A computational predictor of the anaerobic mechanical power outputs from a clinical exercise stress test

Efrat Leopold; Tamir Tuller; Mickey Scheinowitz

doi:10.1371/journal.pone.0283630

Peer Review History

Original SubmissionJune 12, 2022
12 Jun 2022 Author Response Attachments Attachment Submitted filename: Leopold Reply letter to reviewers Final.docx https://doi.org/10.1371/journal.pone.0283630.r001
16 Aug 2022 Decision Letter - Emiliano Cè, Editor PONE-D-22-16892A computational predictor of the anaerobic mechanical power outputs from a clinical exercise stress testPLOS ONE Dear Dr. Scheinowitz, 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 Sep 30 2022 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. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: A computational predictor of the anaerobic mechanical power outputs from a clinical exercise stress test General Order of authors is not consistent through submission. A main issue is that you did not perform GXT but you used parameters from CPET test. CPET test require wearing a mask that may affect the exercise parameter, thus I am not convinced that it is meaningful using these adapted variables. Introduction Page 9, lines 4-6- The most common standard graded exercise test (GXT) include 5 incremental increase of intensity which terminate when a heart rate (HR) of 85% to 100% of 6 age-adjusted maximal HR is achieved [5]. The reference does not support the information in the sentence, please change reference. Page 9, line 7- Numerous studies have previously shown…. Please provide references for this sentence. Page 9, line 10- Since measuring phosphagen and glycogen contents is complicated, these metabolic systems are usually reflected via power output measurement using the WAnT. Please provide references for this sentence. Page 9, line 12- Therefore, since knowing the anaerobic components is important, performing an 13 anaerobic exercise test is required. Why is knowing the anaerobic component is important? Please explain or provide reference. There is some explanations in line 19, but it should be clearer. Page 9, line 21- This information is of 22 special interest for athletes. Athlete’s population is not usually performing GXT, as you pointed yourself that this test is usually performed on non- health population. Page 10, line 34- Anaerobic metabolism becomes dominate and allows the generation of additional mechanical power output. References do not support the data in the session, please provide references that are more relevant. Page 10, line 42- outputs…. Delete one Page 11, line 63- References 17, 18 should be inserted after: “which is considered as the most popular anaerobic test”. Page 12, line 93- Based on this, we have extracted 25 new features representing standard GXT as detailed in supplementary Table S1. Please indicate the 25 features in the text. Page 13, line 122- Please elaborate on the equation, for example, what Y stands for? Page 13, line 122- “Prediction of MP using features taken from CPET produced a spearman correlation 177 coefficient of r = 0.91 which is lower than the MP predictions using features taken from 178 standard GXT” Please explain, why is it lower in CPET? Page 16, line 191- “This feature might represent the aerobic contribution during the WAnT”. What feature did you mean? Also, reference 22 does not show anything about aerobic contribution…. Page 16, line 197- “Therefore, this feature can give an indication of lactate accumulation following glycogen metabolism, which is used during the WAnT”. Again, what feature did you mean? What is the importance of this information? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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 Privacy Policy. Reviewer #1: No ******** [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". 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Revision 1
12 Dec 2022 Author Response Reviewer #1: 1. General - Order of authors is not consistent through submission. We have changed it accordingly. 2. A main issue is that you did not perform GXT but you used parameters from CPET test. CPET test require wearing a mask that may affect the exercise parameter, thus I am not convinced that it is meaningful using these adapted variables. We agree with the reviewer and indeed wearing a mask during CPET may affect the results. However, since the developed prediction model included data from within the same individual who underwent both tests (aerobic and anerobic) we can assume that even if such an error exists, it would affect the entire population. Introduction 3. Page 9, lines 4-6- The most common standard graded exercise test (GXT) include 5 incremental increase of intensity which terminate when a heart rate (HR) of 85% to 100% of 6 age-adjusted maximal HR is achieved [5]. The reference does not support the information in the sentence, please change reference. We have revised the sentence accordingly and added another reference: “A standard graded exercise test (GXT) include incremental increase [5] which terminate at submaximal or maximal intensities based on age-adjusted maximal HR [6].” [6] Noonan V, Dean E. Submaximal exercise testing: clinical application and interpretation. Physical therapy. 2000 Aug 1;80(8):782-807. 4. Page 9, line 7- Numerous studies have previously shown…. Please provide references for this sentence. We have added the following references – [1] Bogdanis GC, Nevill ME, Boobis LH, Lakomy HK. Contribution of phosphocreatine and aerobic metabolism to energy supply during repeated sprint exercise. J Appl Physiol. 1996 Mar 1;80(3):876-84. [2] Bogdanis GC, Nevill ME, Lakomy HK, Boobis LH. Power output and muscle metabolism during and following recovery from 10 and 20 s of maximal sprint exercise in humans. Acta Physiol Scand. 1998 Jun;163(3):261-72. [3] Green S. Measurement of anaerobic work capacities in humans. Sports Medicine. 1995 Jan;19(1):32-42. 5. Page 9, line 10- Since measuring phosphagen and glycogen contents is complicated, these metabolic systems are usually reflected via power output measurement using the WAnT. Please provide references for this sentence. We have revised the sentence and added more references – Since measuring phosphagen and glycogen contents is complicated and required muscles samples (1-2), these metabolic systems are usually reflected via power output measurement using the WAnT. [1] Barnett C, Carey M, Proietto J, Cerin E, Febbraio MA, Jenkins D. Muscle metabolism during sprint exercise in man: influence of sprint training. J Sci Med Sport. 2004; 7: 314-22. [2] Karlsson J, Saltin B. Lactate, ATP, and CP in working muscles during exhaustive exercise in man. J Appl Physiol. 1970; 29: 598-602. 6. Page 9, line 12- Therefore, since knowing the anaerobic components is important, performing an 13 anaerobic exercise test is required. Why is knowing the anaerobic component is important? Please explain or provide reference. There is some explanations in line 19, but it should be clearer. The information regarding the anaerobic components will provide a better understating about the subjects' physiological capabilities which is especially important for athletes, helping specify the aerobic and anaerobic contribution for exercise training recommendations using a single exercise stress test. Furthermore, assessments of the anaerobic performance can help athletes, team players and individual sports by providing the coach with valuable information about the athletes’ fitness status as well as allowing them to monitor improvement through training. This was added to the discussion section. 7. Page 9, line 21- This information is of 22 special interest for athletes. Athlete’s population is not usually performing GXT, as you pointed yourself that this test is usually performed on non- health population. In our previous manuscript [1] we developed a prediction algorithm for the anaerobic mechanical power outputs driven from CPET. In the current study we wanted to test the hypothesis whether GXT is sufficient to predict the anaerobic mechanical power outputs. The implications of the current study are relevant for both athletes and normal individuals. [1] Leopold E, Navot-Mintzer D, Shargal E, Tsuk S, Tuller T, Scheinowitz M. Prediction of the Wingate anaerobic mechanical power outputs from a maximal incremental cardiopulmonary exercise stress test using machine-learning approach. PLoS one. 14(3):e0212199, 2019. 8. Page 10, line 34- Anaerobic metabolism becomes dominate and allows the generation of additional mechanical power output. References do not support the data in the session, please provide references that are more relevant. We have changed the reference to the following one: Scott CB. Contribution of anaerobic energy expenditure to whole body thermogenesis. Nutrition & Metabolism. 2005 Dec;2(1):1-9. 9. Page 10, line 42- outputs…. Delete one We have deleted one accordingly. 10. Page 11, line 63- References 17, 18 should be inserted after: “which is considered as the most popular anaerobic test”. We have changed it accordingly. 11. Page 12, line 93- Based on this, we have extracted 25 new features representing standard GXT as detailed in supplementary Table S1. Please indicate the 25 features in the text. We have added this information into the text. 12. Page 13, line 122- Please elaborate on the equation, for example, what Y stands for? Yreal refers to the real value of the predicted feature – either PP or MP. Yprediced refers to the predicted value that is calculated – either PP or MP. We have incorporated those changes into the revised manuscript in the materials and methods section. 13. Page 13, line 122- “Prediction of MP using features taken from CPET produced a spearman correlation 177 coefficient of r = 0.91 which is lower than the MP predictions using features taken from 178 standard GXT” Please explain, why is it lower in CPET? The prediction correlations are similar in both CPET and GXT (only slightly higher by 0.04%, in features taken from a standard EST). Since eventually the GXT features were extracted from the CPET data, the prediction correlation for the GXT was high. Page 16, line 191- “This feature might represent the aerobic contribution during the WAnT”. What feature did you mean? Also, reference 22 does not show anything about aerobic contribution…. We meant the VO2max feature and changed that in the text. We have also changed the reference to the following one: Smith JC, Hill DW. Contribution of energy systems during a Wingate power test. Br. J. Sports Med. 1991; 25: 196-9. 14. Page 16, line 197- “Therefore, this feature can give an indication of lactate accumulation following glycogen metabolism, which is used during the WAnT”. Again, what feature did you mean? What is the importance of this information? We have meant to the ventilatory anaerobic threshold feature and have changed it in the text accordingly. In this paragraph we attempted to explained the rationale behind the chosen aerobic features and the physiological reasons of why these features best predict the anaerobic mechanical power outputs. This is information is important in order to understand the physiological explanation behind of the chosen features. https://doi.org/10.1371/journal.pone.0283630.r003
19 Dec 2022 Decision Letter - Emiliano Cè, Editor PONE-D-22-16892R1A computational predictor of the anaerobic mechanical power outputs from a clinical exercise stress testPLOS ONE Dear Dr. Scheinowitz, 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. ============================== ACADEMIC EDITOR:Dear Authors,your manuscript has been reviewed by one expert in the field that retrieved several major issues to be considered in the revision process. Please submit your revised manuscript by Feb 02 2023 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. Please include the following items when submitting your revised manuscript: 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 you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. 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, Emiliano Cè Academic Editor PLOS ONE [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.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0283630.r004
Revision 2
21 Jan 2023 Author Response Following the email we received, we included the three items in the revised version. Attachments Attachment Submitted filename: Response to reviewers Final.docx https://doi.org/10.1371/journal.pone.0283630.r005
13 Mar 2023 Decision Letter - Emiliano Cè, Editor A computational predictor of the anaerobic mechanical power outputs from a clinical exercise stress test PONE-D-22-16892R2 Dear Dr. Scheinowitz, 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 for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. 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, Emiliano Cè Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0283630.r006
Formally Accepted
25 Apr 2023 Acceptance Letter - Emiliano Cè, Editor PONE-D-22-16892R2 A computational predictor of the anaerobic mechanical power outputs from a clinical exercise stress test Dear Dr. Scheinowitz: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Emiliano Cè Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0283630.r007

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