Reviewer ’s report  
 
Title: Breast cancer relatives' physical activity intervention needs a nd preferences: Qualitative 
results  
 
Version: 0 Date: 08 Sep 2015  
 
Reviewer: Catherine Granger  
 
Reviewer's report:  
 
The authors have written a paper titled "Breast cancer relatives' physical activity intervention 
needs and preferences: Qualitative results" for BMC Women's Health. This paper describes a 
qualitative study conducted to 1)  learn about the physical activity intervention preferences and 
needs of FDFRs of breast cancer patients and 2) develop a targeted physical activity intervention 
based on the first round of focus groups and then present the intervention to the participants  in a 
second round of focus groups to gain additional feedback for further intervention refinements. 
This topic is important, addresses a current gap in the literature and I believe would be of interest 
to readers.  
The paper is well written, clear, conci se and informative. The authors clearly justify the need for 
this work. It is a novel concept using focus groups to tailor an intervention and re -analyse 
changes with further focus groups. Unfortunately the authors have not gone on to re -test the 
changes t o the intervention (in a quantitative approach), although this is a suggestion for further 
research/next step.  
 
Please find below my comments for the authors to respond to and address in their paper:  
Abstract  
- The abstract is not written clearly and doe s not make sense when read in isolation without 
the full paper: Are the participants relatives of breast cancer survivors as stated in the 
sentence "first -degree female relatives (FDFRs) of breast cancer survivors" or are they 
actual breast cancer survivor s as the methods suggest "Twenty participants first completed a 
12-week physical activity intervention". Please clarify and amend accordingly. (This is clear 
in paper but not abstract)  
- The aims of the study are also not clear in the abstract. Are the aim s to "understand how to 
change one of those modifiable factors: physical activity" or "to develop a targeted physical 
activity intervention" or both? Please clarify and amend. (This is clear in paper but not 
abstract)  
- Please remove the sentence under bac kground regarding methodology as this is confusing 
when reported in this section "This study used formative qualitative research with first -
degree female relatives (FDFRs) of breast cancer survivors to better understand how to 
change one of those modifiabl e factors: physical activity."  
 
Introduction  
- Please elaborate on the statement "One review reported a 22% risk reduction for moderate 
intensity physical activity and 26% risk reduction for vigorous intensity physical 
activity[10]." This needs clarificat ion and further information regarding the amount of 
moderate or vigorous physical activity associated with these risk reductions.  
- Please check and confirm the statement "The American Cancer Society established physical 
activity recommendations for cance r prevention [18] of engaging in at least 150 minutes of 
moderate -vigorous intensity exercise" - most recommendations state either 150minutes of 
moderate PA per week or 75 minutes of vigorous PA per week or an equivalent combination 
of both. In addition pl ease add the words 'per week' to this recommendation they are the 
weekly recommendations not daily or otherwise.  
 
Methods  
- Why were women who were engaged in more than 90minutes of moderate PA per week 
excluded - please justify  
- The authors refer to another paper which includes further details of the PA intervention, 
however I think it would be wise to include slightly more information in the paper as well. 
Please consider adding the following information: where did participants  exercise, was it 
supervised vs not -supervised, how much exercise were they instructed to do, what type of 
exercise (aerobic, resistance), how was exercise progressed, and was adherence to exercise 
measured? This information is vital in allow readers to ac curately interpret the views and 
suggested changes. In addition: if information was received in the mail, how was this 
tailored to the patient (i.e how did the patient give information back to the therapist to 
inform the information sent in the mail) -this needs clarification?  
- The numbers of participants in each focus group (4 -6) are low. Please reference this number 
and provide information to justify a minimum of 4 participants is sufficient for this type of 
methodology.   
- Further information on the m ethodology of the focus groups is required, including was the 
facilitator known or not known to the participants?  
 
Results  
- Please present standard deviation with mean age and use the term mean rather than average  
- Please provide country currency for $$  
- The addition of a table provide information on sample demographics is recommended  
- Please provide information on previous exercise history for participants  
- Please provide information on adherence to exercise program for participants  
 
Discussion / co nclusions  
- Please make it clear to readers than the steps from here are to re -test the proposed changes to 
the invention and also establish if these changes are effective at increasing adherence to PA, 
gaining physical and psychological benefits of PA and  reducing cancer risk.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please sp ecify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fee s, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financiall y from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial com peting interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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