Title: Effects of exercise on sex steroid hormones (estrogen, progesterone, testosterone) in
eumenorrheic females. A systematic review and meta-analysis
Version: 1 Date: 06 Mar 2024
Reviewer's report:
The systematic review and meta-analysis conducted on the effects of exercise on sex
steroid hormones (estrogen, progesterone, testosterone) in eumenorrheic females present a
comprehensive overview of existing literature. While the study contributes valuable insights to
the field, certain areas warrant attention and could enhance the overall robustness of the findings.
1. Inclusion Criteria and Study Selection:
- Clarify the criteria for selecting studies, including the types of exercise interventions and the
study duration stating why 2012 to 2023 studies were included. This information is crucial
for understanding the scope and applicability of the findings. A clear description of outcome
measures is  to be included in the methodology
2. Heterogeneity Among Included Studies:
- Address and discuss the substantial heterogeneity observed among the included studies. Details
about Variations in exercise protocols, participant characteristics, and hormonal assessment
methods may have contributed to the heterogeneity. Provide a sensitivity analysis to explore the
impact of these variations on the overall results.
3. Publication Bias:
- Assess and discuss the potential for publication bias within the meta-analysis. Funnel plots or
statistical tests such as Egger's test could be employed to examine asymmetry in the data and
evaluate the likelihood of selective reporting.
4. Quality Assessment of Included Studies:
- Conduct a thorough quality assessment using a reliable and valid scale of the included studies to
evaluate the risk of bias. This information is essential for gauging the reliability of the evidence
synthesized in the meta-analysis.
5. Dose-Response Relationship:
- Explore the existence of a dose-response relationship between exercise intensity, duration,
and frequency with changes in sex steroid hormones. A more nuanced analysis could provide
valuable insights into the optimal exercise parameters for hormonal modulation.
6. Consideration of Menstrual Cycle Phases:
- Given the cyclical nature of sex steroid hormone fluctuations in eumenorrheic females, discuss
the potential impact of menstrual cycle phases on the observed hormonal changes. Stratifying
the analysis based on menstrual cycle phases might reveal differential effects.
7. Implications for Different Age Groups:
- Address the potential age-related variations in hormonal responses to exercise. Consider
discussing whether the observed effects are consistent across different age groups of
eumenorrheic females. A separate table should be included for this information.
8. Future Research Directions:
- Propose avenues for future research, including specific gaps in the literature that need to be
addressed. This could guide researchers and contribute to the ongoing knowledge development
in this area.
General concerns
1. A few general concerns are to be addressed. The authors have included quasi-experimental
studies in the review of how they have prevented the bias as it included only a single group.
2. There were major concerns about the formatting of the manuscript according to the journal
guidelines
3. Authors are advised to give a grammar check. As the manuscript has major grammatical errors