PONE-D-24-25027Effects of menstrual cycle on cognitive function, cortisol and metabolism after a single session of  aerobic exercisePLOS ONE

Dear Dr. Jahromi,

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Ayman Abdelaziz Swelum

Academic Editor

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: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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: No

Reviewer #2: Yes

Reviewer #3: No

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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: Thank you for such an interesting study. I have a few comments and suggestions, if you don't mind:

1- In the abstract: would you mind Please to structure the abstract by including opening keywords before each paragraph, such as Aim, Study Design, Results, and Conclusion.

2- In the study materials:

- Study setting?

- Would you mind to highlight the type of the study?

- Has any one of the statistical professionals calculated the sample size for you prior to the study? as 12 sample size could be carrying a limitation of the statistical power and increase type 2 error.

- Could you please put a measurable identifications for the different terms you used in the inclusion criteria such as:noramal regular cycle, no obesity , follicular phase, luteal phase.

- You started your study with 12 participants, however you devided them into 5 and 5 in each phasse, any explanation?

2- Would you mind updating some of your references?

3- Highlighting strength and limitations of your study would give a realistic impression and would reflect positively on the study application.

4- The article would benefit from English proofreading as there are several grammatical mistakes.

Reviewer #2: An interesting and novel study,thank you for the effort done,i may suggest in future research to recruit a bigger sample and give longer period for follow up ,also to correlate the results with clinical outcome like fertility.

Reviewer #3: ABSTRACT: The sentence in lines 6-8 should be recasted and grammar corrected.

INTRODUCTION: Some grammatical errors that need to be corrected. Page 4, paragraph 1, the last sentence is not clear and should be recasted.

METHODS: The authors should state the university where the study was conducted and its location and also how they determined their sample size. Page 4, 1st paragraph, line 3, what do the authors mean by active young female students? The authors should explain how they selected those who participated in the study, what they mean by - physical and mental health to exercise (page 4, last line), how they determined those who were obese in order to exclude them. They should also give examples of the diseases that could affect study variables. The authors should state the name of the ethics review board that approved the conduct of the study.

DISCUSSION: There are grammatical errors that make some sentences difficult to understand. Under strengths and limitations, the last sentence is not clear and should be recasted.

REFERENCES" Some do not appear complete eg numbers 17, 21 and 25

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Reviewer #1: No

Reviewer #2: Yes: Mohsen M A Abdelhafez

Reviewer #3: No

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PONE-D-24-25027R1Effects of menstrual cycle on cognitive function, cortisol, and metabolism after a single session of  aerobic exercisePLOS ONE

Dear Dr. Koushkie Jahromi, 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: The authors have improved the manuscript in its revised version. However, a revision is mandatory before its acceptance. Please follow all the reviewers comments and reply to their questions. ==============================

Please submit your revised manuscript by Oct 23 2024 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,

Ayman A. Swelum

Academic Editor

PLOS ONE

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

Reviewer #4: (No Response)

Reviewer #5: (No Response)

Reviewer #6: (No Response)

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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

Reviewer #4: Partly

Reviewer #5: Yes

Reviewer #6: Partly

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

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: 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

Reviewer #4: No

Reviewer #5: Yes

Reviewer #6: 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: (No Response)

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: 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: (No Response)

Reviewer #4: Manuscript Number: PONE-D-24-25027R1

Article Type: Research Article

Full Title: Effects of menstrual cycle on cognitive function, cortisol, and metabolism after a single session of aerobic exercise

Overall, Thanks for an interesting study. However, this reviewer found some issues and concerns in this manuscript.

1. Authors should maximize the accessibility and reusability of the data by selecting a file format from which data can be efficiently extracted (for example, spreadsheet are preferable to PDFs or images when providing tabulated data). Please see Plos Data in Supporting Information files on https://journals.plos.org/plosone/s/data-availability#loc-acceptable-data-sharing-methods

2. Authors may use a description of supporting information. Please see https://journals.plos.org/plosone/s/supporting-information

3. Abstract: Conclusion:

It is better to add the word “ may” before (do not affect cognitive function). Or replace the follicular and luteal phases with “days 7–10 (follicular) and days 21-24 (mid-luteal phase) do not occur… etc.”

4. Intoduction:

Please mention the physiological importance of days 7–10 (follicular) and days 21-24 (mid-luteal phase) in the menstrual cycle and its importance on cognitive function (in comparison to other studies).

5. Material and Methods:

I. The Experiments must have appropriate sample sizes as 12 sample size carrying a limitation of the statistical power as may reduce the confirmability of the results.

II. What is the material status of the participants and if they nulliparous, primiparous, or multiparous? should be mentioned and in the abstract too.

III. The study has no hormonal analysis or clinical observation to confirm the days of menstrual and other physiological parameters/conditions.

IV. The suitability of the crossover method in this study needs to be clarified. Why did you choose it?

V. The study relied on salivary cortisol measurements, and there was no measurement of plasma cortisol levels, which might provide a more accurate assessment of systemic cortisol responses to exercise.

6. Discussion:

The study has no hormonal analysis indicating the estrogen/progesterone level. Therefore, it would be better to put a reference in “During the follicular phase (days 7–10 of the menstrual cycle), estrogen levels are similar to those during the luteal phase (days 21–24 of the menstrual cycle)”.

Reviewer #5: Well, that was an interesting one, thank you very much to raise such an interesting subject.

I have the following comments:

(1)in the exclusion criteria:

(a)can you give us a simple ideas about the number of volunteers who were excluded due to any of the criteria ?

for example those with HADS score > 7.

(b) why you have limited the included age 22 to 30, why not more , for example 18 to 35, that is 22 seems to be the age of graduation.

(2)in the "Procedure" Section:

(a)have you used any means to determine the date of ovulation ? so that you can determine precisely the date of exercise.

(b)have you confirmed the ovulation ? since in cases of unovulation, you will not have the required level of progesterone in the leuteal phase to exert its physiological effects.

(c)since the core theoretical background of the study is the effect of estradiol and counter effect of progesterone, I think it was prudent to measure both in either phases of the cycle, besides, leuteal phase progesterone level will give us a hint about ovulation, and here, may be, we can find a mathematical correlation between the hormonal levels and the factors studied.

(d)did you give instructions about smoking prior to exercise (as it was given with regards to alcohol), this need to be mentioned in this section.

(3)in the "Exercise protocol" Section:

the first paragraph was repeated.

(4)in the "Saliva sampling and assay" Section:

I feel the ambiguity of the biochemical analysis method, can you make it more clear ?.

(5)in the "Cognitive function" Section:

in the text you need to mention the time unit (ms) at least once.

(6)in the last paragraph of the results:

"In addition, comparison of changes (post-exercise – pre-exercise) using t-test indicated that reaction time for congruent colors was not statistically significant"

I think it is "incongruent", not "congruent", please check that.

(7)in the "Discussion" section:

(a)in the second paragraph you have mentioned "HPA" as an abbreviation in its first occurrence in the text of article, please to be preceded by its full name: "hypothalamic-pituitary-adrenal axis" at this site.

(b)you have mentioned the following:

"RER in the follicular phase (0.892±0.076) was lower(non-significantly) than in the luteal phase (0.893±0.057), which indicated higher lipolysis in the follicular phase"

I think the reverse is true, please cross check with reference cited.

Thank you and I was really interesting reading and reviewing the article.

Reviewer #6: Dear authors, thank you for your interesting research and focus on performance of women athletes and exercise in women in general. I see that important changes have been made regarding the previous review, so this is greatly appreciated. The article is read more easily and the structure is more visible and clear. The statistical analysis is very well described and performed and the data well presented. I would like to address some points I consider important for the interpretation of the study and for creating further research:

- I guess no treatments were taken by the participants, nor suplements that can affect menstrual cycle. Since it is not mentioned and it is the base of the study, I suggest to indicate it. One to mention is the absence of hormonal treatment (e.g. oral contraceptives).

- I would focus more on describing menstrual cycle characteristics since it is the basis of your study: there is no data regarding menstrual cycle duration of the participants. The normal range defined at your study is very wide, and such differences in your participants may affect interpretation of the study (specially in the luteal phase, which can vary greatly).

I guess that ovulation was not assessed and, if so, more precise limitation should be added (e.g. variability in menstrual cycles and, thus, interpretation and comparability of data).

- Since every participant got measured in 2 cycles, did you compare data between first and second cycle? Some differences might be used as extra-information if you find them useful or limitation in case relevant differences are observed (because of variation in the same woman accross cycles).

- As other reviewers have appointed, the limitations should be added in depth: the results of the study are very interesting and they can make a difference for future studies, but conclusions cannot be made based on just 2 cycles: usually, implications are seen in the long term (such as cognition and modification of the amount of fat tissue) and many factors may influence menstrual cycle and thus, training.

- I would recommend as well to point out some strenghts of your study if you might consider: the type of information you want to provide women with, the type of training considering the phase of the cycle, and the importance of knowledge of self cycles and feelings in training to improve the response to exercise and, in general, including menstrual health when considering about all aspects of life and, such as this study, in exercising.

I would suggest extra review of punctuation to read it even more easily after the great corrections already made.

I hope you find the review useful and thank you again for your work.

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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: No

Reviewer #4: No

Reviewer #5: Yes: Nassar Taha Yaseen Alibrahim

Reviewer #6: No

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Effects of menstrual cycle on cognitive function, cortisol, and metabolism after a single session of  aerobic exercise

PONE-D-24-25027R2

Dear Dr. Maryam Koushkie Jahromi,

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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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,

Ayman A. Swelum

Academic Editor

PLOS ONE