Reviewer ’s report  
 
Title: Effects of prolonged exercise versus multiple short exercise sessions on risk for metabolic  
syndrome and atherogenic index in middle -aged obes e women: A randomised controlled trial  
 
Version: 0 Date: 14 Jun 2016  
 
Reviewer: Xuewen Wang  
 
Reviewer's report:  
 
This study addresses an interesting question that is relevant for the public health. There is a few 
issues that need to be addressed before the manuscript can be accepted.  
 
 
 
Abstract:  
 
Some data to show the primary findings of the study should be added to th e Results.  
 
 
 
Introduction:  
 
The focus of the introduction seems to focus on obesity rather than metabolic syndrome. While 
the two are related, metabolic syndrome should be the focus since its components are being 
examined in the manuscript.  
 
 
The authors ref ers "a balanced diet" as treatment for obesity. Please note that this is not correct 
as that balanced diet refers to the content of diet, which is unlikely associated with weight loss.  
 
 
Needs a reference for the statement "Women have particularly high mor bidity rates in midlife".  
 
 
The gap in the literature this study intended to fill should be clearly described. As written, it has 
been shown that several short exercise sessions are as beneficial as one single long session. Then 
why is this study needed?  
 
 
 
Methods:  
 
Clarify "an effect size of .30" is for which variable.  
 
Under "Graded exercise test", because there are measurement errors and daily variance, it is 
incorrect to say "precisely 200 kcal" for an exercise session. Was maximum heart rate age -
predicted ? Misspelled word "thrice".  
 
 
Several studies have shown that the 5 L/kcal value of the VO2 and calorie expenditure relation is 
only correct for a small population. This is another reason the exercise calorie expenditure could 
not be precise. Why was 200 kcal the target exercise calori e expenditure? Was it the same for all 
participants?  
 
 
What is the rational for 300 kcal dietary restriction? How was daily energy expenditure 
calculated from basal metabolic rate? Was basal metabolic rate calculated or measured?  
 
 
When the outcome measures were measured after the exercise program, how long was it from 
the last exercise to the time blood samples were drawn?  
 
 
Provide information regarding exercise adherence.  
 
 
 
Discussion:  
 
Could exercise adherence contribute to the different findings from vario us studies? Were the 
cited studies conducted with or without dietary intervention? Information on the amount of 
weight loss would be helpful.  
 
 
 
 
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 specify 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 o r 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.  
 
I am able to assess the statistics  
 
Quality of written Englis h 
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, fees, funding,  or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
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financially 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?  
 
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below.  If your reply is yes to any, please give details below.  
 
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