PONE-D-24-31823The impact of interventions in the workplace promoting exercise and a healthy diet among shift workers: a systematic reviewPLOS ONE

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Additional Editor Comments:

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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: Partly

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: N/A

Reviewer #2: Yes

Reviewer #3: I Don't Know

Reviewer #4: Yes

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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

Reviewer #3: Yes

Reviewer #4: 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

Reviewer #3: Yes

Reviewer #4: 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: Comments:

The manuscript addresses a valid research question within the journal's scope. Additionally, it explores an important issue regarding the impact of interventions promoting healthy eating and/or physical activity among shift workers.

The title accurately reflects the manuscript's focus and is concise, while the abstract precisely describes the objectives, methods, results, and conclusions.

To improve the structure and flow of the manuscript, I would like to offer some comments, questions, and suggestions.

Abstract:

- Provide protocol registration information;

- Indicate how risk of bias was assessed.

Introduction

- Define the WHO abbreviation upon first mention.

Materials and Methods

- Define the PICO strategy, clarifying the Population, Intervention, Control, and Outcomes beyond just identifying the central question;

- It is unnecessary to provide dates in parentheses; I suggest including the dates in the just main text instead;

- Additionally, phrases like "(for instance, sex)" or "(for instance, number of employees)" and similar citations are unclear. It is ambiguous whether only the items in parentheses are considered in the studies or whether additional data are included. I suggest rephrasing: "No limitations were established regarding the gender of the subject, workplace size, number of employees, and [list additional items]."

Exclusion Criteria

- Were other study types, such as general reviews (narrative, systematic with or without meta-analysis), preclinical studies, ecological studies, and cost-effectiveness analyses, included? If not, consider stating this explicitly;

- In this section, it states that "studies on youths less than 18 years old" were excluded, yet in the previous section, it mentions "No limitations were established regarding the characteristics of the subject (for instance, sex)." I suggest specifying "evaluated individuals aged ≥ 18 years" to clarify this in the eligibility criteria.

Evaluation of Bias

- What about studies that were not RCTs? How were they assessed? I suggest adding an additional evaluation method for them.

Results

Table 1

- Standardize table borders to the same thickness; for clarity, typically only horizontal lines are used.

Line 1: Describe the exclusion criterion as with other lines; if not already mentioned, please specify;

- Line 2: Describe the inclusion criterion similarly; if not already mentioned, please specify;

- Consider using abbreviations only within the table and including descriptions in a line following the table as a caption;

- Move the Author/Year column to the first position, and instead of placing the reference in superscript with the title, insert the reference in square brackets next to the author's name and publication year, as specified in the author’s guide. For example, in the first line: Monnaat Sie, M et al., 2023 [11];

- Only the last name of the first author is necessary, and a semicolon should follow "et al.," Please review and reformat accordingly.

Table 2

- Format the borders similarly to Table 1;

- Include references in square brackets in all rows in column 1;

- Format and standardize italicized items in line 1;

- In the study by Torquati L et al., 2017, correct the text in column 4: "post-intervention anda t 6 months.";

- What are the asterisks in the results in line 1? Please explain;

- Use abbreviations in the table text, with descriptions in a caption for terms such as BMI and FFQ;

- Adjust cell indentation; some spaces are misaligned;

- Specify whether "duration" refers to the intervention or study period to avoid confusion for readers.

First Paragraph of Results Presentation

- Consider adding basic data on sample size (n) and percentages, average age, gender proportions, commonly represented countries, and average duration;

- Clarify "RE-AIM structure."

Line 29, Regarding the Assessment Tool, RoB 2.0

- For studies where this method was not applied, an alternative risk-of-bias assessment tool should be included so all studies undergo bias evaluation;

- Provide a general conclusion of this analysis, classifying the overall risk of bias in your study as low, medium, or high; this information would be beneficial.

Discussion

- The discussion currently presents each study's findings individually; this section should contextualize and connect these findings with the existing literature, incorporating recent references. I recommend restructuring this section;

- Consider presenting these results more succinctly within the results section and using this section to explore common themes that warrant further discussion.

- Include a section on study limitations.

Conclusion

- Highlight key findings and potential areas for further research.

Line Numbering

- Line numbering should be sequential and continuous, without restarting on each page. I suggest correcting this.

References

- I recommend standardizing references throughout the text as specified in the author's guide, using square bracket numbers.

Reviewer #2: The article addresses a highly important and current topic concerning the effects of interventions that promote healthy eating habits and physical activity in the workplace, particularly among shift workers. The systematic analysis of the available literature offers a valuable source of knowledge, with the authors effectively presenting the findings of individual studies, clearly illustrating the positive effects of the interventions undertaken.

However, the article’s introduction requires certain additions. It is currently somewhat brief, and while it outlines the main points, it lacks several essential elements that could better justify the importance of the analysis undertaken. The authors could more extensively describe the physiological mechanisms underlying the effects of shift work on metabolic health. A brief discussion of how disruptions to circadian rhythms affect glucose metabolism, increase the risk of insulin resistance, and alter the secretion of hormones responsible for hunger regulation (e.g., leptin and ghrelin) would better illustrate the scale of health challenges associated with shift work. In the literature review on the impact of shift work on health, it would also be useful to include an overview of existing studies and their limitations, which would better justify the need for a systematic review. It would be worthwhile to indicate what gaps exist in the current literature and what questions remain unanswered. Furthermore, the introduction should expand on the role of the workplace as an environment conducive to health promotion, highlighting why the workplace - due to time spent there and opportunities to implement health programs - is ideal for such interventions. The introduction would also benefit from a discussion of the potential health and economic benefits that effective interventions could bring, in terms of reducing healthcare costs, improving productivity, and enhancing employees' quality of life. This would add a practical dimension to the introduction, useful for both public health specialists and organizational managers.

Aside from these suggestions, the article presents a high level of academic merit. The authors have provided a detailed description of the systematic review methodology, making the process of study selection and the analysis conducted transparent and reliable. A diverse set of databases and well-defined inclusion and exclusion criteria were included, which further enhances the value of the analysis. The results are presented clearly and comprehensibly, allowing readers to easily follow the effects of the interventions analyzed and their impact on the health of shift workers.

Reviewer #3: This systematic review protocol outlines an effort to examine the impact of interventions promoting healthy eating and/or physical activity among shift workers.

The study mentions that no comparison was made between day and night shifts, which is a critical shortcoming. Night shift workers are especially vulnerable to metabolic issues because of disrupted circadian rhythms and glucose metabolism.

The review includes various study designs, such as randomized controlled trials (RCTs), retrospective studies, and pilot interventions. While diversity in study design can provide a broad perspective, the variability in study methods also introduces significant challenges for comparability.

Most studies likely focus on short-term interventions and outcomes, which may not reflect long-term health benefits or risks associated with shift work. Given that the metabolic and health effects of shift work accumulate over time, assessing the long-term sustainability of these interventions is crucial.

The review acknowledges that a variety of interventions were assessed, ranging from dietary changes to physical activity initiatives. While this breadth provides a comprehensive view, it also complicates direct comparisons between studies. Different interventions may have varying impacts on health outcomes, and generalizing the results across all interventions may overlook more effective or less effective strategies. Ideally, the review should stratify findings by intervention type (e.g., diet vs. exercise) to identify which approaches are most beneficial for specific groups of shift workers.

The manuscript highlights the role of managerial support in improving adherence but lacks a detailed exploration of the barriers and facilitators to worker adherence. Shift workers often face practical challenges, such as irregular work hours and sleep deprivation, which can hinder their ability to maintain healthy eating or exercise habits.

Manuscript could benefit from a deeper discussion of the underlying mechanisms by which dietary and physical activity interventions influence health outcomes in shift workers. Understanding the biological pathways involved, such as circadian disruptions affecting glucose metabolism, could help design more targeted interventions. Incorporating this mechanistic understanding would make the findings more scientifically robust and relevant.

The paper mentions the importance of managerial support but does not provide specific policy recommendations for organizations to adopt. Providing actionable insights for workplace policies, such as offering healthier food options during night shifts or scheduling exercise breaks, could enhance the practical utility of the study. Additionally, exploring organizational changes such as rotating shift schedules or offering flexible work hours might further promote health among shift workers. This should be included.

Reviewer #4: Need Major Revision. Here i add my comment please take a look. You are doing well in your article. Best wishes for your next writing and research.

Manuscript Summary: This study investigates workplace promoting exercise and a healthy diet among shift workers, using Systematic review protocol. The authors conclude that the managers are a way of reinforcing the importance of preventative actions and allows a better adaptation of the organizational context to these activities, there is no single solution. Overall, this study adds valuable insights into workers and their development strategies through exercise and healthy diets.

General Comments:

Contribution to the Field: The study addresses some overcoming context like exercise, and diet habits and its necessity. However, not provide any specific outcome like if this will be taken then it provides much more effective way.

Is the paper well written? Yes, very well written but some sections need much more clarity in accent use.

Specific Comments:

Introduction: In the introduction, the structure needs to be altered. Also, the research gap could be explained more.

Why particularly this day and night shift workers were selected could be explained? In the end of the introduction, how this study could help to solve the problem could be added.

What is the main question addressed by the research?

Methods: Is it relevant and interesting? Very interesting manuscript

How original is the topic? Many groups are studying this topic.

Figures/Tables: Is the text clear and easy to read? Yes, very interesting to read.

Conclusion: Well define.

Recommendations for Improvement:

Please include any additional comments on the tables and figures and quality of the data.The tables and figures are nicely formatted. The way they have added limitations and practical applications make this manuscript pretty unique and clear.

Additional comments:

1. What is the main question addressed by the research? The group is trying to applied for other group of worker like all types of worker? Write it more specifically.

2. What parts do you consider original or relevant for the field? What specific gap in the field does the paper address? A lot of research is going on this exercise and nutrition and its relevant.

3. What specific improvements should the authors consider regarding the methodology? What further study should be considered? Maybe a broader type of sample size of article may be including Scopus index articles.

Decision Recommendation: Major Revision.

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Reviewer #1: Yes:  Marcela Gomes Reis

Reviewer #2: No

Reviewer #3: Yes:  M. João Reis Lima

Reviewer #4: Yes:  Al Azim

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Submitted filename: Comments.docx

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Submitted filename: Reviewer Md. Al Azim.docx

The efficacy of interventions in the workplace promoting exercise and a healthy diet among shift workers: a systematic review

PONE-D-24-31823R1

Dear Dr. dos Reis,

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.

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Kind regards,

António Raposo

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 #2: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: 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 #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #2: N/A

Reviewer #3: Yes

Reviewer #4: Yes

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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 #2: Yes

Reviewer #3: Yes

Reviewer #4: (No Response)

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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 #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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 #2: Thank you for making the revisions to your manuscript. The changes you made have improved the paper, and I appreciate your efforts.

Reviewer #3: Considering the major improvements made in the paper, I think that the manuscript can now be published.

Reviewer #4: (No Response)

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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 #2: No

Reviewer #3: Yes:  M. João Reis Lima

Reviewer #4: Yes:  Al Azim

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