Dear Dr, Al-Hemedi,

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 Dec 20 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'.
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We look forward to receiving your revised manuscript.

Kind regards,

Nour Amin Elsahoryi, pHD

Academic Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. 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. Thank you for stating the following financial disclosure:

“This study was supported by Jordan University of Science and Technology (research grant no: 20240008).”

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

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“This study was supported by Jordan University of Science and Technology (research grant no: 20240008).”

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Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

“This study was supported by Jordan University of Science and Technology (research grant no: 20240008).”

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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

Additional Editor Comments:

Below are consolidated comments and recommendations drawn from both reviewers’ reports and the manuscript content:

1. Study Aim and Conceptual Clarity

The abstract and introduction do not clearly articulate whether the study aims to examine associations between physical exercise and academic achievement, or merely to describe prevalence patterns.

→ Revise the abstract to explicitly state the study’s primary research question, hypothesis, and analytic direction (e.g., “to assess the association between physical activity patterns and CGPA among medical students”).

In the introduction (lines 59–90), the rationale is general and repetitive. Clarify what makes this study novel or contextually relevant to Jordan. For example, emphasize the lack of regional data, sociocultural constraints, or institutional policies affecting student lifestyles.

2. Methodological Transparency

Sampling and Period: Specify how respondents were distributed across the research period (December 2023–July 2025). Reviewer 1 noted that this long duration could overlap with exam sessions and vacation periods, potentially biasing participation and activity levels.

→ Add a short table or sentence explaining data collection waves and timing.

Inclusion/Exclusion Criteria: The inclusion criteria are very broad (“active medical student in Jordan”). No exclusion criteria are described. Clarify whether students with chronic illness, disabilities, or athletic status were excluded or analyzed separately.

Survey Administration: The methods section (lines 94–112) needs more detail on how the survey was distributed and how anonymity was maintained. The text currently conflicts (“anonymous questionnaire” vs. “not anonymous”).

→ Explain the mode of distribution (e.g., via WhatsApp, official email lists) and how consent was obtained.

Questionnaire Design: Mention the number of items per section, response scales (e.g., Likert, multiple choice), and whether any items were adapted from validated instruments.

3. Statistical Analysis

Reviewer 2 correctly notes that the analytical framework is unclear. Currently, you report two logistic regression models—one predicting CGPA and another predicting physical activity.

→ You need to justify this dual-model approach or reframe it as a single multivariate model focusing on academic performance as the primary outcome, with physical activity as a key predictor alongside demographics.

Add clear definitions for “high academic performance” (CGPA >3.5) and explain why this cutoff was chosen.

Ensure that all variables included in the logistic regression are described (independent and dependent).

Consider providing adjusted ORs and confidence intervals in one concise summary table, with p-values properly formatted (e.g., p < 0.05).

4. Results Clarification

In Table 1, ensure that percentages add up and that total counts are consistent.

Explain the discrepancy between inclusion criteria (medical field students only) and the 10.8% of respondents from non-medical programs (Dentistry, PharmD). Clarify whether these were included in analysis or excluded later.

Injury data (Table 2) require more clarity — specify whether injuries were recent or lifetime occurrences.

Simplify the results narrative: avoid repeating entire table contents in text; instead, highlight the key significant associations and trends.

5. Discussion and Interpretation

The discussion section (lines 156–244) currently reads as a broad literature summary rather than an interpretation of your data.

→ Begin by restating the main findings quantitatively (e.g., “Only 54.8% engaged in any physical activity, lower than Poland (81%) and Brazil (66%)”).

→ Discuss why Jordanian students might differ — institutional load, cultural context, gender patterns, or infrastructure.

Narrow the discussion to variables that were significantly related to CGPA (age, nationality, university) and propose plausible explanations.

→ For example, explore how institutional academic load or student living conditions might account for lower performance among non-Jordanian students.

Strengthen the final paragraph by linking the results directly to policy or educational recommendations (e.g., structured exercise breaks, on-campus wellness programs).

6. English and Formatting

Overall readability is acceptable, but there are multiple grammatical and syntactic errors that obscure meaning (e.g., “Health improvement and stress relief their drove motivation” → “Health improvement and stress relief were the main motivators”).

→ A thorough language revision is recommended prior to resubmission.

Avoid redundancy in the abstract and discussion. Simplify long sentences and use consistent tense (past for results, present for interpretation).

7. Data Availability and Ethical Statements

Reviewer 1 noted incomplete compliance with PLOS data-sharing requirements.

→ Ensure that the dataset is either uploaded as Supporting Information or deposited in a public repository with an accessible link, not merely “available on request.”

Summary Recommendation

The study addresses an important public health and educational topic but currently lacks sufficient methodological rigor and analytical focus. Substantial revisions are required in the Methods, Statistical Analysis, and Discussion sections to clarify design, strengthen interpretation, and meet PLOS ONE standards.

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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

Reviewer #2: Partly

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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

Reviewer #1: No

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: To increase the scientific quality of the article and provide a clearer understanding of the research, it would be desirable to:

1. describe more precisely how the number of respondents is distributed in the selected research period,

2. emphasize whether the stages of student exam sessions and breaks were taken into account,

3. highlight and describe in more detail the reflection of the established correlations in the work.

Reviewer #2: Abstract and Introduction:

The abstract does not clearly demonstrate the relationship between physical exercise and academic achievement. It is unclear whether the study aims to examine an association between the two variables or to report prevalence data. The research objective should be explicitly stated to reflect the study design.

Novelty and Rationale:

The manuscript would benefit from clarifying what makes this study distinctive. Are there contextual or cultural factors in Jordanian universities that could make the findings novel or relevant to local practice? Highlighting such aspects would strengthen the paper’s contribution.

Inclusion and Exclusion Criteria:

The inclusion criteria appear too broad, and no exclusion criteria are described. Consider clarifying whether specific groups such as student athletes or those with medical conditions or disabilities were excluded, as these could influence physical activity and academic outcomes.

Methods:

The data collection process requires more detail. Indicate how the questionnaire was distributed (e.g., through university email lists, WhatsApp groups, or classroom links). The manuscript states that the questionnaire was not anonymous, yet the data were collected anonymously — this needs clarification. Specify:

- The total number of questionnaires distributed and returned.

- The type of questions used (e.g., Likert scale, binary, open-ended).

- How anonymity was maintained and identifiers were handled.

- How participants were informed about and provided informed consent.

Statistical Analysis:

The description of the analysis is confusing. If the primary aim is to examine the relationship between physical exercise and academic performance, a single multivariate logistic regression should be used, with academic performance as the dependent variable and physical exercise as the key predictor. Using two separate logistic regressions may be conceptually inappropriate unless justified.

Results:

The inclusion criteria specify medical students, yet only 89% of respondents were from medical programmes — this discrepancy should be explained. Additionally, the presentation of results lacks clarity regarding injury data (e.g., whether injuries were recent or past). The response options for reasons to exercise or not exercise also appear limited; consider allowing open-ended responses to capture other possible factors.

Discussion:

The discussion is too general and lacks depth. It would be stronger if focused on the relationship between physical activity level and academic achievement rather than addressing too many unrelated variables. A more critical and analytical interpretation of findings in relation to existing literature is recommended.

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Reviewer #1: No

Reviewer #2: No

**********

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Dear Dr.  Al-Hemedi,

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 Jan 22 2026 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,

Nour Amin Elsahoryi, pHD

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

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:

Thanks, your revision was very thorough and your answers detailed. The paper has become a much better job. The primary objective and analytic focus is now well defined, the sampling frame and administration of survey is better outlined, multivariate logistic regression application is more evident and the data is released in an appropriate way in a public repository. As well, you have refocused the Discussion to put your key findings into the Jordanian context, such as the non-relation between physical activity and academic performance and gender difference in physical activity participation.

Prior to acceptance of the paper, I would wish you consider the following minor issues:

Harmonize the sample size throughout the manuscript.

In several places the total sample is reported as 1,209, while one sentence still reads “1,290 209 university students”, which appears to be a residual editing artifact. Please ensure that the same total N is used consistently in the Abstract, Methods, Results, tables, and cover letter.

Thorough language and style check.

The English is generally understandable, but several typographical and grammatical errors remain and should be corrected (e.g. “psychical activity” → “physical activity”, “Health improvement and stress relief their drove motivation” → “Health improvement and stress relief were the main motivators”, “factosfactors” → “factors”, “was utilized” → “were utilized”, consistent use of “cGPA/CGPA”, etc.). A careful proof-reading or professional language editing is recommended to meet journal standards.

Clarify questionnaire development.

In your response letter you state that some items were adapted from validated instruments but also that “No items were adapted from previous literature”, which is contradictory. Please make the Methods section explicit and internally consistent: either

(a) specify which items were adapted and cite the original sources, or

(b) state clearly that all items were developed de novo for this study based on the literature, and remove any mention of adaptation.

Minor clarifications.

Explicitly state in the Methods that the sports-injury question referred to lifetime history (ever having had a sports-related injury), to match the explanation given in your response.

Double-check all tables (especially Tables 2–4) for formatting, consistent decimal places, and p-value notation (e.g. use “p < 0.001” rather than “0.000”).

[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.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures 

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. 

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Dear Dr. Al-Hemedi,

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 within Feb 15 2026 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 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,

Nour Amin Elsahoryi, pHD

Academic Editor

PLOS One

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

2. 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 :

Comments to the Author

Thank you for submitting the revised version (R2) and your detailed response. The manuscript is substantially improved in clarity and structure. In particular, the study objective is now more explicit, the analytical strategy is better organized, and the reporting is generally more consistent. I also note that the previously observed inconsistency in the reported proportion for “moderate” physical activity appears to have been corrected and is now aligned across the abstract/text/tables. The sample size reporting is also more consistent.

Before the manuscript can be accepted, please address the following minor but important points:

Language and copyediting (required)

The revised manuscript still contains multiple obvious typographical/spacing issues (e.g., merged words, duplicated letters, and formatting artifacts).

Please perform a final professional proofreading pass and ensure consistent formatting throughout (headings, spacing, punctuation, abbreviations).

Consistency between the response letter and Methods

Your response includes a contradiction regarding whether any questionnaire items were “adapted” from previously validated instruments.

Please ensure the response letter is internally consistent and fully aligned with the final Methods text. If items were adapted, specify from which sources; if not, remove any wording that implies adaptation.

Avoid overstatement of representativeness

Given the convenience/online recruitment approach, please avoid wording that implies the sampling strategy “ensures” or “guarantees” representativeness.

Please revise such statements to more neutral language (e.g., recruitment across different time windows/academic periods to increase coverage), and acknowledge this appropriately as a limitation where relevant.

[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.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures 

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. 

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Physical Exercise and Academic Performance among Students in the Medical field at Jordanian Universities

PONE-D-25-49996R3

Dear Dr. Al-Hemedi,

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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support .

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,

Nour Amin Elsahoryi, pHD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Thank you for the revised version—overall, the paper is now acceptable in content and structure. Only minor points remain:

Consistency check: Please ensure the “moderate activity” percentage/value is identical across the manuscript, tables, and submission letters.

Final proofreading: Do one last copyedit and formatting clean-up (typos, merged words, repeated phrases, spacing/punctuation).

cGPA scale clarification: Explicitly state the maximum cGPA scale used and align all categories accordingly.

Generalizability wording: Keep conclusions appropriately cautious given the convenience sampling and institutional dominance.

Once these minor edits are completed, the manuscript can be accepted.

Reviewers' comments: