Reviewer’s report
Title:  Effects of exercise on Inflammatory Factors and IGF System in Breast Cancer Survivors: A
Meta-analysis
Version: 1 Date: 11 May 2022
Reviewer's report:
* Authors did not address first comment in abstract. There is currently not a rationale for conducting
the analysis in the Background section of the abstract. Only three separate purposes are stated in this
section - no rationale is given as to why these purpose(s) are being explored. * Page 3 line 1 - extra
space before the period * In the conclusion of abstract - it is unclear to me how the authors can make
the claim that these results prevent recurrence. This is not a longitudinal study and therefore I don't
believe authors can make this claim based of their current results. If anything, authors may be able to
claim that these results may have implications for recurrence. But there is not cause/effect relationship
here (as they've indicated in their background section) and no analyses were done to be able to make
this claim. * A lot of good information in the background section - however, not all of it connects from
section to section (i.e., reads a bit sporadic). Suggest authors revise their background section to clearly
outline gaps in literature which will then lead to their purpose(s), which appear to be randomly stated in
the last sentence of the background section. In doing so, I believe this will improve the flow of the
background section, utilizing the information they've provided to more clearly lay out their rationale. *
Page 8 - Lines 14-17: The combination of search terms that the authors provided in their response
should be included in a supplementary file rather than stating they are free to combine. This sentence
should be switched out with "refer supplemental xyz" so all combinations of search terms that were
used. * Inclusion criteria: please define "postoperative rehabilitation". Does simply mean after surgery?
Implying that they could be receiving systemic therapies? This may impact interpretation of results
with the effects of chemo/radiation * Methodology should all be in past tense * Rationale for sensitivity
analysis is unclear - section reads "due to the quantitative of the articles". Reason should be clearly
stated so readers do not have to guess. * Exercise guidelines should probably reference the ACSM
guidelines that both ACS and ASCO refer to * Authors still have not adequately address points made
about the discussion. A good example is section 4.1 of the discussion. This is simply a lit review - there
are no comparisons their own results or implications in this section. This is not appropriate for a
discussion section. * "Exercise is feasible for breast cancer survivors, and exercise not only reduces
side effects, but also improves survival rates in breast cancer patients" - this was not assessed in this
analysis and therefore should not be a conclusion of the study. * Overall - this manuscript still needs
work in terms of grammar and sentence structure. There are many sentences throughout the entire draft
that need restructuring which may in turn improve the overall clarity of the article. 
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Is the study design appropriate to answer the research question (including the use of appropriate
controls), and are the conclusions supported by the evidence presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are  the  images  in  this  manuscript  (including  electrophoretic  gels  and  blots)  free  from  apparent
manipulation?
No