract easier to
read for a general audience and aligns with the guideline.
In some areas, detailed data points like specific percentages for effectiveness (e.g., 87.78% for
ME, 93.29% for RE) can be excessive for an abstract. Summarizing this information in broader
terms (e.g., "RE showed the best efficacy for short-duration exercises") can improve readability
without losing essential information.
Background
While the "Background" section provides context and details on primary dysmenorrhea (PD) and
exercise as a management approach, it does not clearly emphasize why this study is necessary
in the current research landscape or the unique contribution it aims to provide.
Line 36: In the first sentence, “Primary dysmenorrhea (PD), a prevalent gynecological condition,
which affects…” should read “… condition that affects…”. Please check it.
Line 50: please place a full stop after ‘et al’ in citations throughout the text. For example, the
one in this line should read ‘Lorzadeh et al.’ instead of ‘Lorzadeh et al’.
Line 64: Please ensure that all reference indicators in the text are enclosed in square brackets
(with no leading space before the opening bracket) and placed within punctuation (e.g. '(…)
which is essential for informing clinical guidelines and decision-making[17].').
Methods
The methods section is very comprehensive. Please check the following points:
Line 78: Maybe a full stop is missing before ‘HGY’? If a full stop is not needed, consider
rewriting to clarify the sentence structure.
Line 92: Please ensure all references are enclosed in square brackets and placed directly after
punctuation, with no leading space (e.g. '(…) which is essential for informing clinical guidelines
and decision-making[17].').
Line 97: please add a space between the comma and the word ‘focusing’.
Line 102: please add a space between ‘&’ and ‘CWJ’.
For clarity, consider providing a brief description of participant characteristics and criteria for
inclusion/exclusion.
Results
Line 640-641: please add a legend with the meaning of the different abbreviations which can
be found in the table.
Line 623: please include a legend with the meaning of the different abbreviations.
Line 187: please delete the ‘s’ in the word ‘exercises’ so that it is written ‘exercise types’ instead
of ‘exercises types’.
Line 639: please include a legend with the meaning of the different abbreviations.
Line 237: please check the grammar of this line. I think you meant to write ‘compared’ instead
of ‘compares’.
Line 238: please check the grammar of this line adding “the” before the word “highest”.
To improve clarity in interpreting the figures, we suggest adding a brief explanation (maximum
300 words) about how to read them, especially for the SUCRA plots. This can help readers
quickly grasp the significance and comparative efficacy probabilities of the different types of
exercises.
Discussion
Line 306: please remove the space before the comma.
As a suggestion, you could propose future lines of research based on the results of the study to
guide future research in this area.
Conclusion
Please review this paragraph, as some abbreviations are defined while others are not. Since all
terms used in the conclusions appear earlier in the text, you can avoid rewording them (e.g., use
'NMA' directly instead of 'network meta-analysis (NMA)').
Abbreviations
Line 358: please add the final point.
References
Please include the DOI for articles that have one, formatted as "doi: [DOI number]".