Title: Exercise interventions on body composition and quality of life of overweight/obese breast
cancer survivors: a meta-analysis
Version: 1 Date: 17 Jul 2023
Reviewer:  Tarek Tawfik Amin
Reviewer's report:
Comments to the authors:
Title: Exercise interventions on body composition and quality of life of overweight/obese breast
cancer survivors: a meta-analysis
General comments:
- The novelty of the this study is questionable as some provided review of the systematic
reviews handling the subject https://www.frontiersin.org/journals/oncology/articles/10.3389/
fonc.2022.955505/full
- The excessive and significant heterogeneity is another issue in reporting the effect of exercise
on breast cancer survivors and several other variables especially the bone health and again the
HRQoL assessment was conducted using very generic tool.
Specific comments:
Abstract:
- Methods: Weighted mean for which outcome variables?
- Results: you stated in the aim that RCTs were only eligible? This sentence is confusing.
- Mention the results of subgroup analysis in the methods, and then mention it again in the results
section.
- In the conclusion section: Overweight/obese! Were these two categories aggregated or the
results were found separated?  Define both and describe your results accordingly (if applicable).
- The benefits of exercise among breast cancer survivors. Which one?
Introduction:
- More literature about the role of PA on benefits to BC survivors is needed
- Effect of weight loss on BCS (breast cancer survivor? and recurrences?
- What type of PA/fitness you mean?
- “In addition, obesity  has been suggested to increase the risk of recurrence, all-cause mortality,
and long-term morbidities (cardiovascular disease, diabetes, etc.) in breast cancer survivors”
- What do you mean by circumference? Waist hip?
- Where is your rationale? Why you have conducted this meta-analysis in the first place, to solve
some conflicting results? To emphasize the role of exercise on overweight/obese survivors? Or
else
Materials and methods:
- What were your outcome variables?
- “Based on the pre-established  retrieval strategy, studies”
- without language restrictions. (were any of the retrieved studies reported in other languages?
- The selection criteria of the eligible studies should be mentioned before the retrieval strategy.
- In the outcomes, Mention (BMI, Body fat, survivors etc.,).
- “Studies that met any of the above exclusion  criteria were excluded. Additionally, when
multiple studies involving the same data were included, only the study with the most detailed
data was included.”
- “and any unconformities were addressed by discussion .
- Elaborate more on the Cochrane Assessment tool in this section
Statistical analysis:
- Define the variable used for the pooled estimates
- Justify using the random-effect model?
- The Cochrane Q test used for which variables?
- In sensitivity analysis how many studies were eliminated?
- Subgroup analysis was only used for the exercise duration or others?
Screening eligible studies:
- What about the language restriction?
- “Among the eight included studies, two by Brown  et al. [17] involved the same RCT with
registration number NCT01515124, and two by Dieli-Conwright et al. [23] involved the same
RCT with registration number NCT01140282.”
- “The methodological quality of the included studies was medium , with a moderate or high
risk of selection, performance, and detection biases in several studies”
Sensitivity analysis and publication bias:
- Replace insignificant with non-significant
- Funnel plot should be displayed (publication bias) in this section
Discussion section:
- “In terms of the quality of life, exercise intervention showed a tendency to increase PHS and
MHS, but this did not reach statistical significance. Taken  together, these findings indicate
that overweight/obese breast cancer survivors may benefit from exercise intervention for weight
management” .