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I m happy with the current version.
[# PeerJ Staff Note - this decision was reviewed and approved by Jeremy Loenneke, a PeerJ Section Editor covering this Section #]
I am pleased to inform you that the improvements made have successfully addressed the previous concerns, and I am satisfied with the revisions. The revised manuscript is now clear and unambiguous.
The methods are now described with sufficient detail and clarity.
I am pleased to inform you that the validity of the findings is well supported by the data presented.
Line 334: "Tai Chi significantly improve SLSC..." should say "Tai Chi significantly improved..."
Line 375: "Consequently, Owing to..." - owing should be in lower case.
Line 428: demands on heart rate and ratings of perceived exertion should be connected by "and" rather than just a comma based on the structure of the rest of that sentence.
Line 432: 6MWD should be 6MWT (the T was replaced with a D in this spot).
No comment.
No comment.
I would like to thank the authors for taking the time to make the suggested changes. The authors have done an excellent job of implementing feedback and making changes where requested. The manuscript has been substantially improved.
Both reviewers still have minor comments to solve. Otherwise the manuscript is fine.
Thank you for submitting your revised manuscript. I appreciate the effort and thought put into your research. After reviewing the submission, I find that it has great potential. However, there are a few points that need further improvement to enhance the clarity and quality of the manuscript:
1. Although the full term for TCEs has been mentioned in the abstract, it would be beneficial to repeat it again in the introduction for the audience’s clarity.
2. In line 136-138, the authors should make the writing more inclusive and align with current best practices for gender-neutral language, I recommend using "they," "them," or "their" when referring to participants instead of gender-specific pronouns like "he" or "she."
3. In line 276-278, the statement "studies have shown" is vague and lacks a specific reference to the studies being discussed.
4. In line 285, the phrase "and improved (Pan et al. 2016)" lacks a clear object or outcome, making it unclear what is being improved.
5. In line 290-291, please provide more explanation or reasons why performance on the Timed Up and Go Test (TUGT) is "contingent upon an individual’s capacity for oxygen supply" is overly broad.
6. In line 313, please provide more discussion about the sentence “Yijinjing can effectively stimulate acupoints around the lumbar spine, thereby improving the walking speed and Fang frequency of the elderly (Yu 2020).”
7. In line 333-335, The second sentence begins with "And," which is typically discouraged in formal writing. It’s better to combine this with the previous sentence or rephrase for a smoother flow.
The experimental design is appropriate for the objectives of the study.
The findings presented in the study appear promising and relevant to the field.
This manuscript has been significantly improved - nicely done!
Line 48-52: This sentence is very long, and the final phrase of it does not grammatically fit. I recommend ending the first sentence at "living environments" and beginning a second sentence with "This underscores...".
Line 48-52: This sentence is more appropriately stated following the next two statistics and I recommend moving it later in the paragraph for clarity.
There are a few grammatical errors remaining:
Line 64: "Some researchers" should not be capitalized.
Line 65: "the balance" should just be "balance"
Line 115 and 135: "overall balanced outcome" should be "overall balance outcome"
Line 136: unless the study being referenced is a case study with a single individual, "his" should be replaced with "their" and he" should be replaced with "they" in the following line.
Line 285: I think there is a word missing prior to the citation - "leading to reduced swaying during one-legged standing and improved..." what was improved?
Line 289: "standed out" should be "stood out".
Line 292: "Unlink" should be "Unlike"
Line 314: I do not think that "Fang" should be part of the word "andFang"
Line 347: "could enchanced" should be "could enhance"
Please provide more explanation on what the TCEs are - for example: Line 78 states that Wuqinxi mimics the movements of several animals and that Yijinjing is a comprehensive series of flexibility exercises. If similar explanations could be provided for the other three exercises, I think understanding would be greatly enhanced.
The results are written in such a way that it reads as an interpretation of a figure rather than an interpretation of the statistics. Rather than stating that "Figure(x) indicates", I recommend stating the results themselves, and then referencing the figure in which it can be seen, ex: "as illustrated by Figure (x)".
It is stated that the databases used to search for the included articles began in January of 1980. Is this the date cut-off for the research included, or is this when the search for these articles began? The phrasing makes this unclear. If the date range for the included research was from 1980 to 2023, I recommend stating this and then also stating the time point in which the literature search actually began.
All p values should be lower case and italicized.
Most statistics are stated with a purpose, such as in line 171 "(SUCRA) was employed to predict and rank intervention effects". However, this is not the case for the league table. Adding this brief explanation would promote clarity for the reader.
Line 192-199: This paragraph reads as a heading to a figure, and not as a paragraph of results. Please state the findings, and not just how to read the plot. Any explanation for how to read the plot should be in the heading of the figure itself. If there is a limitation to how many words can be in a heading than the explanation needs to be shortened.
Line 274-275: as an example of why Tai Chi is beneficial, certain movements are listed. However, these names do not make sense unless someone has a background in Tai Chi. I would consider adding images of the movements listed (ex: 'white crane shining wings' or omitting the specific examples.
The greater explanation of the exercises and why particular improvements were seen with each greatly improves the validity and understanding of the results.
The addition of the optional doses and clinical implications greatly strengthened the manuscript.
The manuscript has been greatly enriched with the additional information provided. Thank you for taking the time to make the alterations suggested. The overall strength and validity of the manuscript has been improved greatly.
In several of the figures, the text size is too small, making it difficult to read. I strongly recommend increasing the font size to improve readability and ensure that all details are clearly visible.
The systematic review study investigates the effectiveness of five traditional Chinese exercises (TCEs)—Baduanjin, Liuzijue, Tai Chi, Wuqinxi, and Yijinjing—in improving balance among older adults using network meta-analysis, which was retrieved from 46 randomized controlled trials from inception to October 2023. Results showed that all TCEs positively impacted balance. Tai Chi significantly improved performance in the single-leg stand with eyes closed (SLSC), 6-minute walk test (6MWT), and Short Form 36-Item Physical Component Summary (SF-36PCS). Liuzijue significantly improved the timed up and go test (TUGT), 6MWT, SF-36PCS, and Berg Balance Scale (BBS). Baduanjin, Wuqinxi, and Yijinjing showed significant effects on the BBS. Tai Chi ranked highest in SLSC, 6MWT, and SF-36PCS, while Liuzijue and Yijinjing ranked highest in TUGT and BBS, respectively. This study suggests Tai Chi, Liuzijue, and Yijinjing are particularly effective for improving static, dynamic, and overall balance outcomes, respectively.
The study is of interest, but adding more introduction to each type of exercise is needed and useful for practical application since some of them are not well known.
Introduction:
1. Since some TCEs are not well known, please add more details about each TCE. Additionally, the description of each TCE could be more detailed in terms of how they specifically benefit balance, e.g., mechanisms to improve balance, rather than just listing their general characteristics.
2. While the text mentions the 'World Guidelines for Falls Prevention and Management for Older Adults,' it does not provide details about the guidelines. Please briefly summarize these guidelines to add depth.
3. The objectives of the study should provide details of each outcome measure (types of balance classified in the study) to make it clearer.
4. Since there are several types of balance focused on in the study, the authors should introduce them, e.g., characteristics and their importance, to link to the objective of the study.
Materials and Methods:
1. The description of the statistical analysis could benefit from more detail about why specific models were chosen based on I² values.
2. The methods section should include more detail about how data were extracted from the included studies and any specific tools or protocols used for this process.
3. The authors should add a section explaining the outcome measures, specifically in terms of characteristics, goals, and interpretation.
Results:
1. Adding an additional table to represent the characteristics of each TCE would be helpful for introducing these exercises to the audience. This table should include important information such as characteristics, number of movements, goals, target group, limitations, and so on.
Discussion:
1. Adding subsections based on the main outcome measures would help the audience follow.
2. The discussion could delve deeper into describing mechanisms or why certain TCEs are more effective for specific balance outcomes.
3. Please discuss why each TCE is effective for specific outcomes. Adding brief mechanistic insights or references would strengthen the arguments.
4. Please add a paragraph or section suggesting the clinical implications.
5. The phrase 'auxiliary parameters' is vague and should be specified or replaced with more precise terms.
6. Some claims, such as the superiority of Tai Chi in improving vestibular function, could benefit from additional references or more detailed evidence to strengthen the argument.
7. The limitations section mentions 'result heterogeneity' but does not provide specific examples of how varying intervention protocols may have impacted the results. More detailed explanations would enhance understanding.
Conclusion:
1. Reordering the sentences might be better, for example, starting with the summarized result and then following with how the exercises significantly improved specific types of balance.
Abstract –
Line 17: TCE is not defined as standing for traditional Chinese exercises before being used as an abbreviation leaving it up to the reader to make the connection. Please use the term and place the abbreviation in parentheses next to it for clarity before using it alone.
Line 21: It is stated that various databases were searched from inception until October 2023. Please specify when inception was.
Line 24: Grammar correction – “Two researchers used Review Manager assessed the quality…” Please change “assessed” to “to assess.”
Introduction –
The authors do an excellent job of briefly describing the traditional Chinese exercises that the review focuses on.
Methods –
Line 116-117: The word Cochrane appears to have been split into two words – please remedy.
Results –
Line 138: I do not see it as necessary to list out all 46 articles that were included in the text. I recommend listing them in a table and not in the text.
Line 151: Listing out all the articles disrupts the flow of the text. If it is unacceptable to use numbers, then I recommend using a table or chart to discuss which specific articles fit each criterion and discussing more generally in the text.
Line 163: Listing all the articles for each step makes it harder to find where the text picks back up again. Again, I recommend using a flow chart to list out which studies fit which category/criteria.
Line 173: The description of the Network Plot should go with the figure title and not in the main text.
Discussion –
Line 262: The font style changes for one of the references – please correct.
Line 263: Be consistent with capitalization of the exercise forms – in this line Tai Chi is not capitalized but it is elsewhere in the text.
Line 287/288: waist strength should be reworded to the muscles being referenced (the core?). I have the same comment regarding “waist-centered exercise”. Is this referring to the core/abdominal muscles?
Figures –
The figures in general have descriptions in the text that I believe would be better listed and expanded upon in the figure headings themselves. This way the description is right next to the figure and it is easier for the reader to determine what they are looking at in the figure.
Introduction –
This study fits well with the scope of the PeerJ journal.
The introduction is very clear and leads to a concise and relevant study aim.
Methods –
Overall, the methodology and process of article selection was thoroughly discussed and easy to interpret.
Line 80: It is stated that various databases were searched from inception until October 2023. Please specify when inception was.
Results –
The meta-analysis findings in the text are well documented. However, some of the headings make it unclear as to what the text is referring to (for example, League Table (Line 208)). Please make it clear whether the text is in reference to a table, a statistical text, or a summation of the analyzed research. I do not recommend using figure/plot names as headings in the text due to the lack of clarity. Instead, use the comparison being made as the heading. Additionally, the descriptions of the figures and plots should be with the specified figure/plot and not in the text because this also hinders the clarity of the findings.
As previously mentioned, the results are well documented. However, the formatting and headings make the results harder to follow. I recommend changing the headings to be more descriptive of the comparisons being made and not the name of the tests or plots. I also recommend moving all descriptions of the figures and plots themselves into the titles of those specific plots and figures so that explanation of what the reader is seeing is closely tied to what they are looking at.
Discussion –
The interpretation of the outcomes is clearly stated and easy to understand. However, there is no discussion regarding the duration or time frame in which these exercises need to be practiced in order to be beneficial. Given that older adults tend to fatigue quicker and prefer exercises that are interesting and engaging, it seems that the time needed to sustain any benefits would be relevant to the reader. Additionally, a discussion of the effort required to perform these activities (heart rate, RPE) could be relevant as well if it was provided in the original research because that may also factor into exercise choice, and fitness as a whole is beneficial for fall reduction.
Overall, the research is interesting and relevant. I recommend altering the formatting of the results section to make it clearer and easier to follow and moving the long in-text citations to tables instead.
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