Electromyography: A Simple and Accessible Tool to Assess Physical Performance and Health during Hypoxia Training. A Systematic Review

Round 1

Reviewer 1 Report

Review sustainability-932184: Electromyography: Sustainable tool to determine physical performance and health care during physical activity in hypoxic situations. Systematic review

The authors took up a very interesting topic of EMG value analysis during physical activity but under special conditions such as hypoxia. There is a lack of data on this issue in the scientific literature.

The subject and material are valuable and interesting, however, the manuscript requires rebuilding and changes.

The entire manuscript should be stylistically corrected.

Some (major) remarks are listed belows

Introduction:  

Line 50: hypobaric, characterized - instead - hypobaric Characterized

Line 56: consist of - instead - consist in

Lines 65-66: The construction of this sentence is completely incomprehensible - Readers can only guess what the authors meant.

Lines 75 and 77 – once again repetition

Format the table 1 to align the content of each column.

Lines 85-89: unrelated to these sentences - infections vs systemic inflammations. Besides, the second sentence has nothing to do with the purpose of the work.

Lines 90-102: This is not a review article - the main therapies should be listed - and not every possible drug individually. In this part authors should focus on the validity and effectiveness of the pharmacological treatment used in the current study

Lines 116-124: This part of introduction should be placed in discussion chapter to justify the choice of therapeutic method used in this study.

Materials and methods:

This section of the manuscript is well compiled. It contains all the sections necessary for creating a systematic overview.

There are minor linguistic errors, e.g. repetitions, to be improved:

Sentence in lines 98-101 is almost the same as in lines 106-108

Line 130 : “used EMG use…”

Line 133-134: “subject subjects…”

Table 2 should also be formatted so that the numbers are in one row and above each other (applies to item numbering and% values)

Results:

The most important caveat: Each systematic review or meta-analysis needs descriptive evidence synthesis - unfortunately we do not find it in this article. Reader should be informed about general findings from analysis and in the table can find details of each study. In the form like here, the readers themselves have to analyze the presented data.

Some missing parts we find in discussion, some not  - but they should generally be included in this section.

Data are presented in two tables (3 and 4) - as previous - should be formatted.

Discussion:

The strongest part of the manuscript.

Some minor linguistic errors.

Author Response

Point-by-Point Response to Reviewer’s Comments

We would like to sincerely thank the reviewer for the helpful suggestions. We have considered all the comments and modified the manuscript based on the reviewer’s suggestions. All the changes have been highlighted in yellow through the manuscript. We feel that the quality of the manuscript has been significantly improved with these modifications. We hope our revision and accompanied responses an acceptance of our manuscript for publication Sustainability.

In addition, an English native speaker has reviewed the manuscript to ensure there are not grammatical mistakes.

Sincerely,

Dr. Fernandez-Lazaro

INTRODUCTION

1. Rev: Line 50: hypobaric, characterized - instead - hypobaric Characterized

Authors: The authors have amended the issue as follows:

Page 2, lines 51-52: “It has two subtypes: hypobaric hypoxia, characterized by an atmospheric pressure lower than 760 mm Hg….”

2. Rev: Line 56: consist of - instead - consist in

Authors: To improve clarity, we have modified the sentence as follows:

Page 2, lines 58-62: “Two common techniques that simulate altitude training in elite athletes are the intermittent hypoxic exposure (IHE) and intermittent hypoxic training (IHT). IHE is implemented through lengths of passive stay in hypoxic environment or through breathing in an environment with reduced oxygen concentration, whereas IHT consists of training sessions under hypoxic conditions [2]”.

3. Rev: Lines 65-66: The construction of this sentence is completely incomprehensible - Readers can only guess what the authors meant.

Authors: To improve clarity, we have modified the sentence as follows:

Page 2, lines 64-68:” Thus, when SaO2 is lower than 90%, the adaptive physiological response is met in different systems such as the respiratory, cardiovascular, endocrine, metabolic, hematological, immune system as well as skeletal muscle (Table 1) [1]. In this context, functional and molecular adaptations in skeletal muscle tissue under hypoxic conditions are achieved [3]”.

4. Rev: Lines 75 and 77 – once again repetition

Authors: Thank you for your observation. We have removed the sentence from the manuscript as written below:

Page 3, lines 77-81: “The EMG is a recording equipment composed of several elements: electrodes, amplifiers, and registration system. It has two types of electrodes, internal or needle electrodes [Deep EMG or Integrated EMG (iEMG)], and surface electrodes [Kinesiological or Superficial EMG (sEMG)]. The EMG signal is emitted by the electrodes and is collected in the amplifier which detects potential difference and eliminates interference”.

5. Rev: Format the table 1 to align the content of each column

Authors: Thank you for your suggestion. I corrected the format (please see Table 1 in the new version of the manuscript)

6. Rev: Lines 85-89: unrelated to these sentences - infections vs systemic inflammations. Besides, the second sentence has nothing to do with the purpose of the work.

Authors: The authors do not understand the reviewer’s’ suggestion. Please, we kindly request for further explanation.

7. Rev: Lines 90-102: This is not a review article - the main therapies should be listed - and not every possible drug individually. In this part authors should focus on the validity and effectiveness of the pharmacological treatment used in the current study

Authors: The authors do not understand the reviewer’s’ suggestion. Please, we kindly request for further explanation.

8.Rev: Lines 116-124: This part of introduction should be placed in discussion chapter to justify the choice of therapeutic method used in this study.

Authors: The authors do not understand the reviewer’s’ suggestion. Please, we kindly request for further explanation.

MATERIALS AND METHODS

9.Rev: Sentence in lines 98-101 is almost the same as in lines 106-108.

Authors: We thank the reviewer for the concern. We have now removed repetitive information.

10. Rev: Line 130 : “used EMG use…”

Authors: We have now modified the sentence as follows:

Page 4, lines 124-126: “Therefore, inclusion criteria included articles (i) depicting a well-designed study that included the used of EMG during physical activity under hypoxic conditions in humans.

11. Rev: Line 133-134: “subject subjects…”

Authors: We have now modified the sentence as follows:

Page 4, lines 127-128: “Alternatively, exclusion criteria included: (i) publications without results in human and non-related to hypoxia training”.

12. Rev: Table 2 should also be formatted so that the numbers are in one row and above each other (applies to item numbering and% values)

Authors: Thank you for the reviewer’s suggestion. We have now modified Table 2. Please see the new version of the manuscript.

RESULTS

13. Rev: The most important caveat: Each systematic review or meta-analysis needs descriptive evidence synthesis - unfortunately we do not find it in this article. Reader should be informed about general findings from analysis and in the table can find details of each study. In the form like here, the readers themselves have to analyze the presented data.

Some missing parts we find in discussion, some not - but they should generally be included in this section.

Authors: We appreciate reviewers’ concern. The authors have incorporated a new table to facilitate readers the interpretation of the results. In addition, the authors have addressed the issues to missing parts of the discussion. Please, see Table 3 in the new version of the manuscript.

14. Rev: Data are presented in two tables (3 and 4) - as previous - should be formatted

Authors: Thank you for your recommendation. The tables were formatted and incorporated at the end of the manuscript. We made Table 4A and Table 4B as we believe that information in these tables are very related.

DISCUSSION

15. Rev: The strongest part of the manuscript.

Authors: We appreciate the comment.

16. Rev: Some minor linguistic errors.

Authors: The manuscript has been edited by a native English speaker.

Author Response File: Author Response.pdf

Reviewer 2 Report

The systemic review evaluated the scientific evidence of EMG as an instrument for the monitoring of the different responses of skeletal muscles subjected to an external stimulus such as hypoxia and physical activity.

The title is confusing.

Why studies with women were excluded?

The paragraph with line 81-90 does not transition well from the previous paragraph, or the paragraph after

4.8 seems not fit well with the other discussion

Author Response

Point-by-Point Response to Reviewer’s Comments

We would like to sincerely thank the reviewer for the helpful suggestions. We have considered all the comments and modified the manuscript based on the reviewer’s suggestions. All the changes have been highlighted in green through the manuscript. We feel that the quality of the manuscript has been significantly improved with these modifications. We hope our revision and accompanied responses an acceptance of our manuscript for publication Sustainability.

In addition, an English native speaker has reviewed the manuscript to ensure there are not grammatical mistakes.

Sincerely,

Dr. Fernandez-Lazaro

1. Rev: The title is confusing.

Authors: We have now modified the title (please see below). However, if the reviewer has any additional suggestions, we are open to modify it.

Electromyography: A simple and accessible tool to assess physical performance and health during hypoxia training. A systematic review

2. Rev: Why studies with women were excluded?

Authors: We excluded female athletes because they have different intensity and physiological responses to exercise than male athletes, which may directly influence EMG results [11-13].

References

11. Gallo Flórez R. Physiological changes in sports women. Education Fisical Sports. 1995, 17, 1-7.
12. Córdova Martínez A. Sports Physiology (1ed). Madrid: Síntesis. 2013.
13. París CL. Influence of sex in the practice of sports. Biology of sportswomen. Arbor. 2000, 165, 249-263
14. Rev: The paragraph with line 81-90 does not transition well from the previous paragraph, or the paragraph after.

Authors: Thank you for the concern. We have smoothed the transition between paragraphs as follows:

Page 3, lines 86-81: “EMG has multiple potential applications, not least as a diagnostic tool. In some cases, patients are diagnosed after the onset of the first symptoms after a lengthy preclinical phase”.

4. Rev: 4.8 seems not fit well with the other discussion

Authors: Thank you for the concern We have modified the discussion section and create a new subsection (5. Application of electromyography for a sustainable lifestyle) in which we discussed the application on EMG related to quality of health and quality of life (pages 10-11, lines 314-325) as well as physical performance (pages 11-12, lines 330-351).

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The introduced corrections increased the value of the work.

The text in the corrected sentences is more consistent and accessible to the reader without causing confusion.

The revision of the tables also increased their transparency.

Indeed, remarks 6, 7 and 8 relating to the introduction of the parts were included incorrectly due to a text editor error and did not apply to your manuscript - so you could not correctly respond to them.

In conclusion, I have no objections.

Reviewer 2 Report

No further comments

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.