Effect of Hydration on Pulmonary Function and Development of Exercise-Induced Bronchoconstriction among Professional Male Cyclists
, Vasileios T. Stavrou 2, Ioannis Pantazopoulos 3, Zoe Daniil 2, Aggeliki K. Kontopodi-Pigaki 1 and Konstantinos Gourgoulianis 2
Round 1
Reviewer 1 Report
Dear authors
Below you will find some doubts and suggestions that I hope can contribute to the final version of your manuscript.
Line 107-109 – I still think that this statements should be reviewed.
Line 149 –MEF25-75% is widely use, as you said, but has limitations. But why you don’t really discuss MEF25-75% results, given that you think it’s a way to access small airways (that you mentioned in line 399)?
Line 152- Is there a reason for using two different references for spirometry? In line 144 the reference is 2005 guidelines and ins line 152 the 2019 guidelines
Line 162- I think this is not correct. According to ATS/ERS, 2019 guidelines for spirometry: “…is to achieve a minimum of three acceptable FEV1 and three acceptable FVC measurements.” There is no need for measurements to be consecutive and only 3 most of the time it is not enough to have good quality FVC’s. If this is what was done, it may have had a negative impact on the results.
Line 163- this criterion is not in line with what is written on line 148 or in the abstract
Line 429 – Using cardiopulmonary exercise testing for EIB accessement isn’t consensual. But since it was used and V̇O2máx results were interesting they could have been also discussed.
Kind regards
Some minor checks are needed
Author Response
Response to reviewers
Paper title: Effect of hydration on pulmonary function and development of exercise-induced bronchoconstriction among professional male cyclists
Manuscript ID: arm-2410364
We thank the reviewer for the comments that have helped us to improve the paper. All changes have been indicated by red color within the text. Below you will find a point-by-point response to your comments.
Reviewer 1
Comments 1. Lines 107-109:
Response: We thank the reviewer for his/her valuable comment. We reviewed the statements.
Comments 2. Line 149: MEF25-75% is widely used, but has limitations. But why you don’t really discuss MEF25-75 results, given that you think it is a way to access small airways (that you mentioned in line 399?)
Response: We thank the reviewer for his/her suggestion. We have placed within the text a relevant reference for your observation. We list it below: The MEF25-75% is a potentially sensitive marker of obstruction of peripheral airflow [57], and it is reduced in early bronchial impairment, which is associated with small airway disease [58]. The role of small airways in EIB still needs to be clarified and more studies are needed to assess if small airway function and inflammation may be considered reliable predictive markers of EIB in elite athletes [59]. In our study, there is a strong correlation between hydration status and improvement in MEF25-75% among elite cyclists.
Also, we have placed in the paragraph with the limitations: Finally, MEF25-75% is widely used to estimate small airway dysfunction, but it has some limitations. Apart from spirometry, there are many other methods for assessing small airway function, such as impulse oscillometry, computed tomography, body plethysmography, inert gas washout, and Magnetic Resonance Imaging.
Comments 3. Line 152. Is there a reason for using two different references for spirometry?
Response: We thank the reviewer for his/her suggestion. We did the correction.
Comments 3. I think this is not correct. According to ATS/ERS, 2019 guidelines for spirometry: “…is to achieve a minimum of three acceptable FEV1 and three acceptable FVC measurements.” There is no need for measurements to be consecutive and only 3 most of the time it is not enough to have good quality FVC’s. If this is what was done, it may have had a negative impact on the results.
Response: We thank the reviewer for his/her suggestion. We did the correction: . For each pulmonary function test, the best three of all performed measurements, that met the ATS/ERS criteria were evaluated. The largest one was retained to calculate the spirometric values.
Comments 4. This criterion is not in line with what is written on line 148 or in the abstract
Response: We thank the reviewer for his/her suggestion. We did the correction.
Comments 5. Line 429 – Using cardiopulmonary exercise testing for EIB accessement isn’t consensual. But since it was used and V̇O2máx results were interesting they could have been also discussed.
Response: We thank the reviewer for his/her suggestion. We have placed within the text a paragraph about VO2:
4.3. Effects of hydration on exercise capacity
Hydration plays a significant role in athletic performance [61], including its impact on maximal oxygen uptake (VO2 max). VO2 max is a measure of an individual’s maximum capacity to utilize oxygen during intense exercise. Proper hydration helps regulate body temperature during exercise [58,59]. When the body is dehydrated, it struggles to dissipate heat efficiently, leading to an increase in core body temperature [62]. Elevated body temperature can negatively affect VO2 max [62,63]. Adequate hydration supports thermoregulation, allowing athletes to maintain optimal body temperature and, in turn, preserve their VO2 max [61,62,63]. Hydration status affects blood volume [64], which is crucial for oxygen delivery to working muscles [65]. Additionally, dehydration reduces blood volume [64] and increases blood viscosity [66]. As a result, oxygen delivery to the muscles decreases, limiting the VO2 max. Optimal hydration helps maintain proper blood volume, promoting efficient oxygen transport and utilization. Finally, dehydration can lead to an elevated heart rate [64,67] and increased cardiovascular strain [64,68]. A higher heart rate can reduce cardiac output during exercise, leading to reduce the oxygen delivery to the muscles, affecting VO2 max. Maintaining hydration levels helps regulate heart rate and cardiac output, supporting optimal VO2 max. Our study is in accordance with the literature, supporting a strong correlation between hydration status and improvement in VO2 max among elite cyclists.
Reviewer 2
Comments 1. . 1. I am happy that the manuscript was revised according to my previous comments
Response: We thank the reviewer for the help.
Comments 2. Please if it possible do not limit your statistical analysis to descriptive. I think it will be easy to apply correlational analysis to your data
Response: We thank the reviewer for his/her suggestion. We applied correlational analysis between hydration – fev1, hydration – vo2 max, fev1-vo2 max.
Comments 3. Please present more deeper limitations of your study
Response: We thank the reviewer for his/her suggestion.
Reviewer 2 Report
Thank you for the possibility to review this important article on hot topic: Effect of hydration on pulmonary function and development of exercise-induced bronchoconstriction among professional male cyclists
I have some proposals:
1. I am happy that manuscript was revised according to my previous comments
2. Please if it possible do not limit your statistical analysis to descriptive. I think it will be easy to apply correlational analysis to your data
3. Please present more deeper limitations of your study
Author Response
Response to reviewers
Paper title: Effect of hydration on pulmonary function and development of exercise-induced bronchoconstriction among professional male cyclists
Manuscript ID: arm-2410364
We thank the reviewer for the comments that have helped us to improve the paper. All changes have been indicated by red color within the text. Below you will find a point-by-point response to your comments.
Reviewer 1
Comments 1. Lines 107-109:
Response: We thank the reviewer for his/her valuable comment. We reviewed the statements.
Comments 2. Line 149: MEF25-75% is widely used, but has limitations. But why you don’t really discuss MEF25-75 results, given that you think it is a way to access small airways (that you mentioned in line 399?)
Response: We thank the reviewer for his/her suggestion. We have placed within the text a relevant reference for your observation. We list it below: The MEF25-75% is a potentially sensitive marker of obstruction of peripheral airflow [57], and it is reduced in early bronchial impairment, which is associated with small airway disease [58]. The role of small airways in EIB still needs to be clarified and more studies are needed to assess if small airway function and inflammation may be considered reliable predictive markers of EIB in elite athletes [59]. In our study, there is a strong correlation between hydration status and improvement in MEF25-75% among elite cyclists.
Also, we have placed in the paragraph with the limitations: Finally, MEF25-75% is widely used to estimate small airway dysfunction, but it has some limitations. Apart from spirometry, there are many other methods for assessing small airway function, such as impulse oscillometry, computed tomography, body plethysmography, inert gas washout, and Magnetic Resonance Imaging.
Comments 3. Line 152. Is there a reason for using two different references for spirometry?
Response: We thank the reviewer for his/her suggestion. We did the correction.
Comments 3. I think this is not correct. According to ATS/ERS, 2019 guidelines for spirometry: “…is to achieve a minimum of three acceptable FEV1 and three acceptable FVC measurements.” There is no need for measurements to be consecutive and only 3 most of the time it is not enough to have good quality FVC’s. If this is what was done, it may have had a negative impact on the results.
Response: We thank the reviewer for his/her suggestion. We did the correction: . For each pulmonary function test, the best three of all performed measurements, that met the ATS/ERS criteria were evaluated. The largest one was retained to calculate the spirometric values.
Comments 4. This criterion is not in line with what is written on line 148 or in the abstract
Response: We thank the reviewer for his/her suggestion. We did the correction.
Comments 5. Line 429 – Using cardiopulmonary exercise testing for EIB accessement isn’t consensual. But since it was used and V̇O2máx results were interesting they could have been also discussed.
Response: We thank the reviewer for his/her suggestion. We have placed within the text a paragraph about VO2:
4.3. Effects of hydration on exercise capacity
Hydration plays a significant role in athletic performance [61], including its impact on maximal oxygen uptake (VO2 max). VO2 max is a measure of an individual’s maximum capacity to utilize oxygen during intense exercise. Proper hydration helps regulate body temperature during exercise [58,59]. When the body is dehydrated, it struggles to dissipate heat efficiently, leading to an increase in core body temperature [62]. Elevated body temperature can negatively affect VO2 max [62,63]. Adequate hydration supports thermoregulation, allowing athletes to maintain optimal body temperature and, in turn, preserve their VO2 max [61,62,63]. Hydration status affects blood volume [64], which is crucial for oxygen delivery to working muscles [65]. Additionally, dehydration reduces blood volume [64] and increases blood viscosity [66]. As a result, oxygen delivery to the muscles decreases, limiting the VO2 max. Optimal hydration helps maintain proper blood volume, promoting efficient oxygen transport and utilization. Finally, dehydration can lead to an elevated heart rate [64,67] and increased cardiovascular strain [64,68]. A higher heart rate can reduce cardiac output during exercise, leading to reduce the oxygen delivery to the muscles, affecting VO2 max. Maintaining hydration levels helps regulate heart rate and cardiac output, supporting optimal VO2 max. Our study is in accordance with the literature, supporting a strong correlation between hydration status and improvement in VO2 max among elite cyclists.
Reviewer 2
Comments 1. . 1. I am happy that the manuscript was revised according to my previous comments
Response: We thank the reviewer for the help.
Comments 2. Please if it possible do not limit your statistical analysis to descriptive. I think it will be easy to apply correlational analysis to your data
Response: We thank the reviewer for his/her suggestion. We applied correlational analysis between hydration – fev1, hydration – vo2 max, fev1-vo2 max.
Comments 3. Please present more deeper limitations of your study
Response: We thank the reviewer for his/her suggestion.
