Exertional Rhabdomyolysis and Ultra-Trail Races: A Systematic Review Highlighting the Significant Impact of Eccentric Load

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Your study constitutes a noteworthy addition to the field of sports medicine and exercise physiology with your systematic review of exertional rhabdomyolysis (ER) in ultra-trail (UT) races. Below, I have provided detailed comments and suggestions to enhance the clarity, readability, and overall impact of your manuscript.

- To improve clarity and readability, streamline complex sentences and reduce redundancy.

Example improvement:

Original: "Ultra trail races (UT) involve high energy and extreme muscular demands, which can potentially cause significant muscle breakdown, leading to ER or, at the least, larger increases in creatine kinase (CK) and lactate dehydrogenase (LDH) biomarkers."

Revised: "Ultra-trail races (UT) necessitate high energy and extreme muscular exertion, which can result in significant muscle breakdown, leading to ER and elevated biomarkers such as creatine kinase (CK) and lactate dehydrogenase (LDH)."

Your adherence to PRISMA guidelines and the comprehensive literature search is laudable. Including additional details on the search strategy and selection process for the included studies would further enhance transparency.

- Add a flowchart detailing the search strategy, inclusion and exclusion criteria, and number of studies at each stage of the selection process.

- Consider revising the Methods section to improve conciseness.

- For the results, consider using summary tables for key data points and providing detailed tables as supplementary materials. In the discussion and conclusions, we strive to make certain sections more concise.

- To enhance clarity and readability, avoid lengthy sentences, and use the active voice whenever possible.

 

Revised: "We conducted a systematic search of relevant literature following the PRISMA method."

Simplified: "Ultra trail races (UT) require high energy and extreme muscular effort, causing significant muscle breakdown and increasing creatine kinase (CK) and lactate dehydrogenase (LDH) biomarkers."

Simplified: "These findings suggest that ER is often misdiagnosed in UT, potentially leading to acute kidney injury."

Active voice: "We conducted a systematic search of relevant literature using the PRISMA method."

Consistent: "We conducted a systematic search of relevant literature following the PRISMA method."

Expanded: "These findings underscore the need for better diagnostic criteria and preventive measures for ER. Coaches and medical professionals should monitor CK and LDH levels in runners before and after UT races to identify early signs of ER and implement appropriate hydration and recovery strategies."

 

Your manuscript represents a significant contribution to the field of ER in ultra-tail races. By implementing the recommended revisions, you will significantly improve the clarity, readability, and overall caliber of the manuscript. We commend your commitment to advancing your knowledge in this important area.

Comments on the Quality of English Language

The paper "Exertional Rhabdomyolysis and Ultra-Trail Races: A Systematic Review Highlighting the Significant Impact of Eccentric Load" demonstrates a good command of the English language. However, there are several areas in which improvements can be made for clarity, conciseness, and grammatical accuracy. The following are some comments and suggestions.

 

Abstract:

Sentence clarity: "It is characterized by muscle pain, weakness, and myoglobinuria, which may lead to acute kidney injury and worsen the patient's prognosis."

Suggested revision: "It is characterized by muscle pain, weakness, and myoglobinuria, potentially leading to acute kidney injury and worsening the patient's prognosis."

Avoid redundancy: "Ultra trail races (UT) involve high energy and extreme muscular demands, which can potentially cause significant muscle breakdown, leading to ER or, at the least, larger increases in creatine kinase (CK) and lactate dehydrogenase (LDH) biomarkers."

Suggested revision: "Ultra trail races (UT) involve high energy and extreme muscular demands, potentially causing significant muscle breakdown and leading to ER or increased levels of creatine kinase (CK) and lactate dehydrogenase (LDH) biomarkers."

 

Introduction:

Consistency in terminology: "Ultra-endurance sports are defined as strenuous exercises that involve either a distance greater than 42,195 km or a duration of more than 6 hours."

Suggested revision: "Ultra-endurance sports are defined as strenuous exercises involving distances greater than 42.195 km or durations exceeding 6 hours."

Clarity and flow: "These races require extreme effort from participants and can be extremely demanding for their bodies."

Suggested revision: "These races demand extreme effort from participants and are highly taxing on their bodies."

 

Methodology:

Clarity and brevity: "Included papers were selected by two independent reviewers according to the established inclusion and exclusion criteria. Mendeley Desktop®v.2,112.0 (Elsevier, The Netherlands) was used to remove duplicate articles and analyse both titles and abstracts."

Suggested revision: "Two independent reviewers selected the included papers based on established criteria. Mendeley Desktop®v.2,112.0 (Elsevier, The Netherlands) was used to remove duplicates and analyze titles and abstracts."

Consistency in format: "The systematic review was checked and fully accepted on April 8, 2024, by PROSPERO (CRD 42024529946)."

Suggested revision: "The systematic review was accepted by PROSPERO (CRD 42024529946) on April 8, 2024."

 

Results:

Simplify complex sentences: "Episodes of ER were assessed in prospective descriptive, cohort and even comparative studies, but no articles were found that met the inclusion criteria with trial or intervention-type designs in UT."

Suggested revision: "Episodes of ER were assessed in prospective descriptive, cohort, and comparative studies, but no articles meeting the inclusion criteria for trial or intervention-type designs in UT were found."

Ensure subject-verb agreement: "All of them reported increments comprised between 1.76– and 5.98–fold pre vs post levels."

Suggested revision: "All of them reported increases ranging from 1.76 to 5.98-fold pre vs post levels."

 

Discussion:

Improve readability: "Our hypothesis was not entirely proven, as the UTs with higher elevations did not necessarily result in larger CK increases."

Suggested revision: "Our hypothesis was not fully supported, as UTs with higher elevations did not consistently result in larger CK increases."

Remove unnecessary words: "This heterogeneity in the results obtained can be mainly explained by the great variety of different factors which affect this kind of race."

Suggested revision: "This heterogeneity in results can be explained by the variety of factors affecting this type of race."

 

Conclusion:

Enhanced clarity and conciseness: "Eccentric exercise is a primary factor for increasing MD biomarkers. However, despite the results shown in our systematic review, it is not possible to categorize UT race risks solely based on elevation loss."

 

 

Suggested revision: "Eccentric exercise significantly increased MD biomarker levels. However, our systematic review indicates that UT race risks cannot be categorized solely based on elevation loss."

Author Response

Dear Reviewer,

Thank you for your review. Your feedback has significantly improved the paper. We have incorporated all of your suggestions into this new manuscript and have highlighted the comments you suggested for easier detection in the new manuscript. We hope you find these changes satisfactory.

Thank you very much.
Yours faithfully,

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Well written description of the rate of development and means of diagnosing Exertional Rhabdomyolysis. 

The authors methodological design for writing this review is sound and commendable. 

The introduction is very informative and provides a descriptive segue to the body of the review. 

The results and conclusion are clean and concise. 

Author Response

Dear Reviewer,

We sincerely appreciate the time and effort you have dedicated to enhancing our manuscript. We have incorporated the changes recommended by the other reviewer into this revised version of the manuscript. We hope you find these changes satisfactory.

Yours faithfully, [Your Name]

Author Response File: Author Response.pdf