Aerobic and Postural Strength Exercise Benefits in People with Schizophrenia

Round 1

Reviewer 1 Report

This paper seems relevant, interesting, novel and should be attractive to those working in mental health care. I does need to highlight that it is not an RCT and that the methods need to note this along with providing cautionary points in the Discussion and Conclusions. The use of Sedentary Behaviour (SB) in the Title and in the script is somewhat confusing especially as the key conclusions in the Abstract, Discussion and Conclusions do not really refer to SB in an over way. There are results on Daily Sed time but these seem somewhat secondary. Perhaps the title and focus/aims should be changed to: Aerobic and Postural Strength Exercise Benefits in People (not patients) with Schizophrenia.

A key element for comparing the two modes of exercise, which needs highlighting more is the difference in baseline measures and hence affecting the validity of the comparisons

The Units of Measurement are not given in the Tables?

 

Author Response

Thank you so much for your review, We all consider the work with people affected by severe mental problems a great but extremely rewarding task. We carefully studied your comments and addressed the comments highlighting the major points.

a. We clarify that this is not a RCT and describe it in the methodology section as a non-randomized clinical trial.

b. We carry out the suggested rewriting of the results in the abstract, discussion and conclusions.

c. Agreeing with the suggested change in the term ''patients'' has always been a subject of concern in our research group. We consider both ways adequate (people with schizophrenia and patients with schizophrenia) and adopted your final suggestion of "people".

Your sincerely,

Michele Szortyka

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for the opportunity to review this study. I consider the idea of comparing two different physical exercise interventions very interesting, but I found several concerns regarding the outcomes assessed to test and compare intervention effects.

There is a big gap in the rationale of the sedentary behavior as the main outcome as well as the main focus of intervention effects of this study.

How the authors can attest to the benefits of two different intervention protocols having as reference a secondary measurement of sedentary behavior? Of course, any type of intervention can improve the sedentary behavior of those who spend 12 hours or more sitting on a chair or sofa. I cannot find the novelty in this study as it is present.

Unfortunately, I cannot approve the manuscript for publication as it presents taking into account the issues raised above.

Author Response

Thank you so much for your review.  There is a need for additional research on complementary treatments in people affected by schizophrenia. They suffer from a wide range of barriers to access physical activity and exercise, including social stress and discrimination, comorbidities, instrinsic mood disregulation, reduced self-confidence and  low levels od social support, resulting in sedentary pattern of life. The need for adequate treatments is what makes this work relevant. Although the literature presents some studies, including meta-analyses measuring the effects of aerobic exercise, interventions on postural exercise are extremely scarce. As long as we could identify, there are no head-to-head comparisons of these two interventions in schizophrenia. We added the measurement of physical flexibility to the other physical parameters because of its effect over balance and mobility, and in consequence, over social interaction and well-being. People affected by severe mental illness also have the body sick and this should be addressed in treatment and rehabilitation. Considering this together with your critics, we carefully reviewed and rewrote the abstract, discussion and conclusions in order to fulfill your comment about the need for higher coherence in the article.

Your sincerely,

Michele Szortyka

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Dear authors, please respond in a specific letter to each point raised by me during the review process and highlight in another color the changes made. I cannot follow how it is.

Author Response

Dear Review,

You requested a specific letter showing the requested changes, I have re-reviewed your request and you asked me in the review the use about the sedentary behavior measure, perhaps the measure of sedentary behavior as a measure of change may not seem interesting but I would like to emphasize that the change in sedentary behavior is extremely important,both for the benefits it brings to the patient, but also the type of population studied, the patient with severe mental illness such as schizophrenia has twice as many difficulties in performing any physical activity, even the simplest ones.   The application of different but comparable protocols, aerobic exercise has already been presented in meta-analyses showing its effect (although in some parameters our study did not respond in the same way, such as functional capacity by 6-minute walk test) and interventions in postural exercise are extremely scarce, there is no previous data for comparison in this population.   Again, I am available for further questions and possible clarifications. Thank you so much for your review.   Sincerely,  Michele Szortyka 

Author Response File: Author Response.docx