Dear Dr. Smedberg,

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“The salary of K.S. was funded by the Uppsala Diabetes Centre (UDC), Sweden (https://www.uu.se/centrum/diabetes). J.S. received research grants from the “Research Foundation of Agria and the Swedish Kennel Club” (https://www.skk.se/agria-och-skk-forskningsfond/) and A.B. received research grants from “SLU Future One Health”, Swedish University of Agricultural Sciences (https://www.slu.se/en/about-slu/organisation/future-platforms/slu-future-one-health/). J.W.E. and E.R. had funding from the Swedish Diabetes Foundation (https://www.diabetes.se/forskning/diabetesfonden/), the Swedish Research Council (https://www.vr.se/english.html, project 2024-03344) and the Swedish Foundation for Strategic Research (https://strategiska.se/en/, project CMP22-0014). J.W.E. also had funding from the Novo Nordisk Foundation (https://novonordiskfonden.dk/en/) and the European Commission Horizon RIA project PAS GRAS (https://pasgras.eu/en/about-pas-gras, grant agreement ID 101080329).”

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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: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: N/A

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: This is a great pilot study to look at the effects of human-animal joint exercise on important health outcomes like BMI and BCS. It is well written and results are clear. There are a number of limitations, as there are for many pilot studies, which the authors do address most of them, however, I have suggested a few others to consider.

Abstract

- It would be useful to provide a sentence on what kind of exercise regimen you implemented, i.e. describe the methods of the study before listing the results

- Provide data values and p-values for the results you are listing

Introduction

Line 47: Remove “since decades”

Line 54: You have defined physical activity as PA so use the abbreviation throughout the manuscript

Line 55-57: Replace the instances of “associated to” with “associated with”

Methods

Line 76: why were the dogs and humans instructed to wear the accelerometers for different lengths of time (humans 4 days and dog 3 days)?

Line 222-225: This sentence is unclear. Why did you multiply by 7 when you had distinct data for 4 separate days? What does 150 respectively 300 min mean? Why did you choose to make each time a criterion when the WHO recommends any time within this range? Why did you choose the minimum and maximum?

Line 279: Should be “nearest mm and kg, respectively.”

Results

Line 319: So if your total sample size is only 13-15, perhaps a more conservative test of normality should be used like Shapiro-Wilk?

Line 360: It should be 15 and 17%, respectively. I would recheck the entire manuscript for this as I believe you use the term ‘respectively’ quite often.

Discussion

Given that the exercise routine that was implemented involved increasing distance and time each week yet the dogs physical exercise did not increase from baseline, do you think this means that the owners did not comply with the exercise regimen? The dogs physical activity should have increased unless they were all already running their end goal distance at baseline right? Especially since this was only measured once at the end where maximal exercise should have been achieved.

Do you think your population of humans was generally more physically active given that a lot of them met the WHO criteria even at baseline. If so, this should be called out as your results may be totally different had you recruited people who were more inactive. Similarly, the humans used were generally not overweight so this may explain why you saw no differences in BMI or WHR. Did you look at the data based on baseline BMI? Maybe those who started with a greater BMI did show decreases by the end?

I think you are missing a big piece of information for the dogs especially but also for the humans and that is diet. I would suspect that even though the dogs were running more as part of the exercise regimen, the human was not adjusting their food intake whereas if the human was doing more exercise, they may be hungrier and eat more for themselves. I think diet needs to be addressed in your discussion relating to the change in BCS but not change in BMI. On the contrary, it could also be explained by the subjectiveness of a BCS in dogs – maybe the change observed was just due to error. Theoretically if the dogs exercise did not change according to your results then their BCS should not change unless the owners were restricting the dogs feed intake which you do not have data on.

Reviewer #2: The study presents considerable potential and value for veterinary science, particularly by addressing physical activity and body condition in dogs alongside their owners. I would also like to highlight that the connection established with the One Health concept is essential in elevating the study to a public health perspective, demonstrating its relevance not only to veterinary science or human health sciences, but to both in an integrated manner. In my view, the topic of canine body condition remains underexplored and insufficiently discussed, particularly in my continent, as observed during my own research in this field. Furthermore, assessing physical activity in association with sleep improvement represents an essential perspective that deserves further exploration within veterinary research.

I have several additional points to raise during my evaluation; however, it is important to note that most of these have already been acknowledged and, in some cases, explicitly discussed by the author, who recognises several limitations of the study.

Firstly, I consider the article to be methodologically constrained, primarily due to the small sample size. I acknowledge that conducting a study of this scope, involving multiple assessments that are highly dependent on participant compliance, requires a substantial level of commitment from dog owners throughout the entire project. Nevertheless, the limited sample size may introduce significant bias across the statistical analyses, potentially masking positive findings that may have been observed but did not reach statistical significance (p > 0.05). Although the challenges in maintaining a larger sample are understandable and clearly justified by the author, this limitation reduces the robustness of the results and highlights the need for further studies with larger samples to allow more definitive conclusions.

Another point of concern relates to the eight-week evaluation period, which raises questions regarding whether meaningful changes could realistically occur within such a short timeframe and be detected statistically. Given the relevance and alignment of the study objectives, a longer follow-up period (such as six months or even one year) might be more appropriate to capture more definitive outcomes. While extended follow-up presents practical challenges due to participant adherence, this remains an important consideration.

Additionally, the structure of the baseline and intervention periods warrants further clarification. It is unclear why accelerometers were not used throughout the entire eight-week period, as continuous monitoring would have generated a more comprehensive dataset for statistical analysis. Moreover, a single week used as a reference period appears insufficient, as it may represent an atypical week in the routine of the owner and dog. This concern similarly applies to the intervention period, as data appear to have been collected only during the final week of the study. Short assessment windows increase the likelihood of outliers and introduce additional bias. Extending data collection over a longer period would likely provide a more reliable representation of habitual behaviour. Still on the subject of this time period, it was confusing to my understanding: the study lasted eight weeks, but only two weeks of data collection. What were the other six weeks used for?

Regarding the outdoor exercise programme, allowing owners to choose their preferred distance is a positive aspect; however, this approach may also have influenced the statistical outcomes. The absence of significant changes in secondary outcomes, such as BMI and BCS, may be partially attributable to the fact that a substantial proportion of participants selected shorter distances. A discussion or stratified analysis comparing the 2, 5, 7.5 and 10 km groups could have provided valuable insights into the relationship between exercise distance, physical activity levels, sedentary behaviour, sleep patterns, and secondary measures. While subdividing an already small sample presents limitations, the influence of distance travelled warrants consideration.

The author notes that exercise distance and intensity were progressively increased throughout the programme; however, it is unclear whether this refers to running sessions, circuit training, or both. Providing further clarification would reduce potential misinterpretation.

Another issue that creates a bias in the assessment: the days of accelerometer use were not standardised. To what extent could this variation (even if only one to two days at most) also influence the final results?

With respect to physical activity classification, although WHO guidelines were applied, these classifications rely partly on self-report. As acknowledged by the author, owners tended to underestimate their physical activity levels, introducing subjective bias. Future studies might benefit from prioritising objective measures, such as accelerometer counts per minute, supplemented by owner reports when necessary.

The assessment of sedentary behaviour also appears insufficiently described. For owners engaged in predominantly seated occupations, it is unclear how periods of low counts per minute were classified. Similarly, for dogs whose owners work outside the home full-time, opportunities for physical activity may be limited unless deliberately facilitated. Addressing these aspects would strengthen the interpretation of sedentary behaviour.

Now about the samples, I have some questions about dog owners. First, I think it would be important to highlight and discuss the influence of age on physical activity, because as we age, we humans naturally decrease our exercise and even sleep time. Perhaps the research group could assess whether there were few changes in older humans, if this may have masked the results as well. Finally, regarding the owners, during their mental health assessment, were anxiety or depressive disorders taken into account, for example? It is also known that these are common in the human population and directly affect the ability and amount of exercise. Now, regarding the dogs, we must also consider the issue of breed and age. Some breeds have greater ‘energy’ and exercise more easily because they are animals genetically bred for hunting, for example, or with better biomechanics for exercise. In addition, younger animals are also more predisposed to exercise, and this may also influence the results. Again, I understand that the sample was small, preventing the authors from making such assessments, but it is my job to point out this bias and suggest different assessments to be made in a future study (or even discussions to be held in this article).

Now, regarding the assessment of dogs' sleep, using whether or not the owner was awakened by their pet during the night as a basis for assessing the dogs' sleep is of little use, as this does not mean that the dog was having a proper, uninterrupted period of sleep, only that it did not go to its owner or that the owner did not wake up with their pet.

Regarding the BCS, how was it performed? Did a single assessor perform the entire BCS for each patient during the reference period and after the intervention period? Was there more than one assessor? Was the assessor experienced? I believe this should be reported because, as we know, although the BCS is an excellent indicator of a dog's body condition, it has a significant flaw in terms of subjectivity, as its qualitative nature can lead to assessor-dependent variations. Therefore, if different assessors were involved during the study or if they were inexperienced, this could explain some changes or even the absence of changes. In addition, the author could discuss precisely this point: that despite the minimal variations in BCS in the study, it is a subjective parameter and that in a short period of time it may not show visible and significant variations to the extent that the assessor can identify a change in score.

I conclude here with praise, as the study involves a topic that is rarely discussed but deserves closer attention from researchers. Even with the small sample size, it managed to overcome this difficulty by producing an excellent article with an impeccable discussion. That said, I would like to add that the discussion presented by the authors is extremely satisfying to read, follows a fluid line of reasoning, and exposes all the difficulties and possible biases that the work faced, without neglecting the importance of the research. The authors themselves highlight most of the limitations I describe here (albeit with some flaws to be corrected or improved upon, at least in the future) and also point out the lack of research on the subject, which prevents some more in-depth discussions. However, I am pleased to note that this study has begun the process of generating measures to establish future standards for these accelerometer values, physical activities, and sleep assessments in dogs, and even more so that all of this is intertwined (very well thought out) with the concept of One Health in a vision focused on human and animal health in unison.

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

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Reviewer #1: No

Reviewer #2: Yes:Ricardo de Souza BuzoRicardo de Souza BuzoRicardo de Souza BuzoRicardo de Souza Buzo

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Effects of a joint outdoor exercise program for dog owners and dogs on physical activity, sedentary time and sleep-related behaviors

PONE-D-25-61363R1

Dear Dr. Smedberg,

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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Wolfgang Blenau

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: N/A

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: (No Response)

Reviewer #2: (No Response)

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what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->

Reviewer #1: No

Reviewer #2: Yes:Ricardo de Souza BuzoRicardo de Souza BuzoRicardo de Souza BuzoRicardo de Souza Buzo

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