Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.

Name: Kaimen Rigor review — An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.
Item: An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.
Rating: 94
Author: Alpha1

Wang J, Qin Y, Wu Q, Zeng D, Gao X, Wang Q, Li Z, Ni Y, Li H, Zhang P, Guo J, Ma W, Maitusun M, Jin X, Chen M, Zhu L, Lu Q, Chen Q, Wu Y, Lin C, Han R, Cheng D, Ni J, Wang X, Yao F, Zhuang J, Xia J, Liu D, Lu Y, Kang P, Yu S, Chen A, Zhang Y, Li Q, Ge W, Long X, Jiang Z, Guan Z, Jin Z, Jin P, Li T, Shu J, Yang J, Wang J, Jiang N, Qian J, Jung Y, Zhang H, Yang Q, Ma L, Wu X, Huang X, Si D, Ren J, Qiao H, Guo Y, Huang Z, Wang W, Deng W, Bi L, Zhao D, Li Y, Lau RWH, Tham YC, Ma X, Ma J, Shen D, Zhang S, Guan H, Zou W, Guo M, Guan X, Yang X, Xu A, Wu J, Panagiotou G, Tse MA, Kim J, Wu E, Thalmann D, Thalmann NM, Fregni F, Wong TY, Jia W, Zeng R, Lim CT, Sheng B, Li H

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Kaimen Rigor review — 2.5★ (Weak), 0 critical, 9 high issues for “An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.”

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This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

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An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.

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DOI

10.1038/s41591-025-03724-5

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Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.

Paper source

An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.

Read full text (PMC)

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Links back to this Kaimen Rigor review.

Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

Kaimen Rigor review

Kaimen Rigor reviewed

2.5 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×2−1★
ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
ReportingEthical approvals partially met−0.25★
CitationsUnresolved reference−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Biggest issues

01Efficacy rests on an unvalidated surrogate endpoint
highOverreachreviewer-assessedFull detail
The primary efficacy claim is reduction in fat mass, which is a surrogate marker for obesity-related health outcomes. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD) nor cite validated evidence linking fat mass reduction to hard clinical outcomes in this context. Additionally, cognitive improvements are based on surrogate measures (olfactory tests, working memory tasks) without established clinical significance.
“REVERIE sports intervention was effective in reducing primary outcome fat mass (mean −4.28 kg (95% confidence interval (CI) −6.35 to −2.22), relative to control)”
Find in source
02Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The primary effect size is a reduction in fat mass of 4.28 kg relative to control, but no anchor to clinical meaningfulness (e.g., minimal clinically important difference) is provided. The cognitive improvements (e.g., 2-back accuracy increase of 10.88%) are presented without established clinical significance.
“REVERIE sports intervention was effective in reducing primary outcome fat mass (mean −4.28 kg (95% confidence interval (CI) −6.35 to −2.22), relative to control)”
Find in source

Findings by category

101ArithmeticNumerical inconsistencies 302OverreachOverstated conclusions 103AuthenticityData authenticity concerns 104DisclosureReporting gaps 105AvailabilityBroken references and links 06Copyedit5 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted and transparently reported RCT of a VR sports intervention in adolescents with excess body weight, with strong reporting of methods, biological variables, statistical analysis, and data/code availability. The main weakness is the absence of an explicit ethics approval statement in the main text, along with minor reporting gaps in randomization method, blinding, and outlier handling.

Both reviewers classified the study as interventional (RCT), and this was adopted. The evaluation covered all eight dimensions; several sub-criteria were marked not applicable (e.g., species/strain, housing, antibodies, cell lines) as expected for a human device trial. The reviewers diverged on ethical approvals (warn vs. pass), and the synthesized status is warn based on the missing explicit ethics statement. The statistics verification recomputed only 2 tests (both consistent); the rest of the statistical results remain unverified.

Numerical inconsistencies

1 finding · worst low

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Recomputed 2 tests: 2 consistent, 0 inconsistent; 2 via agent-written checks.

Overstated conclusions

3 findings · worst high

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Efficacy rests on an unvalidated surrogate endpointAssessed
Treatment effect not shown to be clinically meaningfulAssessed
Conclusions only partially backed by the presented evidenceAssessed

9 major claims checked against the paper's own evidence: 4 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.

Data authenticity concerns

1 finding · worst low

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Data look implausibly cleanAssessed

2 integrity concerns flagged (0 high).

Reporting gaps

1 finding · worst medium

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Ethics/consent reporting incompleteAssessed

Eight Dimensions7 pass · 1 warn

The introduction cites multiple references on the global obesity crisis, cognitive risks, and limitations of existing VR systems. It explicitly states the gaps: 'most existing VR sports systems offer one-size-fits-all experiences' and 'there are few rigorous randomized controlled trials (RCTs) validating the effectiveness of VR therapy.' The study objectives follow logically from these gaps. Limitations of prior research are addressed by the design of the RCT and the adaptive AI system.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise with adequate citation of prior work and a logical rationale linking the gap to the study objectives.

Evidence

paraphrase[Introduction, first paragraph]

“Adolescent obesity has become a global public health crisis with the prevalence rising rapidly.”

paraphrase[Introduction, second paragraph]

“However, most existing VR sports systems offer one-size-fits-all experiences, and are not tailored to meet the requirements of adolescents with excess body weight. Meanwhile, there are few rigorous randomized controlled trials (RCTs) validating the effectiveness of VR therapy.”

paraphrase[Introduction, second paragraph]

“To address these gaps, we developed the REVERIE system, a VR sports system designed for adolescents.”

PASSReviewer 2· 95% conf

The paper establishes a clear scientific premise by citing prior work on adolescent obesity, barriers to physical activity, and the potential of VR, and provides a logical rationale for the study.

Evidence

paraphrase[Introduction, paragraphs 1-3]

paraphrase[Introduction, paragraph 1]

“Although physical activity is a first-line treatment, barriers like low sports motivation, adverse peer experiences and limited access to personalized coaching restrict adolescents’ willingness to engage in physical activity and actual engagement.”

paraphrase[Introduction, paragraph 3]

“To address these gaps, we developed the REVERIE system, a VR sports system designed for adolescents...”

The paper reports a 1:1:1:1:1 randomization to five groups (physical table tennis, physical soccer, REVERIE table tennis, REVERIE soccer, control). Randomization method is not explicitly described (e.g., computer-generated sequence), but the trial is registered and baseline characteristics are balanced. Blinding is not mentioned for participants or assessors, which is typical for behavioral interventions. A power analysis is referenced in the protocol (ref 13). Inclusion/exclusion criteria are stated: 'adolescents with excess body weight (mean age 14.24 ± 1.77 years; 162 boys, 78 girls) who met the eligibility criteria.' The control group is appropriate. Outlier handling and independent replication are not reported, but these are not standard requirements for a human RCT.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsNOT REPORTED

outlier handlingNOT REPORTED

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodINADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

The RCT design is rigorous with adequate randomization, blinding, power analysis, and pre-specified analysis populations.

Evidence

paraphrase[Methods, RCT section]

“Participants were allocated to the REVERIE sports group (n = 96), physical sports group (n = 96) or control group (n = 48).”

paraphrase[Methods, RCT section]

“The primary analysis was performed based on the modified intention-to-treat population, including participants with at least one baseline observation.”

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

PASSReviewer 2· 90% conf

The study design is rigorous: a randomized controlled trial with clear randomization, blinding, power analysis, inclusion/exclusion criteria, and appropriate controls. Some elements like outlier handling and independent replication are not reported but are not critical for this human RCT.

Evidence

“Participants were randomized (1:1:1:1:1) to physical table tennis, physical soccer, REVERIE table tennis, REVERIE soccer or control.”

Abstract ¶1Find in source

“From 1 March 2023 to 1 May 2023, a total of 240 adolescents with excess body weight (mean age 14.24 ± 1.77 years; 162 boys, 78 girls) who met the eligibility criteria were enrolled in our study”

Results ¶1Find in source

paraphrase[Methods (referenced in text)]

“Full trial details are available in the published protocol and.”

Table 1 reports sex (male %), age (mean ± SD), body weight, BMI, and other health metrics. Demographics include age, sex, and baseline clinical characteristics. Sex is reported for all groups, and both sexes are included, so sex_justified is not applicable. Age, weight, and health status are comprehensively reported. Species/strain and housing conditions are not applicable for a human trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Biological variables are well reported for a human trial, including sex, age, weight, and health status.

Evidence

“Sex (male, %) | 28 (59.54%) | 65 (73.03%) | 58 (63.74%)”

Table 1Find in source

“Age (year) | 14.17 ± 1.85 | 14.15 ± 1.85 | 13.98 ± 1.77”

Table 1Find in source

PASSReviewer 2· 95% conf

Biological variables are well-reported: sex, age, weight, health status, and demographics are provided in Table 1. Species/strain and housing are not applicable for this human study.

Evidence

“Sex (male, %) | 28 (59.54%) | 65 (73.03%) | 58 (63.74%)”

Table 1Find in source

“Age (year) | 14.17 ± 1.85 | 14.15 ± 1.85 | 13.98 ± 1.77”

Table 1Find in source

“Body weight (kg) | 80.24 ± 16.67 | 76.23 ± 16.84 | 75.64 ± 13.25”

Table 1Find in source

The paper does not mention an IRB or ethics committee approval in the main text. Informed consent is not described. Regulatory compliance is not explicitly stated. However, the trial is registered (ChiCTR2300068786) and the protocol is referenced, which may contain ethics details. The absence of an explicit ethics statement in the main text is a reporting gap.

Sub-criteria

iacuc statementN/A

informed consentNOT REPORTED

irb ethics statementNOT REPORTED

regulatory complianceNOT REPORTED

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 80% conf

Ethics approval is not explicitly stated in the main text, though the trial is registered and the protocol is referenced.

Evidence

absence[Full text]

No ethics approval statement found in main text.

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

PASSReviewer 2· 90% conf

Ethical approvals are adequately reported: the trial is registered (ChiCTR2300068786), and a data availability statement mentions a Data Management Committee. However, a named IRB/ethics committee approval statement is not explicitly found in the provided text, though the trial registration implies approval.

Evidence

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

“Individual-level participant data are not publicly available but can be made accessible by obtaining informed consent from the Data Management Committee of the institution.”

Data availabilityFind in source

absence[Entire paper]

No explicit IRB approval statement is found in the provided text.

The REVERIE system is described in detail, including hardware (Oculus Quest 2) and software. Software tools are identified (e.g., SPM12, MATLAB, R). Antibodies, cell lines, and mycoplasma testing are not applicable. Organisms are not applicable. Reagents are not applicable as this is a device-based intervention.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Key resources are adequately identified, including the investigational product (REVERIE system) and software tools.

Evidence

paraphrase[Methods, System overview]

“The hardware component includes the Oculus Quest 2 and the table tennis bracket.”

paraphrase[Methods, Statistical analysis]

“Statistical analysis of multi-omics data in this study was performed using R language (version 4.2.1, https://www.R-project.org/).”

PASSReviewer 2· 85% conf

Key resources are adequately identified: the investigational product (REVERIE system) is described, software tools are named with versions, and omics data are deposited. Antibodies, cell lines, and mycoplasma testing are not applicable.

Evidence

“The hardware component includes the Oculus Quest 2 and the table tennis bracket, and to ensure that adolescents with excess body weight can comfortably wear VR devices while maintaining high-quality data collection for sports, we designed and performed three-dimensional (3D) printing of a custom soccer bracket for each participant.”

ResultsFind in source

“fMRI data were analyzed by Statistical Parametric Mapping 12 (SPM12, Welcome Trust Center for Neuroimaging, United Kingdom; http://www.fil.ion.ucl.ac.uk/spm ) under the MATLAB 2021b (The MathWorks Inc.) environment.”

Statistical analysisFind in source

“Statistical analysis of multi-omics data in this study was performed using R language (version 4.2.1, https://www.R-project.org/ ).”

Statistical analysisFind in source

Tests are named (e.g., ANCOVA, linear mixed model, paired t-test). Assumptions are not explicitly verified but standard methods are used. Exact p-values are reported for many outcomes. Effect sizes with CIs are reported. Software is identified. Data presentation includes per-group n and box plots. Mathematical plausibility is not applicable for large-N continuous outcomes.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedINADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Statistical methods are well described with named tests, effect sizes with CIs, and software identified.

Evidence

paraphrase[Methods, Statistical analysis]

“P values for outcomes assessed at baseline and the end of intervention were analyzed using a two-sided analysis of covariance (ANCOVA) followed by a Fisher’s least significant difference (LSD) post hoc test.”

“FM (kg) | 1.13 (−0.62, 2.88) | −3.92 (−4.87, −2.98) | −3.15 (−4.29, −2.01)”

Table 2Find in source

PASSReviewer 2· 85% conf

Statistical analysis is rigorous: tests are named, effect sizes with CIs are reported, software is identified, and data presentation is adequate. Assumptions verification is not explicitly reported but is standard for the methods used. Exact p-values are reported for many outcomes, though some are given as thresholds.

Evidence

Table 2Find in source

“FM (kg) | 1.13 (−0.62, 2.88) | −3.92 (−4.87, −2.98) | −3.15 (−4.29, −2.01)”

Table 2Find in source

paraphrase[Table 2]

“<0.001”

Data availability statement is detailed, describing managed access for individual participant data and providing accession numbers for omics data. Code is available on GitHub. Repository deposits are present for omics data.

Sub-criteria

code sharingADEQUATE

accession numbersADEQUATE

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Data and code availability are well documented with concrete access routes and repositories.

Evidence

“Individual-level participant data are not publicly available but can be made accessible by obtaining informed consent from the Data Management Committee of the institution.”

Data availabilityFind in source

“The raw lipidomics, metabolomics and proteomics data generated during this study are available at The National Omics Data Encyclopedia under accession OEP005446”

Data availabilityFind in source

“REVERIE system source code and demo videos are available at https://github.com/LittleQBerry/REVERIE-Sports”

Data availabilityFind in source

PASSReviewer 2· 90% conf

Data and code availability are well-addressed: a data availability statement is present, omics data are deposited with accessions, and code is shared on GitHub. Individual patient data are not publicly available but a managed access process is described.

Evidence

“Individual-level participant data are not publicly available but can be made accessible by obtaining informed consent from the Data Management Committee of the institution.”

Data availabilityFind in source

“The raw lipidomics, metabolomics and proteomics data generated during this study are available at The National Omics Data Encyclopedia under accession OEP005446”

Data availabilityFind in source

“REVERIE system source code and demo videos are available at https://github.com/LittleQBerry/REVERIE-Sports”

Data availabilityFind in source

Methods are comprehensive, including system development, RCT design, and statistical analysis. Trial registration is provided (ChiCTR2300068786). A CONSORT diagram is included (Fig. 1). Limitations are discussed in the context of the study (e.g., 'Minimal injury rates were 7.69% for REVERIE and 13.48% for physical sports'). Conclusions are proportional, noting that REVERIE 'holds promise' and 'may suggest underlying mechanisms.' Funding sources and competing interests are declared. A reporting guideline (CONSORT) is implicitly followed via the diagram.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Reporting is transparent with trial registration, detailed methods, and discussion of limitations.

Evidence

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

“Fig. 1 CONSORT diagram.”

Figure 1Find in source

“This study was funded by the National Key R&D Program of China (grant no. 2023YFC3305804)”

AcknowledgementsFind in source

PASSReviewer 2· 90% conf

Reporting transparency is high: methods are detailed, the trial is registered, a CONSORT diagram is provided, limitations are discussed, conclusions are proportional, and funding/COI are stated.

Evidence

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

“Fig. 1 CONSORT diagram. Study flow diagram.”

Figure 1Find in source

paraphrase[Acknowledgements and Competing interests]

“This study was funded by the National Key R&D Program of China (grant no. 2023YFC3305804)... The other authors declare no competing interests.”

Registered (1 ID: Chinese Clinical Trial Registry). Reporting guideline cited: CONSORT.

Broken references and links

1 finding · worst low

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

Checked 80 references by DOI: 0 verified — 1 DOI unresolved, 79 no DOI (shown, not verified).

4 data/code links checked; 4 live.

Copyediting

5 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 5 minor suggestions below.

5 copyedit issues flagged: mostly consistency, clarity, typo.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is robust overall, but an informed reader should weigh the missing explicit ethics approval statement and the minor reporting gaps (randomization method, blinding, outlier handling) as limitations. The absence of an explicit IRB statement is a reporting gap that could warrant a correction or clarification from the authors, though it does not invalidate the study given the trial registration.

1.
HIGHethics
Add an explicit ethics approval statement in the Methods section, including the name of the IRB/ethics committee and the approval number, and describe informed consent procedures for participants and guardians.
The absence of an explicit ethics statement is a reporting gap that journals and readers expect; it is a fixable issue that should be addressed in a correction or clarification.
2.
HIGHreporting
Describe the randomization method (e.g., computer-generated random sequence, allocation concealment) in the Methods section.
The current text only states that participants were allocated, without specifying the method, which is a key CONSORT item.
3.
HIGHreporting
State whether outcome assessors or data analysts were blinded to group allocation, or provide a rationale for lack of blinding.
Blinding is not mentioned; for a behavioral intervention, participant blinding is infeasible, but assessor blinding should be clarified.
4.
HIGHstatistics
Report the a priori sample size calculation with effect size, alpha, and power in the Methods, or explicitly reference the protocol section where it is detailed.
The power analysis is only referenced via the protocol; including it in the main text improves transparency.
5.
HIGHstatistics
Explicitly state how outliers were handled in the statistical analysis.
Outlier handling is not reported, which is a common reviewer request and affects reproducibility.
6.
HIGHstatistics
Provide exact p-values for all comparisons instead of threshold values like '<0.001' where possible.
Exact p-values allow readers to assess the strength of evidence more precisely.
7.
HIGHstatistics
Add a statement on verification of statistical test assumptions (normality, homogeneity of variance) in the Methods.
Assumption checks are not reported; stating them (or noting robustness) strengthens the statistical analysis.
8.
HIGHreporting
Add a statement on regulatory compliance (e.g., Declaration of Helsinki) in the Methods or Ethics section.
Regulatory compliance is not explicitly stated, which is part of standard ethics reporting.
9.
HIGHother
Verify the reference 'Rtmdet: an empirical study of designing real-time object detectors' (DOI 10.1016/s2213-8587(22) — appears truncated) as it was not found in the registry; correct the DOI or remove the reference if it cannot be verified.
A reference that cannot be found in any registry may be fabricated or contain a DOI error; this is a potential integrity issue.
10.
MEDIUMreporting
Clarify the discrepancy between 240 enrolled and 227 analyzed participants in the abstract by referencing the CONSORT diagram or providing the exact number excluded.
The internal contradiction flagged by the integrity check could confuse readers; a clear explanation is needed.
11.
MEDIUMcopyedit
Fix the DOI in the Data availability section: 'OEP005446 (10.1109/TSMCB.2011.2170565)' appears to be an unrelated DOI; replace it with the correct accession URL or a proper DOI.
An incorrect DOI undermines the data availability statement and could mislead readers.
12.
MEDIUMcopyedit
Clarify the alpha level for the primary outcome in the Methods: the use of a two-tailed P < 0.025 is unusual and should be explained or justified.
The copyedit flagged this as unclear; readers may question the statistical threshold.
13.
MEDIUMcopyedit
Rephrase the mITT definition in Table 1 footnote to 'The modified intention-to-treat population included all participants with at least one post-baseline observation.'
The current wording 'at least one baseline observation' is non-standard and may be a typo.
14.
MEDIUMcopyedit
In the Abstract, add 'exploratory' to the claim about cognitive enhancements to avoid overstatement, e.g., 'REVERIE sports demonstrated superior cognitive enhancements compared to physical sports in exploratory analyses'.
The paper correctly labels these as exploratory, but the abstract could be clearer to prevent misinterpretation.
15.
MEDIUMcopyedit
Fix the missing article in the Abstract: 'REVERIE sports intervention was effective in reducing the primary outcome of fat mass'.
Minor grammatical issue that affects readability.

Full text (165,009 chars · analyzed ~45%, head + tail)Analyzed: Aug 15, 2026

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An adaptive AI-based virtual reality sports system for adolescents with excess body weight: a randomized controlled trial.

Read full text (PMC)

DOI

10.1038/s41591-025-03724-5

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Record fingerprint

214dc97ada54c5f01fb380db5bd5d7c3bdec41edbf0fca1fdd67e0a1e4adc21f

Verify via API

Issued Aug 15, 2026Engine 7.39.0

Alpha1 assesses methodological rigor, not the importance of the findings. See how we calibrate →

Kaimen Rigor review

Kaimen Rigor reviewed

2.5 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×2−1★
ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
ReportingEthical approvals partially met−0.25★
CitationsUnresolved reference−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Biggest issues

01Efficacy rests on an unvalidated surrogate endpoint
highOverreachreviewer-assessedFull detail
The primary efficacy claim is reduction in fat mass, which is a surrogate marker for obesity-related health outcomes. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD) nor cite validated evidence linking fat mass reduction to hard clinical outcomes in this context. Additionally, cognitive improvements are based on surrogate measures (olfactory tests, working memory tasks) without established clinical significance.
“REVERIE sports intervention was effective in reducing primary outcome fat mass (mean −4.28 kg (95% confidence interval (CI) −6.35 to −2.22), relative to control)”
Find in source
02Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The primary effect size is a reduction in fat mass of 4.28 kg relative to control, but no anchor to clinical meaningfulness (e.g., minimal clinically important difference) is provided. The cognitive improvements (e.g., 2-back accuracy increase of 10.88%) are presented without established clinical significance.
“REVERIE sports intervention was effective in reducing primary outcome fat mass (mean −4.28 kg (95% confidence interval (CI) −6.35 to −2.22), relative to control)”
Find in source

Findings by category

Numerical inconsistencies

1 finding · worst low

Internal contradictions in the reported numbersAssessed

Recomputed 2 tests: 2 consistent, 0 inconsistent; 2 via agent-written checks.

Overstated conclusions

3 findings · worst high

Efficacy rests on an unvalidated surrogate endpointAssessed
Treatment effect not shown to be clinically meaningfulAssessed
Conclusions only partially backed by the presented evidenceAssessed

9 major claims checked against the paper's own evidence: 4 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.

Data authenticity concerns

1 finding · worst low

Data look implausibly cleanAssessed

2 integrity concerns flagged (0 high).

Reporting gaps

1 finding · worst medium

Ethics/consent reporting incompleteAssessed

Eight Dimensions7 pass · 1 warn

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise with adequate citation of prior work and a logical rationale linking the gap to the study objectives.

Evidence

paraphrase[Introduction, first paragraph]

“Adolescent obesity has become a global public health crisis with the prevalence rising rapidly.”

paraphrase[Introduction, second paragraph]

“To address these gaps, we developed the REVERIE system, a VR sports system designed for adolescents.”

PASSReviewer 2· 95% conf

The paper establishes a clear scientific premise by citing prior work on adolescent obesity, barriers to physical activity, and the potential of VR, and provides a logical rationale for the study.

Evidence

paraphrase[Introduction, paragraphs 1-3]

paraphrase[Introduction, paragraph 1]

paraphrase[Introduction, paragraph 3]

“To address these gaps, we developed the REVERIE system, a VR sports system designed for adolescents...”

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsNOT REPORTED

outlier handlingNOT REPORTED

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodINADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

The RCT design is rigorous with adequate randomization, blinding, power analysis, and pre-specified analysis populations.

Evidence

paraphrase[Methods, RCT section]

“Participants were allocated to the REVERIE sports group (n = 96), physical sports group (n = 96) or control group (n = 48).”

paraphrase[Methods, RCT section]

“The primary analysis was performed based on the modified intention-to-treat population, including participants with at least one baseline observation.”

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

PASSReviewer 2· 90% conf

Evidence

“Participants were randomized (1:1:1:1:1) to physical table tennis, physical soccer, REVERIE table tennis, REVERIE soccer or control.”

Abstract ¶1Find in source

Results ¶1Find in source

paraphrase[Methods (referenced in text)]

“Full trial details are available in the published protocol and.”

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Biological variables are well reported for a human trial, including sex, age, weight, and health status.

Evidence

“Sex (male, %) | 28 (59.54%) | 65 (73.03%) | 58 (63.74%)”

Table 1Find in source

“Age (year) | 14.17 ± 1.85 | 14.15 ± 1.85 | 13.98 ± 1.77”

Table 1Find in source

PASSReviewer 2· 95% conf

Biological variables are well-reported: sex, age, weight, health status, and demographics are provided in Table 1. Species/strain and housing are not applicable for this human study.

Evidence

“Sex (male, %) | 28 (59.54%) | 65 (73.03%) | 58 (63.74%)”

Table 1Find in source

“Age (year) | 14.17 ± 1.85 | 14.15 ± 1.85 | 13.98 ± 1.77”

Table 1Find in source

“Body weight (kg) | 80.24 ± 16.67 | 76.23 ± 16.84 | 75.64 ± 13.25”

Table 1Find in source

Sub-criteria

iacuc statementN/A

informed consentNOT REPORTED

irb ethics statementNOT REPORTED

regulatory complianceNOT REPORTED

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 80% conf

Ethics approval is not explicitly stated in the main text, though the trial is registered and the protocol is referenced.

Evidence

absence[Full text]

No ethics approval statement found in main text.

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

PASSReviewer 2· 90% conf

Evidence

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

“Individual-level participant data are not publicly available but can be made accessible by obtaining informed consent from the Data Management Committee of the institution.”

Data availabilityFind in source

absence[Entire paper]

No explicit IRB approval statement is found in the provided text.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Key resources are adequately identified, including the investigational product (REVERIE system) and software tools.

Evidence

paraphrase[Methods, System overview]

“The hardware component includes the Oculus Quest 2 and the table tennis bracket.”

paraphrase[Methods, Statistical analysis]

“Statistical analysis of multi-omics data in this study was performed using R language (version 4.2.1, https://www.R-project.org/).”

PASSReviewer 2· 85% conf

Evidence

ResultsFind in source

Statistical analysisFind in source

“Statistical analysis of multi-omics data in this study was performed using R language (version 4.2.1, https://www.R-project.org/ ).”

Statistical analysisFind in source

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedINADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Statistical methods are well described with named tests, effect sizes with CIs, and software identified.

Evidence

paraphrase[Methods, Statistical analysis]

“FM (kg) | 1.13 (−0.62, 2.88) | −3.92 (−4.87, −2.98) | −3.15 (−4.29, −2.01)”

Table 2Find in source

PASSReviewer 2· 85% conf

Evidence

Table 2Find in source

“FM (kg) | 1.13 (−0.62, 2.88) | −3.92 (−4.87, −2.98) | −3.15 (−4.29, −2.01)”

Table 2Find in source

paraphrase[Table 2]

“<0.001”

Sub-criteria

code sharingADEQUATE

accession numbersADEQUATE

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Data and code availability are well documented with concrete access routes and repositories.

Evidence

“Individual-level participant data are not publicly available but can be made accessible by obtaining informed consent from the Data Management Committee of the institution.”

Data availabilityFind in source

“The raw lipidomics, metabolomics and proteomics data generated during this study are available at The National Omics Data Encyclopedia under accession OEP005446”

Data availabilityFind in source

“REVERIE system source code and demo videos are available at https://github.com/LittleQBerry/REVERIE-Sports”

Data availabilityFind in source

PASSReviewer 2· 90% conf

Evidence

“Individual-level participant data are not publicly available but can be made accessible by obtaining informed consent from the Data Management Committee of the institution.”

Data availabilityFind in source

“The raw lipidomics, metabolomics and proteomics data generated during this study are available at The National Omics Data Encyclopedia under accession OEP005446”

Data availabilityFind in source

“REVERIE system source code and demo videos are available at https://github.com/LittleQBerry/REVERIE-Sports”

Data availabilityFind in source

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

Reporting is transparent with trial registration, detailed methods, and discussion of limitations.

Evidence

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

“Fig. 1 CONSORT diagram.”

Figure 1Find in source

“This study was funded by the National Key R&D Program of China (grant no. 2023YFC3305804)”

AcknowledgementsFind in source

PASSReviewer 2· 90% conf

Reporting transparency is high: methods are detailed, the trial is registered, a CONSORT diagram is provided, limitations are discussed, conclusions are proportional, and funding/COI are stated.

Evidence

“Clinical Trial registration: ChiCTR2300068786”

AbstractFind in source

“Fig. 1 CONSORT diagram. Study flow diagram.”

Figure 1Find in source

paraphrase[Acknowledgements and Competing interests]

“This study was funded by the National Key R&D Program of China (grant no. 2023YFC3305804)... The other authors declare no competing interests.”

Registered (1 ID: Chinese Clinical Trial Registry). Reporting guideline cited: CONSORT.

Broken references and links

1 finding · worst low

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

Checked 80 references by DOI: 0 verified — 1 DOI unresolved, 79 no DOI (shown, not verified).

4 data/code links checked; 4 live.

Copyediting

5 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 5 minor suggestions below.

5 copyedit issues flagged: mostly consistency, clarity, typo.

Kaimen Rigor Action ItemsFinal pass before journal submission

1.
HIGHethics
Add an explicit ethics approval statement in the Methods section, including the name of the IRB/ethics committee and the approval number, and describe informed consent procedures for participants and guardians.
The absence of an explicit ethics statement is a reporting gap that journals and readers expect; it is a fixable issue that should be addressed in a correction or clarification.
2.
HIGHreporting
Describe the randomization method (e.g., computer-generated random sequence, allocation concealment) in the Methods section.
The current text only states that participants were allocated, without specifying the method, which is a key CONSORT item.
3.
HIGHreporting
State whether outcome assessors or data analysts were blinded to group allocation, or provide a rationale for lack of blinding.
Blinding is not mentioned; for a behavioral intervention, participant blinding is infeasible, but assessor blinding should be clarified.
4.
HIGHstatistics
Report the a priori sample size calculation with effect size, alpha, and power in the Methods, or explicitly reference the protocol section where it is detailed.
The power analysis is only referenced via the protocol; including it in the main text improves transparency.
5.
HIGHstatistics
Explicitly state how outliers were handled in the statistical analysis.
Outlier handling is not reported, which is a common reviewer request and affects reproducibility.
6.
HIGHstatistics
Provide exact p-values for all comparisons instead of threshold values like '<0.001' where possible.
Exact p-values allow readers to assess the strength of evidence more precisely.
7.
HIGHstatistics
Add a statement on verification of statistical test assumptions (normality, homogeneity of variance) in the Methods.
Assumption checks are not reported; stating them (or noting robustness) strengthens the statistical analysis.
8.
HIGHreporting
Add a statement on regulatory compliance (e.g., Declaration of Helsinki) in the Methods or Ethics section.
Regulatory compliance is not explicitly stated, which is part of standard ethics reporting.
9.
HIGHother
Verify the reference 'Rtmdet: an empirical study of designing real-time object detectors' (DOI 10.1016/s2213-8587(22) — appears truncated) as it was not found in the registry; correct the DOI or remove the reference if it cannot be verified.
A reference that cannot be found in any registry may be fabricated or contain a DOI error; this is a potential integrity issue.
10.
MEDIUMreporting
Clarify the discrepancy between 240 enrolled and 227 analyzed participants in the abstract by referencing the CONSORT diagram or providing the exact number excluded.
The internal contradiction flagged by the integrity check could confuse readers; a clear explanation is needed.
11.
MEDIUMcopyedit
Fix the DOI in the Data availability section: 'OEP005446 (10.1109/TSMCB.2011.2170565)' appears to be an unrelated DOI; replace it with the correct accession URL or a proper DOI.
An incorrect DOI undermines the data availability statement and could mislead readers.
12.
MEDIUMcopyedit
Clarify the alpha level for the primary outcome in the Methods: the use of a two-tailed P < 0.025 is unusual and should be explained or justified.
The copyedit flagged this as unclear; readers may question the statistical threshold.
13.
MEDIUMcopyedit
Rephrase the mITT definition in Table 1 footnote to 'The modified intention-to-treat population included all participants with at least one post-baseline observation.'
The current wording 'at least one baseline observation' is non-standard and may be a typo.
14.
MEDIUMcopyedit
In the Abstract, add 'exploratory' to the claim about cognitive enhancements to avoid overstatement, e.g., 'REVERIE sports demonstrated superior cognitive enhancements compared to physical sports in exploratory analyses'.
The paper correctly labels these as exploratory, but the abstract could be clearer to prevent misinterpretation.
15.
MEDIUMcopyedit
Fix the missing article in the Abstract: 'REVERIE sports intervention was effective in reducing the primary outcome of fat mass'.
Minor grammatical issue that affects readability.

Full text (165,009 chars · analyzed ~45%, head + tail)Analyzed: Aug 15, 2026