PONE-D-23-36999Inter- and Intra-Observer Reliability and Agreement of O2Pulse Inflection during Cardiopulmonary Exercise Testing: A Comparison of Subjective and Novel Objective MethodologyPLOS ONE

Dear Dr. Nickolay,

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PLOS ONE

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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?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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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.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Generally, this article is clear, well-written and concise. The introduction is relevant and theory based. The authors provided enough and sufficient information about the previous studies' results for readers to understand the rationale and aim of this study. The methods are generally appropriate. Overall, the results are clear and compelling. Moreover, this is a high quality manuscript that has implications for the theoretical basis, diagnosis and identification of inflections in O2Pulse during CPET

Reviewer #2: In my opinion, the article is complete and does not need corrections. This article can be one of the good articles of the magazine.

The only suggestion I have is that they prepare a schematic figure for the methodology..

Reviewer #3: In the present study, the authors investigated the inter-and intra-observer reliability and agreement of O2 pulse inflection and compared subjective measure of O2 pulse inflection with a novel objective method. The study is interesting in nature and the manuscript is well organized. I put some comments on the manuscripts for authors’ consideration.

1. Line 86-87; according to the Fick principle, O2 pulse depends on both SV and Ca-vO2.

2. Line 151-153; Did the authors used any criteria for including the HIIT or MISS trial data? I recommend the author to provide more information in this regard. For instance, why just the tests performed on cycle ergometer were included?

3. Line 164; I recommend the author to provide clear definition or specific criteria for defining “experienced” and “novice” examiner in this study.

4. Line 169; What was the exact time between the first and second observation of the experienced examiner?

5. From the methodological point of view, despite the fact that it was mentioned in the limitation section, when the main goal of this study was to establish a novel objective method by comparing it with a common subjective method, using a novice examiner and basing the conclusion on that might raise some concerns. Please elaborate more on that.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Ehsan Amiri

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Inter- and Intra-Observer Reliability and Agreement of O2Pulse Inflection during Cardiopulmonary Exercise Testing: A Comparison of Subjective and Novel Objective Methodology

PONE-D-23-36999R1

Dear Dr. Nickolay,

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.

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Kind regards,

Zulkarnain Jaafar

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

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

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

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

Reviewer #3: Yes

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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.

Reviewer #3: Yes

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: The authors have addressed all my comments, and the manuscript is now appropriate for publication. I have no further comments.

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7. 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 #3: Yes: Ehsan Amiri

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