Effects of different exercise types and cycles on pain and quality of life in breast cancer patients: A systematic review and network meta-analysis

Jin Dong; Desheng Wang; Shuai Zhong

doi:10.1371/journal.pone.0300176

Peer Review History

Original SubmissionOctober 31, 2023
20 Dec 2023 Decision Letter - Hidetaka Hamasaki, Editor PONE-D-23-35809Effects of different exercise types and cycles on pain and quality of life in breast cancer patients: a systematic review and network meta-analysisPLOS ONE Dear Dr. Wang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 03 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In the online submission form, you indicated that All relevant data are within the manuscript and its additional file. The data are available from the corresponding author on reasonable request. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either a. In a public repository, b. Within the manuscript itself, or c. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. 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Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 6. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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 Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 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 Reviewer #3: Yes ****** 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 Reviewer #3: Yes ****** 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: There are many errors in write up e.g. the referrence is missing - Training for 12 weeks falls under which category? - Referrence for Jadad scale - Table 2- please write particioants (n)- because if not, not sure what partcipants mean - Arrangement- Table 2 after Figure 1?- not tally with text - Discussion may need to be improved. Mostly expalin the results of the review, may suggest to include abou what do you think cause the certain exercise is better than others- with supported literature Reviewer #2: The manuscript is well-written that few minor revisions needed. The methodology looks strong and perfect. Please revise accordingly in the attached file. Thanks for the interesting manuscript. I think the conclusion should be clear and concise, and give recommendations for effective utilization of your study findings. Reviewer #3: Introduction, 1st paragraph: "Additionally, a systematic review... [9] [10]." If there is a systematic review about QoL in Breast cancer patients, why have you performed another one? Please refer the interest or innovation of yours here, which I understand that exists. Methods, Study selection The exclusion criteria (b) also considered excluding conference papers published with peer-review? Please be more specific. Methods, Data extraction and definition (last parapgraph) "If the required data could not... excluded from consideration." - I hope that the exclusion was just for meta-analysis and that it was considered in the systematic review. Please be more specific. Methods, Data synthesis and analysis (second paragraph) Consider changing to "A p-value greater or equal to 0.05 indicated that ….. Conversely, if the p-value was less or equal to 0.05…" Results 1st paragraph: "eventually, a total of 36 papers… (Error! Reference source not found.)… screening process is shown in (Error! Reference source not found.)" All the tables - normalize the number of significant digits (consider using integers just for counts, 2 decimal places for means and standard deviations, 3 decimal digits for p-values) and align text on the left, number on the right All the manuscript - use the p-value in small caps, an always consider p > 0.05 instead of p > 0.05 in all the sentences where it appears ****** 6. 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: Yes: Zaw Zaw Aung Reviewer #3: Yes: Bárbara Oliveiros ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-23-35809_Comments.docx https://doi.org/10.1371/journal.pone.0300176.r001
Revision 1
26 Dec 2023 Author Response Dear reviewers: Thank you for your comments concerning our manuscript. Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our researches. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in red in the paper. The main corrections in the paper and the responds to the reviewer’s comments are as flowing: Reviewer #1: There are many errors in write up e.g. the referrence is missing Response: Thank you very much for these constructive comments and we have double-checked and revised. - Training for 12 weeks falls under which category? Response: This 12-week training is short-term and is described at the end of the first paragraph of the "2.4 Data Extraction and Definitions" section. - Referrence for Jadad scale – Response: Thank you for your suggestion. We have added references for the Jadad scale. KIM S Y, KIM K N, KIM D W, etc. Reporting Quality Analysis of Randomized Controlled Trials in Journal of Neurosurgical Anesthesiology: A Methodological Assessment[J/OL]. Journal of Neurosurgical Anesthesiology, 2021, 33(2): 154. https://doi.org/10.1097/ANA.0000000000000662. Table 2- please write particioants (n)- because if not, not sure what partcipants mean - Arrangement- Table 2 after Figure 1?- not tally with text Response: Thank you for your suggestion. we have made changes to address the above issues in line with your suggestions. - Discussion may need to be improved. Mostly expalin the results of the review, may suggest to include abou what do you think cause the certain exercise is better than others- with supported literature Response: Thank you for your comment. We have optimised and modified the discussion section. Reviewer #2: The manuscript is well-written that few minor revisions needed. The methodology looks strong and perfect. Please revise accordingly in the attached file. Thanks for the interesting manuscript. I think the conclusion should be clear and concise, and give recommendations for effective utilization of your study findings. 1.Introduction: The manuscript contains an elaborate literature review, but definitions of the key concepts should be included. Some operational definitions are included in discussion section, I think it is better to move to introduction. Response: Thank you for your comments. We have adjusted and revised the conclusion and discussion sections. 2.How about the operational definition of breast cancer? Shall we describe in introduction section? Response: Thank you for your comments. The study population was operationally defined as patients with stage I-III breast cancer, aged ≥18 years, who had been diagnosed and completed surgery. We have added it to the introductory section. 3. Is there any categorization or staging of breast cancer? Any articles describe whether there is the difference in QoL or dependent variables according to stage of the breast cancer? Were the studies reviewed on all types or stages of breast cancer? Shall we include some information about these? Response: Breast cancer patients with stage I-III were included in our study, but it was not possible to count the amount of effect in breast cancer patients with different stages. During our review, we did not find any relevant literature reporting significant differences in quality of life among breast cancer patients with different stages, and we will continue to monitor this issue. The studies we reviewed involved breast cancers of I-III, and some of the descriptions have been modified in the Inclusion Exclusion Criteria section. 4. There may be inclusion criteria for certain types of exercises assigned to breast cancer patients in these reviewed RCTs. The authors may need to elaborate more on this. E.g., Which stage of breast cancer patients are assigned to YOGA, and so on. I am curious which stages of breast cancers included for exercise therapy. Response: None of the literature we included had detailed stages or analyses of breast cancer patients, so we were unable to analyse and elaborate in more depth. 5. “Breast cancer's prevalence has steadily risen over recent decades, notably among younger age groups.” – please add citation, and could you please describe what age groups 15-24 or something age group? Response: Thank you for your comment. We found from data from two Global Cancer Surveys that the minimum average age of breast cancer patients decreased from 31.3 years in 2018 to 29.7 years in 2020, but we did not find more detailed statistics by age group. BRAY F, FERLAY J, SOERJOMATARAM I, etc. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J/OL]. CA: A Cancer Journal for Clinicians, 2018, 68(6): 394-424. https://doi.org/10.3322/caac.21492. SUNG H, FERLAY J, SIEGEL R L, etc. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J/OL]. CA: A Cancer Journal for Clinicians, 2021, 71(3): 209-249. https://doi.org/10.3322/caac.21660. 6. Conclusion section is not clear and concise. It still describes some data and CI. I recommend to revise this section to better and clear understanding by the readers. Response: Thank you for your suggestion. we have made changes to address the above issues in line with your suggestions. Reviewer #3: Introduction, 1st paragraph: 1."Additionally, a systematic review... [9] [10]." If there is a systematic review about QoL in Breast cancer patients, why have you performed another one? Please refer the interest or innovation of yours here, which I understand that exists. Response: Thank you for your comment. In previous studies researchers only analysed the types of exercise and did not compare different exercises. In our study it was necessary to determine the effects of different exercise cycles and different types of exercise on patients' quality of life and other aspects of health. 2.Methods, Study selection The exclusion criteria (b) also considered excluding conference papers published with peer-review? Please be more specific. 3. Methods, Data extraction and definition (last parapgraph) "If the required data could not... excluded from consideration." - I hope that the exclusion was just for meta-analysis and that it was considered in the systematic review. Please be more specific. 4. Methods, Data synthesis and analysis (second paragraph) Consider changing to "A p-value greater or equal to 0.05 indicated that ….. Conversely, if the p-value was less or equal to 0.05…" 5. Results 1st paragraph: "eventually, a total of 36 papers… (Error! Reference source not found.)… screening process is shown in (Error! Reference source not found.)" 6. All the tables - normalize the number of significant digits (consider using integers just for counts, 2 decimal places for means and standard deviations, 3 decimal digits for p-values) and align text on the left, number on the right 7. All the manuscript - use the p-value in small caps, an always consider p > 0.05 instead of p > 0.05 in all the sentences where it appears Response: Thank you very much for these constructive comments and we have made changes to address the above issues in line with your suggestions. We hope that these changes will meet with your approval. If you have any other questions, please do not hesitate to send us your comments. Sincerely, Jin Dong De-sheng Wang Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0300176.r002
26 Jan 2024 Decision Letter - Hidetaka Hamasaki, Editor PONE-D-23-35809R1Effects of different exercise types and cycles on pain and quality of life in breast cancer patients: a systematic review and network meta-analysisPLOS ONE Dear Dr. Wang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 11 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Hidetaka Hamasaki Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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: (No Response) Reviewer #2: (No Response) ******** 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: In the abstract, what do you mean by “anti-rent” exercise? In the introduction, suggest to describe about what does it mean by usual care. Basically the exercise modalities compared were only aerobic, resistance and yoga. Any consideration to include other mode of exercise? Fatigue was not mention in the beginning as one of the outcome that the author wants to study How does the short and long duration exercise program been decided? Any literature to support this? Selection criteria for the article: patients with breast cancer, did you include patients pre and post-surgery? Suggest to specify, resistance exercise- type of exercise, does it involves the upper limb exercise or non-specific. How about muscle endurance exercise, does it included in the analysis? Reviewer #2: (No Response) ****** 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: Yes: Zaw Zaw Aung ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0300176.r003
Revision 2
26 Jan 2024 Author Response Dear reviewers: Thank you for your comments concerning our manuscript. Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our researches. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in red in the paper. The main corrections in the paper and the responds to the reviewer’s comments are as flowing: Reviewer #1: Q1: In the abstract, what do you mean by “anti-rent” exercise? Response: Sorry, this is a spelling error, we mean "resistance exercise". Thank you for checking, we have corrected it. Q2: In the introduction, suggest to describe about what does it mean by usual care. Response: Thanks for your suggestion, we have included an explanation of usual care in the introduction. Q3: Basically the exercise modalities compared were only aerobic, resistance and yoga. Any consideration to include other mode of exercise? Response: Yes, the only types of exercise we are currently comparing are aerobic exercise, resistance exercise and yoga. Because these three exercises are currently more studied, and are easier to implement in clinical practice. In future studies, we will consider adding more exercise methods for comparison to improve the breadth of the study. Q4: Fatigue was not mention in the beginning as one of the outcome that the author wants to study. Response: Thank you for asking, but we do mention the fatigue as a secondary outcome measure in the paragraph on “2.3 outcome”. Q5: How does the short and long duration exercise program been decided? Any literature to support this? Response: Yes, there are literature on long and short term exercise. Here are two references: a) https://doi.org/10.1016/j.jshs.2022.12.008. b) https://doi.org/10.1038/nrneurol.2017.128. Q6: Selection criteria for the article: patients with breast cancer, did you include patients pre and post-surgery? Response: In 2.2 Study selection, we defined breast cancer patients as "patients with stage 1-3 breast cancer over 18 years old who had undergone surgery" in the inclusion and exclusion criteria. Q7：Suggest to specify, resistance exercise- type of exercise, does it involves the upper limb exercise or non-specific. How about muscle endurance exercise, does it included in the analysis? Response: Thanks for your suggestion, we have included an explanation of different types of exercise, including resistance exercise, in "2.4Data extraction and definition". For muscular endurance exercise, we classified it as resistance exercise for analysis. Sincerely, De-sheng Wang Jin Dong Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0300176.r004
30 Jan 2024 Decision Letter - Hidetaka Hamasaki, Editor PONE-D-23-35809R2Effects of different exercise types and cycles on pain and quality of life in breast cancer patients: a systematic review and network meta-analysisPLOS ONE Dear Dr. Wang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: Thank you for submitting your revised manuscript. The authors do not appear to have responded to the comments from Reviewer #2. Due to technical issues with the internet, Reviewer #2 has submitted his report as the attached file. I would appreciate it if you could also respond to the comments and resubmit your manuscript. The comments are as follows: PONE-D-23-35809 Reviewer Comments The manuscript is well-written that only needs minor revision in the following; Introduction: The manuscript contains an elaborate literature review, but definitions of the key concepts should be included. Some operational definitions are included in discussion section, I think it is better to move to introduction. How about the operational definition of breast cancer? Shall we describe in introduction section? Is there any categorization or staging of breast cancer? Any articles describe whether there is the difference in QoL or dependent variables according to stage of the breast cancer? Were the studies reviewed on all types or stages of breast cancer? Shall we include some information about these? There may be inclusion criteria for certain types of exercises assigned to breast cancer patients in these reviewed RCTs. The authors may need to elaborate more on this. E.g., Which stage of breast cancer patients are assigned to YOGA, and so on. I am curious which stages of breast cancers included for exercise therapy. “Breast cancer's prevalence has steadily risen over recent decades, notably among younger age groups.” – please add citation, and could you please describe what age groups 15-24 or something age group? Methodology – perfectly done. Sincerely I have limited experiences with review and network meta-analysis, so that I don’t have special comments on this section. Conclusion section is not clear and concise. It still describes some data and CI. I recommend to revise this section to better and clear understanding by the readers. Thanks to authors for the good manuscript. Sorry for late submission. ============================== Please submit your revised manuscript by Mar 15 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Hidetaka Hamasaki Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Thank you for submitting your revised manuscript. The authors do not appear to have responded to the comments from Reviewer #2. Due to technical issues with the internet, Reviewer #2 has submitted his report as the attached file. I would appreciate it if you could also respond to the comments and resubmit your manuscript. The comments are as follows: PONE-D-23-35809 Reviewer Comments The manuscript is well-written that only needs minor revision in the following; Introduction: The manuscript contains an elaborate literature review, but definitions of the key concepts should be included. Some operational definitions are included in discussion section, I think it is better to move to introduction. How about the operational definition of breast cancer? Shall we describe in introduction section? Is there any categorization or staging of breast cancer? Any articles describe whether there is the difference in QoL or dependent variables according to stage of the breast cancer? Were the studies reviewed on all types or stages of breast cancer? Shall we include some information about these? There may be inclusion criteria for certain types of exercises assigned to breast cancer patients in these reviewed RCTs. The authors may need to elaborate more on this. E.g., Which stage of breast cancer patients are assigned to YOGA, and so on. I am curious which stages of breast cancers included for exercise therapy. “Breast cancer's prevalence has steadily risen over recent decades, notably among younger age groups.” – please add citation, and could you please describe what age groups 15-24 or something age group? Methodology – perfectly done. Sincerely I have limited experiences with review and network meta-analysis, so that I don’t have special comments on this section. Conclusion section is not clear and concise. It still describes some data and CI. I recommend to revise this section to better and clear understanding by the readers. Thanks to authors for the good manuscript. Sorry for late submission. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0300176.r005
Revision 3
31 Jan 2024 Author Response Dear reviewers: Thank you for your comments concerning our manuscript. Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our researches. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in red in the paper. The main corrections in the paper and the responds to the reviewer’s comments are as flowing: Reviewer #1: Q1: In the abstract, what do you mean by “anti-rent” exercise? Response: Sorry, this is a spelling error, we mean "resistance exercise". Thank you for checking, we have corrected it. Q2: In the introduction, suggest to describe about what does it mean by usual care. Response: Thanks for your suggestion, we have included an explanation of usual care in the introduction. Q3: Basically the exercise modalities compared were only aerobic, resistance and yoga. Any consideration to include other mode of exercise? Response: Yes, the only types of exercise we are currently comparing are aerobic exercise, resistance exercise and yoga. Because these three exercises are currently more studied, and are easier to implement in clinical practice. In future studies, we will consider adding more exercise methods for comparison to improve the breadth of the study. Q4: Fatigue was not mention in the beginning as one of the outcome that the author wants to study. Response: Thank you for asking, but we do mention the fatigue as a secondary outcome measure in the paragraph on “2.3 outcome”. Q5: How does the short and long duration exercise program been decided? Any literature to support this? Response: Yes, there are literature on long and short term exercise. Here are two references: a) https://doi.org/10.1016/j.jshs.2022.12.008. b) https://doi.org/10.1038/nrneurol.2017.128. Q6: Selection criteria for the article: patients with breast cancer, did you include patients pre and post-surgery? Response: In 2.2 Study selection, we defined breast cancer patients as "patients with stage 1-3 breast cancer over 18 years old who had undergone surgery" in the inclusion and exclusion criteria. Q7：Suggest to specify, resistance exercise- type of exercise, does it involves the upper limb exercise or non-specific. How about muscle endurance exercise, does it included in the analysis? Response: Thanks for your suggestion, we have included an explanation of different types of exercise, including resistance exercise, in "2.4Data extraction and definition". For muscular endurance exercise, we classified it as resistance exercise for analysis. Reviewer #2: The manuscript is well-written that few minor revisions needed. The methodology looks strong and perfect. Please revise accordingly in the attached file. Thanks for the interesting manuscript. I think the conclusion should be clear and concise, and give recommendations for effective utilization of your study findings. Q1:Introduction: The manuscript contains an elaborate literature review, but definitions of the key concepts should be included. Some operational definitions are included in discussion section, I think it is better to move to introduction. Response: Thank you for your comments. We have adjusted and revised the conclusion and discussion sections. Q2:How about the operational definition of breast cancer? Shall we describe in introduction section? Response: Thank you for your comments. The study population was operationally defined as patients with stage I-III breast cancer, aged ≥18 years, who had been diagnosed and completed surgery. We have added it to the introductory section. Q3: Is there any categorization or staging of breast cancer? Any articles describe whether there is the difference in QoL or dependent variables according to stage of the breast cancer? Were the studies reviewed on all types or stages of breast cancer? Shall we include some information about these? Response: Breast cancer patients with stage I-III were included in our study, but it was not possible to count the amount of effect in breast cancer patients with different stages. During our review, we did not find any relevant literature reporting significant differences in quality of life among breast cancer patients with different stages, and we will continue to monitor this issue. The studies we reviewed involved breast cancers of I-III, and some of the descriptions have been modified in the Inclusion Exclusion Criteria section. Q4: There may be inclusion criteria for certain types of exercises assigned to breast cancer patients in these reviewed RCTs. The authors may need to elaborate more on this. E.g., Which stage of breast cancer patients are assigned to YOGA, and so on. I am curious which stages of breast cancers included for exercise therapy. Response: None of the literature we included had detailed stages or analyses of breast cancer patients, so we were unable to analyse and elaborate in more depth. Q5: “Breast cancer's prevalence has steadily risen over recent decades, notably among younger age groups.” – please add citation, and could you please describe what age groups 15-24 or something age group? Response: Thank you for your comment. We found from data from two Global Cancer Surveys that the minimum average age of breast cancer patients decreased from 31.3 years in 2018 to 29.7 years in 2020, but we did not find more detailed statistics by age group. BRAY F, FERLAY J, SOERJOMATARAM I, etc. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J/OL]. CA: A Cancer Journal for Clinicians, 2018, 68(6): 394-424. https://doi.org/10.3322/caac.21492. SUNG H, FERLAY J, SIEGEL R L, etc. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J/OL]. CA: A Cancer Journal for Clinicians, 2021, 71(3): 209-249. https://doi.org/10.3322/caac.21660. Q6: Conclusion section is not clear and concise. It still describes some data and CI. I recommend to revise this section to better and clear understanding by the readers. Response: Thank you for your suggestion. we have made changes to address the above issues in line with your suggestions. Sincerely, De-sheng Wang Jin Dong Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0300176.r006
19 Feb 2024 Decision Letter - Hidetaka Hamasaki, Editor PONE-D-23-35809R3Effects of different exercise types and cycles on pain and quality of life in breast cancer patients: a systematic review and network meta-analysisPLOS ONE Dear Dr. Wang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Apr 04 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Revision 4
19 Feb 2024 Author Response Dear reviewers: Thank you for your comments concerning our manuscript. Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our researches. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in red in the paper. The main corrections in the paper and the responds to the reviewer’s comments are as flowing: R1: Q1: “Breast cancer's prevalence has steadily risen over recent decades, notably among younger age groups.” This sentence still makes confusing. I think, according to authors’ response, it should be “The prevalence of breast cancer has steadily risen over recent decades (from ….. to ….. during 20.. to 20.. if you have exact information). The age of diagnosing breast cancer becomes younger ………… probably diagnostic facilities and access to healthcare are improving in recent years or if you have relevant information – please add. Response: Thank you for your suggestion. I have reviewed the literature again and revised the part in the introduction. “The age of diagnosing breast cancer becomes younger …… probably diagnostic facilities and access to healthcare are improving in recent years. "We have adjusted these sentences in previous revisions, Mainly through the information obtained in Reference 2. Q2: Inclusions by the reviewed RCTs - Completed surgery for how long? Any categorizations for duration of completed surgery? Durations of illness they suffering may have effects on their QoL, for chronic diseases, the longer the disease duration the poorer QoL in general. Reverse or how about your findings on QoL in these reviewed RCTs? Could you please explain here if you have reviewed and found these facts? Or if not, you may add as weakness or bias or recommend to explore more information in further studies. Response: Your suggestion is very good, however, only a small number of literatures in our included literature mentioned how long to complete surgery for exercise, so we could not perform a categorical analysis of time to complete surgery. As for the relationship between duration of illness and quality of life in chronic patients, there are also insufficient data for analysis in our study, and we will supplement these weaknesses in limitation. Q3: Shall we describe shortly on standard care for CG that you have described in comparison in the later sections? Response: Sure. We defined control measures as usual care, including medication as necessary, health education, general stretching exercises, and passive movements with the help of a physician. We have added this information to the introduction in previous revisions. Sincerely, De-sheng Wang Jin Dong Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0300176.r008
23 Feb 2024 Decision Letter - Hidetaka Hamasaki, Editor Effects of different exercise types and cycles on pain and quality of life in breast cancer patients: a systematic review and network meta-analysis PONE-D-23-35809R4 Dear Dr. Wang, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Hidetaka Hamasaki Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0300176.r009
Formally Accepted
27 Feb 2024 Acceptance Letter - Hidetaka Hamasaki, Editor PONE-D-23-35809R4 PLOS ONE Dear Dr. Wang, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Hidetaka Hamasaki Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0300176.r010

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