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The reviewer concludes, and I concur, that the revised version adequately addresses all the prior reviewer comments and that the manuscript is now ready for publication.
[# PeerJ Staff Note - this decision was reviewed and approved by Jafri Abdullah, a PeerJ Section Editor covering this Section #]
Clear
Original
Ok
No
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**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors agree that they are relevant and useful.
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The manuscript is generally written with an appropriate academic tone. The structure is coherent and aligns with the norms for a systematic review and meta-analysis. The introduction provides sufficient context regarding internet addiction and its impact on adolescents. However, the authors should consider enhancing the background by citing recent contributions to the field to strengthen the timeliness and relevance of their work.
In particular, I recommend including in the introduction articles around the lifestyle and behavioral profiles of adolescents. For example: Assessment of Lifestyle, Eating Habits and the Effect of Nutritional Education among Undergraduate Students in Southern Italy. Nutrients. 2023;15(13):2894. doi:10.3390/nu15132894.
**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful.
The methodology is rigorous and adheres to PRISMA guidelines. The inclusion and exclusion criteria are clearly defined using the PICOS framework. The data extraction and quality assessment were carried out by multiple researchers with a clear dispute resolution protocol. However, I noted several areas that could be clarified or strengthened:
While demographic details are reported for most studies, age and gender data are missing or inconsistently reported in some cases. This limits the ability to evaluate the representativeness of the samples.
The classification into “Traditional Qigong,” “Conventional Exercise,” and “Other” is thoughtful, but it might benefit from clearer operational definitions of each category.
There is variability in what constitutes “control” across studies (e.g., silence, no treatment, education). A table summarizing the control condition per study would increase clarity.
Information on adherence to exercise protocols and dropout rates, if available, should be reported, as these could influence effect sizes and study validity.
The findings are clearly reported, and the statistical methods are appropriate. The use of both Review Manager and Stata reinforces confidence in the robustness of the results. The reported effect size is large (SMD = -1.11), suggesting a strong impact of exercise interventions on internet addiction.
However, heterogeneity is a major concern:
The I² values (~89–90%) indicate considerable between-study variability.
The subgroup analyses, while extensive, do not account for this heterogeneity fully.
The authors acknowledge these limitations and speculate on possible sources (e.g., intervention format, adherence, cultural factors), but more discussion on potential moderator variables—such as baseline internet addiction severity, comorbid conditions, or socioeconomic status—would strengthen the interpretation of findings.
The sensitivity analysis and publication bias assessment are appropriately conducted and support the stability of the conclusions.
Strengths:
- Timely topic with strong practical implications.
- Rigorously conducted meta-analysis with sound statistical methods.
- Comprehensive review of both Western and Eastern exercise paradigms.
- Well-structured manuscript.
Areas for improvement:
- Incorporate additional literature to enrich the discussion of adolescent health behavior.
- Improve clarity in the categorization of interventions and outcomes.
- Provide consistent demographic data across all included studies.
- While no significant publication bias was found, a visual funnel plot and more commentary would be welcome.
- Include a paragraph interpreting the methodological shortcomings found in the risk of bias assessment.
- The article should provide a sufficient introduction and background to demonstrate how the work fits into the broader field of knowledge. Relevant prior literature should be appropriately referenced. Indeed, although relevant as a topic, the study lacks a solid foundation in the scientific literature and requires a different perspective. Other similar works exist, for instance: https://www.sciencedirect.com/science/article/abs/pii/S0306460324002089 https://pubmed.ncbi.nlm.nih.gov/38882324 https://www.sciencedirect.com/science/article/abs/pii/S0165032724012795
- I suggest reformulating the introduction section to highlight the scope of the work better.
- The English language should be revised throughout the whole manuscript.
**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful.
- Methods are described with sufficient information, and the research question is relevant. However, the gap in the literature should be better highlighted. I believe that the search strategy used is too narrow and that other important information has not been gathered. For instance, in the literature retrieval strategy, "rehabilitation exercise" is different from "physical exercise" and may not be considered together.
Results should be reinterpreted after better delineating the search query strategy.
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