Editing a pdf document and inserting new text

Adobe's typical commenting tools aren't really designed to be printed. They're more for onscreen viewing. When printed, they will show up as a little comment icon, with no indcation of what the changes are.

While technically, (if you have a subscription to the full version of Acrobat) you can move the text around, it often behave unpredictably, and this feature doesn't work well with anything beyond the most basic of layouts, like a typical word doc.

Plus, whe you start editing the original text by adding "commenting" text right in the middle of a pragraph, it can become very confusing, very quickly, for whoever is in charge of incorporating those comments back into the original layout document. So it can an quick way to add errors into the document.

For example, take a look at this paragraph where I added "New commented text here." right in the middle of it (using the Edit tool). It's very easy to miss.

However, if you also highlight it, it becomes easier to see.

Also, you might want to try the drawing markup tools and just place them in the margins. Those will let you have a box with an arrow and the text inside of it. That can be a little fiddly if your margins are small, as is the case with this document. But hopefully some of these ideas will work for you.