PONE-D-23-22789Associations of Frailty with Partial and Absolute Sedentary Behaviours among Older Adults: A STROBE-Compliant Analysis of Modifiability by Gender and AgePLOS ONE

Dear Dr. Asiamah,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study is excellent in that it follows the STROBE checklist and confounding factors are also done in detail.

It was a good learning experience for me as well as a reference for conducting my own cross-sectional study.

I would like to ask you a few questions and would be happy if you could answer them.

1.[We followed a recent study [2] to measure sedentary behaviour as a construct of partial sedentary behaviour and absolute sedentary behaviour. Partial sedentary behaviour is time (in minutes) spent sitting while doing an activity such as playing a game or driving on a typical day. It was measured by asking the participants to report time spent sitting in six situations. Absolute sedentary behaviour is the time (in minutes) spent on a typical day while sitting without physically moving any part of the body. It was measured by asking the participants to report time spent while sitting in six situations (e.g., lying down, reclining, viewing TV). Sedentary behaviour was the sum of time reported on the 12 items whereas partial and absolute sedentary behaviours were the sum of their respective 6 items. Appendix A shows questions and items used to measure sedentary behaviour. Frailty was measured with the 15-item Tilburg Clinical Frailty Index (see Appendix B) with two descriptive anchors (yes – 1; no – 0) adopted in whole from a previous study [26]. As noted earlier, we used this clinical measure of frailty to be able to identify implications for clinical or geriatric practice. This scale produced a satisfactory internal consistency in the form of Cronbach’s alpha coefficient = 0.92.]

→How much has the validity of this measure of physical activity been proven in the past? I would appreciate it if you could tell me about previous studies. Also, I thought the study would have been more reliable and valid if, in addition to the questionnaire, an objective measure (such as using an activity meter) had been taken. Why did you not use an activity meter?

2.[The participants were community-dwelling older adults aged 50 years or higher in Ghana. We targeted older adults in two peri-urban towns, each with a combination of low and high socio-economic neighbourhoods. The following inclusion criteria were used to select the participants: (1) having at least a basic education qualification (i.e., basic school living certificate), which we used as an indicator of the ability to complete the questionnaire in English; (2) being a permanent community-dwelling resident aged 50 years or higher, and (3) the ability to walk independently for at least 10 minutes [24]. We calculated the minimum sample size necessary for this study with the G*Power software and recommended statistics (i.e., effect size = 0.2, α = 0.05, power = 0.8) suited for our sample [25]. The minimum sample estimated for HLR analysis with a maximum of 10 predictors was 91. To maximise the statistical power of our tests, we selected as many eligible individuals as possible. There was no sampling frame for this study, so potential participants were selected by research assistants at community and social centres such as supermarkets and events. Research assistants interviewed potential participants at various community centres to assess their eligibility. A total of 1039 older adults who met the above criteria were selected.]

→With regard to the eligibility of the subjects, since the study was conducted on elderly people, was any cognitive function testing done? I was concerned about the reliability of the study since it was mainly a questionnaire-based study.

Reviewer #2: This study uses a unique sedentary time questionnaire for the elderly and examines its correlation with frailty. Although this is an interesting study, the main concerns are listed below.

1. The introduction talks about the reliability of surveys using questionnaires for elderly people, and I think this point is important. Please add a little more detail about whether this can be compensated for by the 12-item questionnaire of this study. Furthermore, “they do not capture human

"feelings or psychology, are generally expensive, and can easily be damaged", but the meaning of this part is unclear.

2. This study interprets the results based on correlation only, but has the two groups, the frailty group and the robust group, been compared? I think it would be more persuasive if this data was also shown.

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Reviewer #1: No

Reviewer #2: No

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Associations of Frailty with Partial and Absolute Sedentary Behaviours among Older Adults: A STROBE-Compliant Analysis of Modifiability by Gender and Age

PONE-D-23-22789R1

Dear Dr. Asiamah,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Kiyoshi Sanada, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you very much for your precise response to my question. I understand it well now.

I will be able to apply the contents to my research in the future.

We look forward to your future activities. Thank you very much.

Reviewer #2: I fully understand the author's response. In the future, we hope to increase the number of subjects and conduct more advanced research.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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