Comment on: The Benefits of Resistance Training in Obese Adolescents: A Systematic Review and Meta-analysis
Sports Medicine - Open volume 9, Article number: 9 (2023)
The study by Ribeiro et al.  described the benefits of resistance training in obese adolescents, but it is necessary to highlight some methodological issues to facilitate subsequent studies.
First, as a matter of detail, I suggest that authors should consider using a combination of medical subject terms (Mesh) and keywords when developing their search strategy, such as adding “resistance training”[Mesh] (https://www.ncbi.nlm.nih.gov/mesh/?term=resistance+training) and “Adolescent”[Mesh] (https://www.ncbi.nlm.nih.gov/mesh/68000293) to the current search strategy. It is possible that some crucial studies were missed by using keywords alone.
Second, there is an error in the forest plot drawn by the authors. Muscle strength, body mass index, cardiorespiratory fitness, waist circumference, lean mass, body fat, and insulin sensitivity are not the same type of outcome, but the authors combined the weights of all studies, reducing the degree of influence of each study on the overall outcome. The correct approach should be (in the case of cardiorespiratory fitness and waist circumference): tick “subtotals only” in “analysis details” of “properties” in the interface of Revman software forest plot” so that each result is independent, as shown in Fig. 1. Although the pooled effect size remains the same, the weight is increased.
Third, the study process for this systematic review and meta-analysis was incomplete. The study included > 10 trials, and publication bias should be determined by plotting funnel plots  and using sensitivity analysis to determine the stability of the results. Based on these results, it is also recommended to use the Grading of Recommendations Assessment, Development, and Evaluation approach  to assess the evidence for resistance training on different outcomes to facilitate clinical practice recommendations.
Availability of data and material
Ribeiro B, Forte P, Vinhas R, Marinho DA, Faíl LB, Pereira A, Vieira F, Neiva HP. The benefits of resistance training in obese adolescents: a systematic review and meta-analysis. Sports Med Open. 2022;8(1):109. https://doi.org/10.1186/s40798-022-00501-3.
Sterne J, Harbord R. Funnel plots in meta-analysis. Stata J. 2004;4:127–41. https://doi.org/10.1177/1536867X0400400204.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. https://doi.org/10.1136/bmj.39489.470347.AD.
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Zhang, F. Comment on: The Benefits of Resistance Training in Obese Adolescents: A Systematic Review and Meta-analysis. Sports Med - Open 9, 9 (2023). https://doi.org/10.1186/s40798-022-00543-7