Dear Dr. Goikoetxea-Sotelo,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Yi Ding

Anhui Polytechnic University

Academic Editor

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?

Reviewer #1: Partly

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

Reviewer #1: No

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

The PLOS Data policy

Reviewer #1: Yes

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

Reviewer #1: Yes

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Reviewer #1: The purpose of this is study is to investigate the response of physiological variables such as heart rate variability (HRV), skin conductance (SC), activity counts and movement repetitions normalized for the maximal capacity (%ACmax and %MOVmax, respectively), and cognitive variables as the NASA-TLX scale to different mental and motor intensity levels of two self-developed upper limb exergames in typically developing children. The authors also investigated the effects of age on the responses of the measures.

The article is interesting, but the relevance and applicability is not very clear. Here are my suggestions:

- The purpose should be clearly stated, avoiding excessive use of acronyms.

- The purpose in the abstract differs from the one presented in the main text.

Introduction:

- The introduction provides detailed information on different types of therapy and their outcomes. However, there is no mention or explanation regarding exergames in the introduction, or how the results from this study can help the therapy procedures.

- The significance of exergames and their relevance to the study's purpose should be addressed. It is unclear how exergames influence the therapy in question.

Methods:

Figure 1 please does not identify the patient.

On page 9, reference number should be added for line 205.

The sample rate for the Polar system needs to be described.

Additionally, the heart rate units used are uncommon and make comparisons with other studies challenging.

Provide more details about the NASA TLX questionnaire, including at least one more paragraph.

Results:

Variables in Table 1 should include their corresponding units.

Figures 6 and 7 are difficult to interpret due to poor resolution.

General comments:

The sample size is small, especially when divided into three age groups.

Based on motor development, the sample size is insufficient to support strong conclusions.

Lastly, the discussion does not clearly explain the relationship between exergames and the therapy.

The study can be very interesting, but does not show clearly its applicability for therapy purposes. For example, what is the importance of HRV increase or decrease in therapy? How 3min gaming practice can improve children skills in the long term?

I hope the comments are useful and help the reader to understand the work more clearly.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

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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.

Dear Dr. Goikoetxea-Sotelo,

Please submit your revised manuscript by Jun 12 2025 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.

• 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 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,

Joanna Tindall, PhD

Staff 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 (if provided):

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

**********

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

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

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Reviewer #1: I would like to thank the authors for the very detailed answers on the response to my comments. It is much more clear now the purpose of the work. The figure added in the review is very clear as well.

some minor comments:

- line 69, the sentence does not look complete.

- Although mentioned the NASA-TLX questionnaire as a supplementary material, in the pdf I have access, it does not show. I suggest the authors to upload it in a repository, same as you did with the games version.

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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: Yes:  Denise Paschoal Soares

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[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

Responses of candidate intensity measures to different mental and motor load levels using upper limb exergames in typically developing children and adolescents

PONE-D-24-29809R2

Dear Dr. Goikoetxea-Sotelo,

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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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,

Steven J. Landry, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for your submission and your careful consideration of the reviewers' comments.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

**********

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

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

Reviewer #1: I would like to thank the authors for the reviewed version. The paper looks very good.

Wish you the best with your future publications.

**********

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: Yes:  Denise Soares

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