Reviewer’s report
Title: 
Serum and Gene Expression Profile of Cytokines Following combination
of Yoga Training and Vitamin D Supplementation in Breast Cancer Survivors: a
randomized controlled trial
Version: 
1 
Date: 
09 Feb 2022
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
The objective of the study is very clear and makes sense given the importance of
exercise/workout, including Yoga, in cancer survivors. The authors have
combined biochemical parameters with QOL issues. The concept is nice but I
have many concerns about the study design as well as presentation -
Several key statements need to be supported by proper references / citations.
Here are some statements for example - "It is suggested that behavioral
modifications such as exercise and a healthy diet are effective in regulating
cytokine balance and managing adverse side effects" and "Most BC patients and
survivors, especially at menopause, have deficiencies in nutritional indicators,
including vitamin D (VD)" in the Background. Please add appropriate
references.
The Background / Introduction is a little too lengthy. All the information
provided therein is good and relevant. I suggest moving some information to
Discussion so as to make Background more focused.
Under 'Participants' authors have mixed inclusion and exclusion criteria. Please
spell them out separately. 
Please provide a table with patient characteristics.
One critical piece of information missing is the history of breast cancer in the
survivors. Breast cancer is not a single disease and the clinical management is
wide and varied. Were the 3 groups evenly matched. It would be important to
provide tabular information about the history of breast cancer in each of three
groups - type of breast cancer (subtype / TNM stage) - type of treatment - how
much time had elapsed (cancer free to this study) - any metastatic disease etc. 
Please provide more details about Borg scale numbering.
The Results section is one long section. Please sub-divide this into sub-sections
for ease of reading.
Some results are described as small paragraphs consisting of one or two
statements. Please organize results professionally in neatly organized
paragraphs.
In the discussion authors note - "High VD dose supplementations led to
significant increases in VD level than low VD dose". Well, there was no control
LVD group. How can this be a meaningful conclusion?
In continuation of the above concern, I am surprised by the missing LVD group
all by itself (without Yoga). Also, what was the logic behind leaving out a 'Yoga-
only' group? After all, vitamin D consumption is not mandatory for breast cancer
survivors.
Conclusions start with 'Totally'. This is unacceptable English. Please edit.
Another critical piece of data missing is the pre- vs post levels of cytokines in
each group. Just comparing the 3 groups for their post-yoga levels leaves out so
much invaluable information. Please pardon me if I missed it but if its there and
I missed it, the write-up needs to improve. However, if its not there, I find this a
major flaw.
Another thing missing is the QOL issues in the Results section and the general
conclusions. Why is it even mentioned if authors do not think its important.
REQUESTED REVISIONS: 
Please see my detailed comments above
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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?
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Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes