Reviewer ’s report  
 
Title:  The effects of prehabilitation versus usual care to reduce postoperative complications in 
high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: 
study protocol of a r andomized controlled trial  
 
Version: 0 Date: 30 Oct 2017 
 
Reviewer:  David  Jenkins  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be in cluded in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
 
General comments  
 
This is a very worthwhile study that describes an important means of improving outcomes for 
CRC patients undergoing surgery.  
 
I feel that the authors need to do a couple of things to their manuscript.  First, there needs to be a 
more specific identification of the limitations of those studies that have been published 
previously in the area.  Though the authors allude to problems with the work of Bruns and Moran 
and they state that more high -quality studies are needed (line 3, page 4), it would be helpful if 
there can be a more specific explanation of how this study will differ to these previous papers 
(and thus significantly advan ce the field).  
 
Second, I do agree that 9 sessions of exercise will significantly improve the fitness of older 
adults who have very low baseline levels of fitness.  However, Dunne et al used 12 sessions of 
interval training in their study.  Therefore, ther e needs to be a statement somewhere in the 
methods stating that the present interval training (which presumably involves participants 
alternating between 60% and 90% VO2peak for 40 minutes in each session) does differ to that of 
Dunne but that it is expect ed that there will nonetheless be significant improvements in fitness.  
There is ample evidence in the HIIT literature showing that improvements result from as few as 
6 sessions (see Gibala's work).    
 
Minors comments include the need to state that the tw o gas analysis systems to be used (at the 
two sites) are the same and that they will be calibrated.  It probably doesn't matter if they are 
different systems, but they do need calibration etc.  
 
Also, can it be assumed that the same therapist will take all the strength measures (which 
presumably will be done at the two different sites also)?  
Dunne et al had a sub -group analysis of high risk patients; I am assuming that this study can also 
do this.  
 
Finally - are there any obvious limitations to the study th at need to be identified?   All studies 
have them…….  
 
Are the metho ds appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional st atistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain o r lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the man uscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the  above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will  be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available unde r an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as  confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  The effects of prehabilitation versus usual care to reduce postoperative complications in 
high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: 
study protocol of a r andomized controlled trial  
 
Version: 0 Date: 30 Oct 2017 
 
Reviewer:  David  Jenkins  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be in cluded in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
 
General comments  
 
This is a very worthwhile study that describes an important means of improving outcomes for 
CRC patients undergoing surgery.  
 
I feel that the authors need to do a couple of things to their manuscript.  First, there needs to be a 
more specific identification of the limitations of those studies that have been published 
previously in the area.  Though the authors allude to problems with the work of Bruns and Moran 
and they state that more high -quality studies are needed (line 3, page 4), it would be helpful if 
there can be a more specific explanation of how this study will differ to these previous papers 
(and thus significantly advan ce the field).  
 
Second, I do agree that 9 sessions of exercise will significantly improve the fitness of older 
adults who have very low baseline levels of fitness.  However, Dunne et al used 12 sessions of 
interval training in their study.  Therefore, ther e needs to be a statement somewhere in the 
methods stating that the present interval training (which presumably involves participants 
alternating between 60% and 90% VO2peak for 40 minutes in each session) does differ to that of 
Dunne but that it is expect ed that there will nonetheless be significant improvements in fitness.  
There is ample evidence in the HIIT literature showing that improvements result from as few as 
6 sessions (see Gibala's work).    
 
Minors comments include the need to state that the tw o gas analysis systems to be used (at the 
two sites) are the same and that they will be calibrated.  It probably doesn't matter if they are 
different systems, but they do need calibration etc.  
 
Also, can it be assumed that the same therapist will take all the strength measures (which 
presumably will be done at the two different sites also)?  
Dunne et al had a sub -group analysis of high risk patients; I am assuming that this study can also 
do this.  
 
Finally - are there any obvious limitations to the study th at need to be identified?   All studies 
have them…….  
 
Are the metho ds appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional st atistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain o r lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the man uscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the  above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will  be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available unde r an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as  confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  The effects of prehabilitation versus usual care to reduce postoperative complications in 
high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: 
study protocol of a r andomized controlled trial  
 
Version: 0 Date: 30 Oct 2017 
 
Reviewer:  David  Jenkins  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be in cluded in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
 
General comments  
 
This is a very worthwhile study that describes an important means of improving outcomes for 
CRC patients undergoing surgery.  
 
I feel that the authors need to do a couple of things to their manuscript.  First, there needs to be a 
more specific identification of the limitations of those studies that have been published 
previously in the area.  Though the authors allude to problems with the work of Bruns and Moran 
and they state that more high -quality studies are needed (line 3, page 4), it would be helpful if 
there can be a more specific explanation of how this study will differ to these previous papers 
(and thus significantly advan ce the field).  
 
Second, I do agree that 9 sessions of exercise will significantly improve the fitness of older 
adults who have very low baseline levels of fitness.  However, Dunne et al used 12 sessions of 
interval training in their study.  Therefore, ther e needs to be a statement somewhere in the 
methods stating that the present interval training (which presumably involves participants 
alternating between 60% and 90% VO2peak for 40 minutes in each session) does differ to that of 
Dunne but that it is expect ed that there will nonetheless be significant improvements in fitness.  
There is ample evidence in the HIIT literature showing that improvements result from as few as 
6 sessions (see Gibala's work).    
 
Minors comments include the need to state that the tw o gas analysis systems to be used (at the 
two sites) are the same and that they will be calibrated.  It probably doesn't matter if they are 
different systems, but they do need calibration etc.  
 
Also, can it be assumed that the same therapist will take all the strength measures (which 
presumably will be done at the two different sites also)?  
Dunne et al had a sub -group analysis of high risk patients; I am assuming that this study can also 
do this.  
 
Finally - are there any obvious limitations to the study th at need to be identified?   All studies 
have them…….  
 
Are the metho ds appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional st atistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain o r lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the man uscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the  above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will  be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available unde r an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as  confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
assistant