Title: The impact of a lifestyle promotion program on anthropometric and clinical
manifestations in adolescents with polycystic ovarian syndrome: a randomized controlled trial
Running title: Lifestyle promotion program in adolescents with polycystic ovarian syndrome
Version: 4 Date: 02 May 2024
Reviewer's report:
Dear authors,
Given teenagers' current lack of physical activity, I believe this topic is important. However,
some areas need to be addressed in order to improve the manuscript. These include the following:
Abstract
Background
- Line 36-37: For more clarity, it could be written:
"Can lifestyle promotion programs, which focus on changing behavioral habits, have an effect
on anthropometric parameters and the manifestation of polycystic ovary syndrome (PCOS) in
adolescents?"
Methods
- Some sentences are unclear and require revision.
Line: 40-42: The third sentence (Their PCOS status was identified … were randomized were
randomly assigned to receive …) is an example of an unclear sentence that needs to be revised.
- Line 43-45: The sentence should be concise.
1. Specify what specific recommendations are being made. For example, "This intervention
provides recommendations for a balanced diet and regular exercise ".Also, the verb should be
last.
2. "including those with PCOS" Instead of "especially those with PCOS"
- The method and instruments for evaluating the outcome should be included in the abstract.
Results
- Line 56-57: It should be written in comparison to the control group.
- Line 58-59: It should be written in comparison to the control group.
Key Words
The words must be a Mesh term.
- In the MeSH database, the term "Lifestyle" was located.
- In the MeSH database, the term " Nutrition Assessment" was located.
- In the MeSH database, the term "Adolescent" was located.
- In the MeSH database, the term "Health promotion" was located.
- Based on the MeSH database, the recommended term is "Health evaluation".
Main Text
Introduction
- In the present study, the training program conducted for two months consisted of eight sessions.
Further research in this area is necessary to address the time frame of the training program.
- Revision: Reference 10 requires revision in terms of the authors' and the journal names.
- Line 95: The reference should be cited at the end.
- The introduction requires revision. It is important to ensure coherence in the introduction in
order to effectively convey the problem. As such, the paragraph from lines 101 to 116 should be
written before the sentences discussing lifestyle management, which are currently in the second
paragraph.
- Revision: References 17-25, 27-29, 31, 34, 36-54, 58-64 require revision in terms of the authors'
and the journal names, and letters. For example, reference 17 should be written as follows:
Romualdi D, Versace V, Tagliaferri V, De Cicco S, Immediata V, Apa R, Guido M, Lanzone
A. The resting metabolic rate in women with polycystic ovary syndrome and its relation to the
hormonal milieu, insulin metabolism, and body fat distribution: a cohort study. J Endocrinol
Invest. 2019 Sep;42(9):1089-1097. doi: 10.1007/s40618-019-01029-2.
Materials and methods
- The Method section need revision based on the journal submission guideline as follows:
The methods section should include:
•  the aim, design and setting of the study
•  the characteristics of participants
•  a clear description of all processes, interventions and comparisons.
•  the type of statistical analysis used, including a power calculation if appropriate
- Line 151 (professional exercise, or a specific diet for three months ago): Why has this time
been considered? Reference is necessary to be written.
- Was the trial assistant a member of the researcher team? Please write in a clear manner.
- Line 158: What is meant by the term 'last test' and 'sonography'? Prior to participating in
the study, the adolescents were referred to a gynecologist for evaluation, and all participants
underwent tests and ultrasound procedures. The Method section should be written in a clear and
concise manner so that other researchers can easily replicate the study.
- It should be clearly stated how long each session and the total sessions lasted (for example:
two months) and how often it occurred (e.g. once a week).
- When discussing the recommended physical activities, it is important to clearly state which
activities are being referred to as well as for diet or It is required that these terms are clearly
defined.
- Which application or platform was used for online training and how was the training
conducted? The sentence should be written more clearly and concisely.
- After the intervention, how were the subjects monitored to ensure they were engaging in
optimal physical activity and maintaining proper nutrition through training for one year? How
were other factors that could potentially affect the outcome controlled, especially during the
days of Corona pandemic?
- Line 203: Secondary outcomes should be written.
- What is the purpose of the division of BMI? Why was the division not reported in the results?
According to Table 1, all of the participants were normal and no cases of obesity or overweight
were reported. It is important to proofread and clarify any unclear statements.
- The accuracy of the tools should be clearly stated.
- Revision: Reference 27 requires revision in terms of the authors' and the journal names
- Sinclair Graphic Instrument needs to be clearly introduced.
- Please determine how much time it takes to complete each questionnaire.
- Line 234 (O'Brien, 2008): The number of the reference should be written.
- Were 64 samples lost to follow-up, resulting in a 5% loss rate? It is considered that the sample
size should be larger with this percentage.
Result
- Line 257: The reason for exclusion from the study should be stated.
- Line 262: Based on Table 2, the baseline BMI for all subjects falls within the normal range.
However, the sentence mentions obese versus non-obese, which may be confusing.
- Line 271-278: The numbers in the text match those in the corresponding table.
- Line 278-280: In this regard (the mean score of FG ), it should be mentioned in the discussion
section.
- Line 267 and 282: This sentence, which pertains to tables 3 and 4, is written in a similar manner
and should be revised to accurately reflect the information presented in the corresponding table.
- P-value should be written based on the tables.
Discussion
- Line 302-306: the second paragraph (PCOS, an endocrine disorder probably transmitted during
the embryonic period ...) should be part of the introduction section.
- Hirsutism and Acne are common symptoms of hyperandrogenism and should be mentioned.
- Line 323-332 (Hyperandrogenism in adolescents can be positively influenced by weight
management  ...): The result of the present study should be compared.
- In the method section, it should be stated regarding this package (line 347) in terms of socio-
cultural, teaching method, and social and communication skills.
- The practical implications of the study's findings for midwives and reproductive health
professionals should be clearly stated.
Figure 1: Diagram
- The boxes in the flow diagram should not be left empty. For instance, please include
information in the follow-up section for the group without PCOS: Lost to follow-up = 0
Table II
- Is this SBP = 18.21 correct?
- Are these DBPs correct?