Abstract

The objective was to ve rify the association between sexual maturation and physical activity during adolescence. A systematic review of articles published between 2008 and 2018 was conducted using the following databases: PubMed/Medline, SciELO, Web of Science, Scopus, Lilacs, and BVS Adolec Brasil. The following descriptors and keywords were used in English and Portuguese: adolescent, sexual maturation, survey, questionnaire, and physical activity. The literature search retrieved 806 articles. Twelve articles were included after applying the selection criteria. Level of physical activity was highest in the initial stage of sexual maturation. Levels of physical activity appear to decrease with advancing sexual maturation status. There is no consensus about the association between sexual maturation and physical activity levels among adolescents within the literature reviewed by this study. Further research is needed to investigate whether this relationship exists and professionals involved in healthcare for adolescents should take effective steps to combat physical inactivity.

Key words
Adolescent; Sexual maturation; Survey; Questionnaire; Physical activity

Introduction

A number of epidemiological studies have sought to measure levels of physical activity in the population and the main factors associated withnon-adherence to physical activity¹1 Mielke GI. Diferenças regionais e fatores associados à prática de atividade física no lazer no Brasil: resultados da Pesquisa Nacional de Saúde-2013. Rev Bras Epidemiol 2015; 18(2): 158-169.

2 Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW. Correlates of physical activity: why are some people physically active and others not? Lancet 2012; 21(6): 258-271.

3 Carvalho MD, Cezário A C, Moura LM, Neto OLS, Junior JBA . Construção da vigilância e prevenção das doenças crônicas não transmissíveis no contexto do Sistema Único de Saúde. Epidemiol Serv Saude 2006; 15(3): 47-65.

4 Alves CFA, Silva RCR, Assis AMO, Souza CO, Pinto EJ, Frainer DES. Factors associated with physical inactivity in adolescents aged 10-14 years, enrolled in the public school network of the city of Salvador, Brazil. Rev Bras Epidemiol 2012; 15(4): 858-870.

5 Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 38(1): 247-257.^-66 Ceschini FL, Miranda MLJ, Andrade EL, Oliveira LC, Araújo TL, Matsudo VR, Figueira Junior AJ. Nível de atividade física em adolescentes brasileiros determinado pelo Questionário Internacional de Atividade Física (IPAQ). R Bras Ci Mov 2016; 24(4): 199-212.. The World Health Organisation (WHO) recommends that adolescents should engage in 300 minutes of moderate - and vigorous - intensity aerobic physical activity per week in a combination of muscle-strengthening and flexibility activities⁷7 World Health Organization (WHO). Physical activity and young people. Geneva: WHO; 2010.^,88 Sociedade Brasileira de Pediatria. Promoção da Atividade Física na Infância e Adolescência. Manual de orientação para atividade física - Grupo de Trabalho em Atividade Física. nº 1, Julho de 2017.. This practice contributes to healthy growth and development and fosters the adoption of good life-style habits in adult life, helping to prevent chronic degenerative diseases⁹9 Chaves TO, Balassiano DH, Araujo CGS. Influência dos hábitos de exercício na infância e adolescência na flexibilidade de adultos sedentários. Rev Bras Med Esporte 2016; 22(4): 256-260..

Physical inactivityis associated with an increase in body fat and therefore a greater risk of heart disease and other health problems such as diabetes mellitus, high blood pressure, osteoporosis, and some types of cancer in later life¹⁰10 Francisco PMSB, Segri NS, Barros MBA, Malta DC. Sociodemographic inequalities in non-communicable chronic disease risk and protection factors: telephone survey in Campinas, São Paulo, Brazil. Epidemiol Serv Saude 2015; 24(1): 7-18.^,1111 Onis Mercedes de. Prevenção do sobrepeso e da obesidade infantis. J Pediatr 2015; 91(2): 105-107.. Obesity is a multifactorial disease that affects all age groups and is currently considered a global epidemic¹⁰10 Francisco PMSB, Segri NS, Barros MBA, Malta DC. Sociodemographic inequalities in non-communicable chronic disease risk and protection factors: telephone survey in Campinas, São Paulo, Brazil. Epidemiol Serv Saude 2015; 24(1): 7-18.

11 Onis Mercedes de. Prevenção do sobrepeso e da obesidade infantis. J Pediatr 2015; 91(2): 105-107.

12 World Health Organization (WHO). Obesity: preventing and managing the globalepidemic. Geneva: WHO; 2000. [cited 2021 Set 8]. Available from: www.who.int/dietphysicalactivity/childhood/en/
www.who.int/dietphysicalactivity/childho...

13 Silva Júnior LM. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr 2012; 30(2): 217-222.^-1414 Neto VG, Palma A. Blood pressure and its association with physical activity and obesity in adolescents: a systematic review. Cien Saude Colet 2014; 19(3): 797-818.. The prevalence of overweight and obesity is high among adolescents and evidence shows that excess body fat can adversely affect quality of life¹²12 World Health Organization (WHO). Obesity: preventing and managing the globalepidemic. Geneva: WHO; 2000. [cited 2021 Set 8]. Available from: www.who.int/dietphysicalactivity/childhood/en/
www.who.int/dietphysicalactivity/childho...

13 Silva Júnior LM. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr 2012; 30(2): 217-222.

14 Neto VG, Palma A. Blood pressure and its association with physical activity and obesity in adolescents: a systematic review. Cien Saude Colet 2014; 19(3): 797-818.^-1515 Castro JM, Ferreira EF, Silva DC, Oliveira RAR. Prevalência de sobrepeso e obesidade e os fatores de risco associados em adolescentes. Rev Bras Obes Nutr Emagr 2018; 12(69): 84-93.. Neto and collaborators stress that excess body fat mass intensifies insulin resistance, causes blood vessel disorder and stiffness, and adversely affects blood pressure levels¹⁴14 Neto VG, Palma A. Blood pressure and its association with physical activity and obesity in adolescents: a systematic review. Cien Saude Colet 2014; 19(3): 797-818.. Within this context, the leading risk factor for cardiovascular diseases among adolescents is excess body fat¹³13 Silva Júnior LM. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr 2012; 30(2): 217-222..

It is important to draw attention to the high rates of physical inactivity among adolescents⁴4 Alves CFA, Silva RCR, Assis AMO, Souza CO, Pinto EJ, Frainer DES. Factors associated with physical inactivity in adolescents aged 10-14 years, enrolled in the public school network of the city of Salvador, Brazil. Rev Bras Epidemiol 2012; 15(4): 858-870.

5 Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 38(1): 247-257.

6 Ceschini FL, Miranda MLJ, Andrade EL, Oliveira LC, Araújo TL, Matsudo VR, Figueira Junior AJ. Nível de atividade física em adolescentes brasileiros determinado pelo Questionário Internacional de Atividade Física (IPAQ). R Bras Ci Mov 2016; 24(4): 199-212.

7 World Health Organization (WHO). Physical activity and young people. Geneva: WHO; 2010.

8 Sociedade Brasileira de Pediatria. Promoção da Atividade Física na Infância e Adolescência. Manual de orientação para atividade física - Grupo de Trabalho em Atividade Física. nº 1, Julho de 2017.

9 Chaves TO, Balassiano DH, Araujo CGS. Influência dos hábitos de exercício na infância e adolescência na flexibilidade de adultos sedentários. Rev Bras Med Esporte 2016; 22(4): 256-260.

10 Francisco PMSB, Segri NS, Barros MBA, Malta DC. Sociodemographic inequalities in non-communicable chronic disease risk and protection factors: telephone survey in Campinas, São Paulo, Brazil. Epidemiol Serv Saude 2015; 24(1): 7-18.

11 Onis Mercedes de. Prevenção do sobrepeso e da obesidade infantis. J Pediatr 2015; 91(2): 105-107.

12 World Health Organization (WHO). Obesity: preventing and managing the globalepidemic. Geneva: WHO; 2000. [cited 2021 Set 8]. Available from: www.who.int/dietphysicalactivity/childhood/en/
www.who.int/dietphysicalactivity/childho...

13 Silva Júnior LM. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr 2012; 30(2): 217-222.

14 Neto VG, Palma A. Blood pressure and its association with physical activity and obesity in adolescents: a systematic review. Cien Saude Colet 2014; 19(3): 797-818.

15 Castro JM, Ferreira EF, Silva DC, Oliveira RAR. Prevalência de sobrepeso e obesidade e os fatores de risco associados em adolescentes. Rev Bras Obes Nutr Emagr 2018; 12(69): 84-93.^-1616 World Health Organization (WHO). Nutrition in adolescence: issues and challenges for the health sector. Geneva: WHO; 2006.. In this respect, the prevalence of the practice of physical inactivity varies widely in some studies⁵5 Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 38(1): 247-257.^-66 Ceschini FL, Miranda MLJ, Andrade EL, Oliveira LC, Araújo TL, Matsudo VR, Figueira Junior AJ. Nível de atividade física em adolescentes brasileiros determinado pelo Questionário Internacional de Atividade Física (IPAQ). R Bras Ci Mov 2016; 24(4): 199-212.

7 World Health Organization (WHO). Physical activity and young people. Geneva: WHO; 2010.

8 Sociedade Brasileira de Pediatria. Promoção da Atividade Física na Infância e Adolescência. Manual de orientação para atividade física - Grupo de Trabalho em Atividade Física. nº 1, Julho de 2017.

9 Chaves TO, Balassiano DH, Araujo CGS. Influência dos hábitos de exercício na infância e adolescência na flexibilidade de adultos sedentários. Rev Bras Med Esporte 2016; 22(4): 256-260.

10 Francisco PMSB, Segri NS, Barros MBA, Malta DC. Sociodemographic inequalities in non-communicable chronic disease risk and protection factors: telephone survey in Campinas, São Paulo, Brazil. Epidemiol Serv Saude 2015; 24(1): 7-18.

11 Onis Mercedes de. Prevenção do sobrepeso e da obesidade infantis. J Pediatr 2015; 91(2): 105-107.

12 World Health Organization (WHO). Obesity: preventing and managing the globalepidemic. Geneva: WHO; 2000. [cited 2021 Set 8]. Available from: www.who.int/dietphysicalactivity/childhood/en/
www.who.int/dietphysicalactivity/childho...

13 Silva Júnior LM. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr 2012; 30(2): 217-222.

14 Neto VG, Palma A. Blood pressure and its association with physical activity and obesity in adolescents: a systematic review. Cien Saude Colet 2014; 19(3): 797-818.

15 Castro JM, Ferreira EF, Silva DC, Oliveira RAR. Prevalência de sobrepeso e obesidade e os fatores de risco associados em adolescentes. Rev Bras Obes Nutr Emagr 2018; 12(69): 84-93.

16 World Health Organization (WHO). Nutrition in adolescence: issues and challenges for the health sector. Geneva: WHO; 2006.^-1717 Castilhos CB, Schneider BC, Muniz LC, Assunção MCF. Qualidade da dieta de jovens aos 18 anos de idade, pertencentes à coorte de nascimentos de 1993 da cidade de Pelotas (RS), Brasil. Cien Saude Colet 2015; 20(11): 3309-3318.. Studies have explored environmental, social, economic, nutritional, psychological, maturational factors in an attempt to understand the determinants of low levels of physical activityamong young people⁴4 Alves CFA, Silva RCR, Assis AMO, Souza CO, Pinto EJ, Frainer DES. Factors associated with physical inactivity in adolescents aged 10-14 years, enrolled in the public school network of the city of Salvador, Brazil. Rev Bras Epidemiol 2012; 15(4): 858-870.

5 Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 38(1): 247-257.

6 Ceschini FL, Miranda MLJ, Andrade EL, Oliveira LC, Araújo TL, Matsudo VR, Figueira Junior AJ. Nível de atividade física em adolescentes brasileiros determinado pelo Questionário Internacional de Atividade Física (IPAQ). R Bras Ci Mov 2016; 24(4): 199-212.

7 World Health Organization (WHO). Physical activity and young people. Geneva: WHO; 2010.

8 Sociedade Brasileira de Pediatria. Promoção da Atividade Física na Infância e Adolescência. Manual de orientação para atividade física - Grupo de Trabalho em Atividade Física. nº 1, Julho de 2017.

9 Chaves TO, Balassiano DH, Araujo CGS. Influência dos hábitos de exercício na infância e adolescência na flexibilidade de adultos sedentários. Rev Bras Med Esporte 2016; 22(4): 256-260.

10 Francisco PMSB, Segri NS, Barros MBA, Malta DC. Sociodemographic inequalities in non-communicable chronic disease risk and protection factors: telephone survey in Campinas, São Paulo, Brazil. Epidemiol Serv Saude 2015; 24(1): 7-18.

11 Onis Mercedes de. Prevenção do sobrepeso e da obesidade infantis. J Pediatr 2015; 91(2): 105-107.

12 World Health Organization (WHO). Obesity: preventing and managing the globalepidemic. Geneva: WHO; 2000. [cited 2021 Set 8]. Available from: www.who.int/dietphysicalactivity/childhood/en/
www.who.int/dietphysicalactivity/childho...

13 Silva Júnior LM. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr 2012; 30(2): 217-222.

14 Neto VG, Palma A. Blood pressure and its association with physical activity and obesity in adolescents: a systematic review. Cien Saude Colet 2014; 19(3): 797-818.

15 Castro JM, Ferreira EF, Silva DC, Oliveira RAR. Prevalência de sobrepeso e obesidade e os fatores de risco associados em adolescentes. Rev Bras Obes Nutr Emagr 2018; 12(69): 84-93.

16 World Health Organization (WHO). Nutrition in adolescence: issues and challenges for the health sector. Geneva: WHO; 2006.

17 Castilhos CB, Schneider BC, Muniz LC, Assunção MCF. Qualidade da dieta de jovens aos 18 anos de idade, pertencentes à coorte de nascimentos de 1993 da cidade de Pelotas (RS), Brasil. Cien Saude Colet 2015; 20(11): 3309-3318.^-1818 Silveira EF, Silva MC. Conhecimento sobre atividade física dos estudantes de uma cidade do sul do Brasil. Motriz Rev de Educ Fis 2011; 17(3): 456-467.. More specifically, some studies have focused on the association between biological maturation and level of physical activity¹⁹19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).

20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.

21 Machado DRL, Barbanti VJ, Borges GA, Januário JA, Puggina EF, Tourinho Filho H. Fidedignidade do questionário puberal simplificado de Cameron. R Bras Ci Mov 2012; 20(2): 43-51.^-2222 Silva SP, Freitas DL, Beunen GP, Maia JAR. The relevance of training in the TW3 method for the evaluation of biological maturation. Rev Bras Cineantropom Desempenho Hum 2010; 12(5): 352-358..

In this respect, evidence suggests that practice of physical activity is more related to biological age than chronological age. Adolescents in the same age group may beat different stages of pubertal development and show different levels of physical activity. Sexual maturation may therefore be a key factor influencing practice of physical activity during adolescence²⁰20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.

21 Machado DRL, Barbanti VJ, Borges GA, Januário JA, Puggina EF, Tourinho Filho H. Fidedignidade do questionário puberal simplificado de Cameron. R Bras Ci Mov 2012; 20(2): 43-51.

22 Silva SP, Freitas DL, Beunen GP, Maia JAR. The relevance of training in the TW3 method for the evaluation of biological maturation. Rev Bras Cineantropom Desempenho Hum 2010; 12(5): 352-358.^-2323 Bacil EDA, Júnior OM, Rechb CR, Legnani RFS, Campos W. Atividade física e maturação biológica: uma revisão sistemática. Rev Paul Pediatr 2015; 33(1): 114-121.^-2424 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.. However, the evidence on this association remains inconclusive²⁵25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.^-2626 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379..

In view of the above, the objective of this study was to investigate and assess the association between sexual maturation and level of physical activity in the current literature on this topic using the following review question: Is there an association between sexual maturation and level of physical activity among adolescents? By gaining a better understanding of this association it is hoped that this study will contribute to the development of new outcome indicators to guide healthy practices and health policies and interventions aimed at promoting adolescent health.

Methods

A systematic literature review was conducted using electronic databases to identify publications that specify the association between sexual maturation and level of physical activity among adolescents. The review encompassed international and national studies that answered the review question, regardless of sex of the study sample. A search of articles published between 2008 and 2018 was undertaken by three independent researchers.

The following bibliographic databases were used: PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), SciELO (Scientific Electronic Library Online), Web of Science, Scopus, LILACS (Latin American and Caribbean Literature on Health Sciences); and BVS Adolec Brasil (Virtual Adolescent Health Library). The following descriptors and keywords were used in Portuguese and English with the Boolean operators or and and: adolescente (adolescent) and maturação sexual(sexual maturation) and inquérito (survey) and questionnaire (questionnaire) and atividade física (physical activity), using the PECO (Population, Exposure, Comparator, and Outcomes) approach²⁷27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511..The term exercício físico (physical exercise) was also used as an analogue for atividade física (physical activity).

The following inclusion criteria were used: epidemiological studies (cross-sectional, case-control, cohort, and clinical trials) and articles examining the relationship between maturation and level of physical activity among adolescents of both sexes published between 2008 and 2018. Case studies, literature reviews, research reports, technical reports, projects, government documents, grey literature, and studies involving animals were excluded.

The following combinations of MeSH (Medical Subject Headings) descriptors and keywords were used in English: physical activity OR physical exercise AND sexual maturation AND surveysand questionnaires AND adolescent; physical activity OR physical exercise AND sexual maturation AND adolescent.The following combinations of DeCS Science and Health Descriptors descriptors and keywords were used in Portuguese: atividade física OR exercício físico AND maturação sexual AND inquérito e questionnaire AND adolescente; atividade física OR exercício físico AND maturação sexual AND adolescente.

The data was collected on 12 July 2018. After the initial search, a filter was applied to the retrieved articles restricting the search to articles published in all languages in the last 10 years (January 2008 to July 2018) involving the 10 to 19 year age group.

Each of the articles retrieved after applying the filter was screened by title and abstract against the inclusion and exclusion criteria and review question and duplicate articles were removed. The review process (identification, screening, eligibility, and inclusion of retrievedarticles) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) protocol²⁸28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342..

Article selection and assessment was performed autonomously by three researchers (CG Campos, FM Carlos, LA Muniz). The full versions of the selected articles were then assessed against the inclusion criteria. Any discrepancies between the three researchers were resolved by group discussion in order to reach consensus based on the inclusion and exclusion. The strength of scientific evidence of each study was graded based on the categories developed by the Agency for Healthcare Research and Quality (AHRQ)²⁹29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov... .

Results

The initial literature search retrieved 806 records, 51 of which were selected after applying the filter andscreening. The reading of the full version of the selected articles resulted in a final selection of 12 articles (Figure 1).

The samples of the selected studies, all of which were international, totaled 13,120 individuals. Six of the studies (50%) were cross-sectional and six were (50%) longitudinal. Chart 1 presents key information on the selected 12 articles.

With regard to age group, the selected studies encompassed the three stages of adolescence: early adolescence (ages 10 and 13), middle adolescence (ages 14 and 16 years), and late adolescence (ages 17 and 20)²⁹29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov... . The large majority of the studies (91,7%; n = 11) focused on early adolescence²⁰20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.^,3030 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.^,2424 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.^,3131 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.^,3838 Kristensen PL, Korsholm L, Moller NC, Wedderkopp N, Andersen LB, Froberg K. Sources of variation in habitual physical activity of children and adolescents: the European youth heart study. Scand J Med Sci Sports 2008; 18(3):298-308.. None of the studies evaluated the period as a whole, as defined by the WHO³⁹39 Campos CG, Muniz LA, Belo VS, Romano MCC, Lima MC. Conhecimento de adolescentes acerca dos benefícios do exercício físico para a saúde mental. Cien Saude Colet 2019; 24(8): 2951-2958..

Five studies identified an inverse association between sexual maturation and physical activity²⁰20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.

21 Machado DRL, Barbanti VJ, Borges GA, Januário JA, Puggina EF, Tourinho Filho H. Fidedignidade do questionário puberal simplificado de Cameron. R Bras Ci Mov 2012; 20(2): 43-51.

22 Silva SP, Freitas DL, Beunen GP, Maia JAR. The relevance of training in the TW3 method for the evaluation of biological maturation. Rev Bras Cineantropom Desempenho Hum 2010; 12(5): 352-358.

23 Bacil EDA, Júnior OM, Rechb CR, Legnani RFS, Campos W. Atividade física e maturação biológica: uma revisão sistemática. Rev Paul Pediatr 2015; 33(1): 114-121.

24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.

25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.

26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.

27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511.

28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342.

29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov... ^-3030 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.^-3131 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.

32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.

33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.^-3434 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.^-3535 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119., while two reported a direct association, showing that more mature girls and boys and those in more advanced stages of sexual maturation tended to be more physically active²⁴24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.

25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.

26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.

27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511.

28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342.

29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov...

30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.

31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.

32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.^-3333 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.. Three studies found that changes inphysical activity are more influenced by sex than maturation¹⁹19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).^,3232 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.^,3737 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485.. Knowles and collaborators showed that a decrease in overall physical activity levels was not influenced by maturational status³⁶36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.. Kristensen and collaborators also reported that maturity was not related to physical activity³⁸38 Kristensen PL, Korsholm L, Moller NC, Wedderkopp N, Andersen LB, Froberg K. Sources of variation in habitual physical activity of children and adolescents: the European youth heart study. Scand J Med Sci Sports 2008; 18(3):298-308..

The studies used various instruments to assess maturational status, including: the Tannerscale (self-assessment)³⁵35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.; percentage of predicted adult stature (the Khamis-Roche method), used to predict mature height from current age¹⁹19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).^,4040 Khamis HJ, Roche AF. Predicting Adult Stature without Using Skeletal Age the Khamis-Roche Method. Pediatrics 1994; 94(4): 504-507.; and the pubertal development scale²⁰20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.^,2424 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.^,3232 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.^,3636 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.. Questions were also asked to determine age at menarche (the status quo method)³⁰30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.⁾ and somatic biological maturity status³¹31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844..

The following instruments were used to measure physical activity: Physical Activity Questionnaire for Adolescents (PAQ-A)¹⁹19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).

20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.

21 Machado DRL, Barbanti VJ, Borges GA, Januário JA, Puggina EF, Tourinho Filho H. Fidedignidade do questionário puberal simplificado de Cameron. R Bras Ci Mov 2012; 20(2): 43-51.

22 Silva SP, Freitas DL, Beunen GP, Maia JAR. The relevance of training in the TW3 method for the evaluation of biological maturation. Rev Bras Cineantropom Desempenho Hum 2010; 12(5): 352-358.

23 Bacil EDA, Júnior OM, Rechb CR, Legnani RFS, Campos W. Atividade física e maturação biológica: uma revisão sistemática. Rev Paul Pediatr 2015; 33(1): 114-121.

24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.

25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.

26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.

27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511.

28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342.

29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov...

30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.

31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.

32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.

33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.

34 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.

35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.

36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.

37 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485.

38 Kristensen PL, Korsholm L, Moller NC, Wedderkopp N, Andersen LB, Froberg K. Sources of variation in habitual physical activity of children and adolescents: the European youth heart study. Scand J Med Sci Sports 2008; 18(3):298-308.

39 Campos CG, Muniz LA, Belo VS, Romano MCC, Lima MC. Conhecimento de adolescentes acerca dos benefícios do exercício físico para a saúde mental. Cien Saude Colet 2019; 24(8): 2951-2958.

40 Khamis HJ, Roche AF. Predicting Adult Stature without Using Skeletal Age the Khamis-Roche Method. Pediatrics 1994; 94(4): 504-507.^-4141 Crocker PRE, Bailey DA, Faulkner RA, Kowalski KC, Mcgrath R. Measuring general levels of physical activity: Preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sport Exer 1997; 29(10): 1344-1349.; Physical Activity Questionnaire for Older Children (PAQ-C)²⁰20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.

21 Machado DRL, Barbanti VJ, Borges GA, Januário JA, Puggina EF, Tourinho Filho H. Fidedignidade do questionário puberal simplificado de Cameron. R Bras Ci Mov 2012; 20(2): 43-51.

22 Silva SP, Freitas DL, Beunen GP, Maia JAR. The relevance of training in the TW3 method for the evaluation of biological maturation. Rev Bras Cineantropom Desempenho Hum 2010; 12(5): 352-358.

23 Bacil EDA, Júnior OM, Rechb CR, Legnani RFS, Campos W. Atividade física e maturação biológica: uma revisão sistemática. Rev Paul Pediatr 2015; 33(1): 114-121.

24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.

25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.

26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.

27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511.

28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342.

29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov...

30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.

31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.

32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.

33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.

34 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.

35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.

36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.

37 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485.

38 Kristensen PL, Korsholm L, Moller NC, Wedderkopp N, Andersen LB, Froberg K. Sources of variation in habitual physical activity of children and adolescents: the European youth heart study. Scand J Med Sci Sports 2008; 18(3):298-308.

39 Campos CG, Muniz LA, Belo VS, Romano MCC, Lima MC. Conhecimento de adolescentes acerca dos benefícios do exercício físico para a saúde mental. Cien Saude Colet 2019; 24(8): 2951-2958.

40 Khamis HJ, Roche AF. Predicting Adult Stature without Using Skeletal Age the Khamis-Roche Method. Pediatrics 1994; 94(4): 504-507.

41 Crocker PRE, Bailey DA, Faulkner RA, Kowalski KC, Mcgrath R. Measuring general levels of physical activity: Preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sport Exer 1997; 29(10): 1344-1349.^-4242 Lee JG, Spence JC, Jeon J. Developing a Korean version of the physical activity questionnaire for older children. Int J Human Movement Sci 2010; 3(2): 61-74.; accelerometer³¹31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.

32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.^-3333 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.

34 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.

35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.

36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.

37 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485.^-3838 Kristensen PL, Korsholm L, Moller NC, Wedderkopp N, Andersen LB, Froberg K. Sources of variation in habitual physical activity of children and adolescents: the European youth heart study. Scand J Med Sci Sports 2008; 18(3):298-308.; questionnaires³²32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.

33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.^-3434 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.^-3535 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.

36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.^-3737 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485.; Seven-Day Physical Activity Recall³⁰30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.; and Physical Activity Questionnaire for Children²⁴24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.

25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.

26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.

27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511.

28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342.

29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov...

30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.

31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.

32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.

33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.

34 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.

35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.^-3636 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566..

A wide range of tools and parameters were used to assess biological maturation and physical activity and various types of statistical analysis were performed to determine the association of interest.

Discussion

The findings show that there is no consensus about the association between sexual maturation and level of physical activity within the reviewed literature.

Benítez-Porres and collaborators found no evidence of an association between sexual maturation and level of physical activity. However, they found a statistically significant association between physical activity and sex (p<0,05), showing that boys were more physically active than girls¹⁹19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).. Most of the studies that compared sexes showed that boys were more physically active than girls; however, the factors related to this difference are not well described in the reviewed literature¹⁹19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).

20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.

21 Machado DRL, Barbanti VJ, Borges GA, Januário JA, Puggina EF, Tourinho Filho H. Fidedignidade do questionário puberal simplificado de Cameron. R Bras Ci Mov 2012; 20(2): 43-51.

22 Silva SP, Freitas DL, Beunen GP, Maia JAR. The relevance of training in the TW3 method for the evaluation of biological maturation. Rev Bras Cineantropom Desempenho Hum 2010; 12(5): 352-358.

23 Bacil EDA, Júnior OM, Rechb CR, Legnani RFS, Campos W. Atividade física e maturação biológica: uma revisão sistemática. Rev Paul Pediatr 2015; 33(1): 114-121.

24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.

25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.

26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.

27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511.

28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342.

29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
http://www.qualityindicators.ahrq.gov...

30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.^-3131 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.^-3232 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.

33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.

34 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.

35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.

36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.^-3737 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485..

Finne and collaborators concluded that early maturing boys, and girls with irregular menstruation, were more likely to be inactivein comparison to their peers (OR = 2,20, CI 95% = 1,36-3,56 and OR = 1,71, CI 95% = 1,06-2,75, respectively)³⁵35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119., while a longitudinal study demonstrated that a decrease in overall physical activity levels over 12 months was not influenced by maturational status³⁶36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.. Likewise, Kristensen and collaborators found no link between maturational status and physical activity³⁸38 Kristensen PL, Korsholm L, Moller NC, Wedderkopp N, Andersen LB, Froberg K. Sources of variation in habitual physical activity of children and adolescents: the European youth heart study. Scand J Med Sci Sports 2008; 18(3):298-308..

In a study with South Korean adolescents, Lee Eun-Young and collaborators found an inverse relationship between biological maturity and physical activity, showing that individuals with advanced pubertal status were less physically active (p <0,001)²⁰20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.. Another study comparing practice of physical activity and sedentary behaviorin 1,324 pre and post menarche girls showed that pre menarche girls practiced physical activity more regularly than post menarche girls (3,5 ± 1,9 times/week compared to 3,0 ± 1,7 times/week, p < 0,001). This difference was statistically significant. However, this study found no evidence of a significant difference in time spent per week doing physical activity between the two groups³⁰30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475..

Guinhouya and collaborators measured biological maturityusing the Prediction of Age of Peak Height Velocity method, observing a correlation between total time spent doing physical activity and maturation in girls. The study showed a significant increase in level of physical activity among preadolescent girls up to the predicted age at peak height velocity (p = 0,028). However, the same study found a pronounced decrease in level of physical activity after children reached the age at peak height velocity, demonstrating that late-maturing adolescents showed low levels of physical activity (p = 0,06)³¹31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844..

The same authors also found a statistically significant correlation between time spent doing moderate-to-vigorous physical activity and predicted age at peak height velocity standardized by sex (p = 0,016 inboysand p = 0,155 ingirls). With regard to overall physical activity (light, moderate, and vigorous), boys were significantly more active than girls (p < 0,0001)³¹31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.. In this respect, a study conducted by Cairney and collaborators showed that participation in physical activity began to decline after age 12 in both sexes and that the rate of decline was greater in girls than in boys³²32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735..

Davison and collaborators investigated the relation between sexual maturation and physical activityin 178 adolescents in the United States using three measure of pubertal development: the Pubertal Development Scale, Tanner’s criteria, and estradiol levels. The study concluded that early maturing girls were less physically active²⁵25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.. The inverse was shown by a school-based study with 4,320 adolescents conducted by Simon and collaborators. Using the Pubertal Development Scaleand a physical activity questionnaire, the authors concluded that advanced puberty was associated with higher levels of physical activity²⁶26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379..

Regular practice of physical activity appears to decline with increasing age in both sexes. With increasing age adolescents are more likely to reduce daily energy expenditure from physical activity. School work, work, access to technology, and the increasing lack of security in cities, are the main social and behavioral factors that lead to inactive life styles. Similarly, the lack of open public spaces for physical activity and the fact that most of these spaces are devoted to children and early teens contribute to low levels of physical activity in middle and late adolescents⁹9 Chaves TO, Balassiano DH, Araujo CGS. Influência dos hábitos de exercício na infância e adolescência na flexibilidade de adultos sedentários. Rev Bras Med Esporte 2016; 22(4): 256-260.

10 Francisco PMSB, Segri NS, Barros MBA, Malta DC. Sociodemographic inequalities in non-communicable chronic disease risk and protection factors: telephone survey in Campinas, São Paulo, Brazil. Epidemiol Serv Saude 2015; 24(1): 7-18.

11 Onis Mercedes de. Prevenção do sobrepeso e da obesidade infantis. J Pediatr 2015; 91(2): 105-107.

12 World Health Organization (WHO). Obesity: preventing and managing the globalepidemic. Geneva: WHO; 2000. [cited 2021 Set 8]. Available from: www.who.int/dietphysicalactivity/childhood/en/
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13 Silva Júnior LM. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr 2012; 30(2): 217-222.

14 Neto VG, Palma A. Blood pressure and its association with physical activity and obesity in adolescents: a systematic review. Cien Saude Colet 2014; 19(3): 797-818.

15 Castro JM, Ferreira EF, Silva DC, Oliveira RAR. Prevalência de sobrepeso e obesidade e os fatores de risco associados em adolescentes. Rev Bras Obes Nutr Emagr 2018; 12(69): 84-93.

16 World Health Organization (WHO). Nutrition in adolescence: issues and challenges for the health sector. Geneva: WHO; 2006.

17 Castilhos CB, Schneider BC, Muniz LC, Assunção MCF. Qualidade da dieta de jovens aos 18 anos de idade, pertencentes à coorte de nascimentos de 1993 da cidade de Pelotas (RS), Brasil. Cien Saude Colet 2015; 20(11): 3309-3318.

18 Silveira EF, Silva MC. Conhecimento sobre atividade física dos estudantes de uma cidade do sul do Brasil. Motriz Rev de Educ Fis 2011; 17(3): 456-467.

19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).

20 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.

21 Machado DRL, Barbanti VJ, Borges GA, Januário JA, Puggina EF, Tourinho Filho H. Fidedignidade do questionário puberal simplificado de Cameron. R Bras Ci Mov 2012; 20(2): 43-51.

22 Silva SP, Freitas DL, Beunen GP, Maia JAR. The relevance of training in the TW3 method for the evaluation of biological maturation. Rev Bras Cineantropom Desempenho Hum 2010; 12(5): 352-358.

23 Bacil EDA, Júnior OM, Rechb CR, Legnani RFS, Campos W. Atividade física e maturação biológica: uma revisão sistemática. Rev Paul Pediatr 2015; 33(1): 114-121.

24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.

25 Davison KK, Werder JL, Trost SG, Baker BL, Birch LL. Why are early maturing girls test active? Links between pubertal develooment, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med 2007; 64(2): 391-404.

26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.

27 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enferm 2007; 15(3): 508-511.

28 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2): 335-342.

29 Agency for Health Care Research and Quality (AHRQ). Quality indicators [cited 2020 Sept 8]. Available from: http://www.qualityindicators.ahrq.gov
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30 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.

31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.

32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.

33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.

34 Erlandson MC, Sherar LB, Mosewich AD, Kowalski KC, Bailey DA, Baxter-Jones AD. Does controlling for biological maturity improve physical activity tracking? Med Sci Sports Exerc 2011; 43(5): 800-807.

35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.

36 Knowles AM, Niven AG, Fawkner SG, Henretty JM. A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls. J Adolesc 2009; 32(3): 555-566.^-3737 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485..

Furthermore, early adolescents tend to have more time to practice physical activity, since they spend less time doing school work and working. Likewise, degree of family dependence / independence can also influence levels of physical activity during the different stages of adolescence as younger adolescents tend to be more influenced by their parents. Adolescents are therefore more likely to practice more physical activity in their younger teens, showing a decline in levels of physical activity as they become more independent⁴4 Alves CFA, Silva RCR, Assis AMO, Souza CO, Pinto EJ, Frainer DES. Factors associated with physical inactivity in adolescents aged 10-14 years, enrolled in the public school network of the city of Salvador, Brazil. Rev Bras Epidemiol 2012; 15(4): 858-870.^,99 Chaves TO, Balassiano DH, Araujo CGS. Influência dos hábitos de exercício na infância e adolescência na flexibilidade de adultos sedentários. Rev Bras Med Esporte 2016; 22(4): 256-260.^,3737 Cumming SP, Standage M, Gillison F, Malina RM. Sex differences in exercise behavior during adolescence: is biological maturation a confounding factor? J Adolesc Health 2008; 42(5): 480-485..

However, alongitudinal study that assessed girls at baseline, six months and 18 monthsfound statistically significant differences in physical activity between maturity groups, showing that early maturers were morephysically active²⁴24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.. Similarly, Kemper and collaborators and Simon and collaborators suggest that early maturers are more physically active and that levels of physical activity were in line with international recommendations²⁶26 Simon AE, Wardle J, Jarvis MJ, Steggles N, Cartwright M. Examining the relationship between pubertal stage, adolescent health behavicurs and stress. Psychol Med 2003; 33(1): 369-379.^,4343 Kemper HC, Post GB, Twisk JW. Rate of maturation during the teenage years: nutrient intake and physical activity between ages 12 and 22. Int J Sport Nutr 1997; 7(2):29-40.37.. Lätt and collaborators also investigated differences in levels of physical activity between early, average, and late maturing boys, showing that average and late maturing boys practiced more physical activity than early maturing boys³³33 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670..

The most widely used instruments for measuring physical activitywerequestionnaires, accelerometers, andpedometers¹⁹19 Benítez-Porres J, Alvero-Cruz JR, Albornoz MC, Correas-Gómez L, Barrera-Expósito J, Dorado-Guzmán M, Moore JB, Carnero EA. The Influence of 2-Year Changes in Physical Activity, Maturation, and Nutrition on Adiposity in Adolescent Youth. PLoS One 2016; 11(9).^,2020 Lee Ey ANK, Jeon JY, Rodgers WM, Harber VJ, Spence JC. Biological Maturation and Physical Activity in South Korean Adolescent Girls. Med Sci Sports Exerc 2016; 48(12):2454-2461.^,2424 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.^,3030 Marques A, Branquinho C, De Matos MG. Girls' physical activity and sedentary behaviors: Does sexual maturation matter? A cross-sectional study with HBSC 2010 Portuguese survey. Am J Hum Biol 2016; 28(4): 471-475.

31 Guinhouya BC, Fairclough SJ, Zitouni D, Samouda H, Vilhelm C, Zgaya h, Beaufort C, Lemdani M, Hubert H. Does biological maturity actually confound gender-related differences in physical activity in preadolescence? Child: care. Health Dev 2012; 39(6): 835-844.^-3232 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.. Guedes and collaborators suggest that the best methods for assessing physical activity and energy expenditure arelaboratory parameters, including doubly labeled water and calorimetry. The latter measures produce high quality results and good classification accuracy. However, these procedures are costly, require trained professionals and well-equipped laboratories, and do not differentiate between physical activity intensity, duration, and frequency⁴⁴44 Guedes DP, Guedes JERP. Measuring physical activity in brazilian youth: reproducibility and validity of the paq-c and paq-a. Rev Bras Med Esporte 2015; 21(6)..

Accelerometers and pedometers have been satisfactorily used in epidemiological studies with adolescents and school children, since the motion sensors can detect practice and levels ofphysical activity. However, their use is infeasible in studies with large samples⁴⁴44 Guedes DP, Guedes JERP. Measuring physical activity in brazilian youth: reproducibility and validity of the paq-c and paq-a. Rev Bras Med Esporte 2015; 21(6).^,4545 Barbosa SC, ColedamDHC, Neto AS, Elias RGM, Neto RO. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr 2016; 34(3): 301-308.. Questionnaires are therefore the most commonly used instruments in national studies. Despite their limitations and issues relating to subjectivity and underestimation / overestimation, questionnaires are key tools because they are relatively inexpensive, easy to use with large samples, require little training to administer, and offer a way to gather large amounts of data which can be used to in formpolicy making⁴⁶46 Bacil EDA, Piola TS, Watanabe PI, Silva MP, Legnani RFS, Santos RF, Campos W. Reproducibility of a questionnaire on physical activity among school students from 9 to 15 years of age. Cien Saude Col 2018;23(11): 3.841-3.848.^,4747 Guedes DP, Lopes CC, Guedes JERP. Reprodutibilidade e validade do questionário internacional de atividade física em adolescentes. Rev Bras Med Esporte 2005; 11(2): 151-158..

The studies high lighted gender-related differences in levels of physical activity. This may be due differences in physical development between sexes, whereby girls tend to develop earlier than boys³²32 Cairney J, Veldhuizen S, Kwan M, Hay J, Faught BE. Biological age and sex-related declines in physical activity during adolescence. Med Sci Sports Exerc 2014; 46(4):730-735.^,4848 Thompson AM, Baxter-Jones AD, Mirwald RL, Bailey DA. Comparison of physical activity in male and female children: does maturation matter? Med Sci Sports Exerc 2003; 35(10): 1684-1690.. Public health interventions aimed at adolescents should there forefocus on biological age and sex rather than chronological age⁴⁹49 Sherar LB, Esliger DW, Baxter-Jones AD, Tremblay MS. Age andgender differences in youth physical activity: does physical maturity matter? Med Sci Sports Exerc 2007; 39(5): 830-835..

The use of a wide range of instruments to measure physical activity and maturational status hinders possible comparisons, inferences, and conclusions regarding international and national recommendations⁵⁰50 Campos MC, Felicidade CA, Aguiar SC, Vieira DSR. Psychometric properties of physical activity questionnaires in adolescence: systematic review. Rev Bras Ativ Fis Saude 2018;23(4): e0045.

51 Instituto Brasileira de Geografia e Estatítica (IBGE). Pesquisa nacional de saúde do escolar: 2015. Coordenação de População e Indicadores Sociais. Rio de Janeiro: IBGE; 2016. 132 p.^-5252 Macêdo MM, Linhares RV, Filho JF. Equations for determining bone age and sexual maturation of children and adolescents. Rev Salud Publica 2015;17(2): 267-276..

In addition, only one study adopted Tanner’s criteria³⁵35 Finne E, Bucksch J, Lampert T, Kolip P. Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS). Int J Behav Nutr Phys Act 2011; 8: 119.. Tanner defined stages of the maturation process based on external primary and secondary sex characteristics, such as the development of pubic hair, genitals, and breasts.The classification can be assessed clinically by qualified health professionals or self-assessed, the latter being the most commonly used alternative in population studies⁵³53 Faria ER, Franceschini SCC, Peluzio MCG, Sant’Ana LFR, Priore SE.Aspectos metodológicos e éticos da avaliação da maturação sexual de adolescentes. Rev Paul Pediatr 2013; 31(3): 398-405..

The Tanner scale is widely used in the field of adolescent health in Brazil, is made available in the Handbook of Adolescent Health, and recommended by the Ministry of Health for assessing sexual maturation⁵³53 Faria ER, Franceschini SCC, Peluzio MCG, Sant’Ana LFR, Priore SE.Aspectos metodológicos e éticos da avaliação da maturação sexual de adolescentes. Rev Paul Pediatr 2013; 31(3): 398-405.^-5454 Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas. Estratégicas. Área Técnica de Saúde de Adolescente. Caderneta de saúde do adolescente, 2ª edição, 1ª reimpressão. Brasília; 2012.. Numerous factors influence the way adolescents understand their adolescence and how it affects their choices about being physically active⁵⁵55 Kantomaa MT, Stamatakis E, Kankaanpää A, Kajantie E, Taanila A, Tammelin T. Associations of Physical Activity and Sedentary Behavior With Adolescent Academic Achievement. J Research Adolesc 2015; 26 (3): 432-442.. Engagement in regular physical activity is therefore influenced by a combination of biological, social, psychological, and environmental factors and characterized by a complex behavioral phenotype. This behavioral model is sufficiently dynamic to interact physiologically with sexual and biological maturational development, leading to an increase in physical inactivity during adolescence⁵⁶56 Malina RM. Biocultural factors in developing physical activity levels. In: Youth Physical Activity and Inactivity. Smith AL, Biddle SJH, editor. Champaign, IL: Human Kinetics, 2008..

Decreased physical activity during sexual maturation can be observed in all mammals. This phenomenon may be related to little-understood changes in the underlying endocrine processes that modulate adolescent growth and sexual maturation. Maturation of the hypothalamic-pituitary-gonadal axis mediates the release of hormones. Subsequent neural reorganization and changes in maturity status and in the body may influence physical activity⁵⁷57 Sherar LB, Cumming SP, Eisenmann JC, Baxter-Jones AD, Malina RM. Adolescent biological maturity and physical activity: biology meets behavior. Pediatr Exerc Sci 2010; 22(3): 332-349..

Another study puts forward a hypothesis for understanding the determinants of levels of physical activity, suggesting the existence of an inherent control / regulatory center for physical activity or energy expenditure by the central nervous system. Based on this thesis, decreased physical activity during adolescence may be related to stages of development, when the body requires additional energy to fuel growth, implying that the metabolism uses a tactical energy rationing mechanism. However, further research is needed to investigate this condition in adolescents⁵⁷57 Sherar LB, Cumming SP, Eisenmann JC, Baxter-Jones AD, Malina RM. Adolescent biological maturity and physical activity: biology meets behavior. Pediatr Exerc Sci 2010; 22(3): 332-349.

58 Rowland TW. The biological basis of physical activity. Med Sci Sports Exerc 1998; 30: 392-399.^-5959 Rowland TW. Biologic regulation of physical activity. New Zealand: Human Kinetics; 2017..

It is also important to mention that major changes take place in the brain during adolescence. Neurochemical and neurotransmitter changes can induce feelings of insecurity, fear, curiosity, and excitation, mood changes, an inability to perceive risks, impulsiveness, and the seeking of new experiences⁶⁰60 Giedd N. Maturação do cérebro adolescente. Enciclopédia sobre o Desenvolvimento na Primeira Infância. 2013; p. 1-5.^-6161 Soares HLR, Gonçalves HCB, Werner JJ. Cérebro e o uso de drogas na infância e adolescência. Rev Psicol 2010; 22(3): 639-640.. In addition, analytical understanding and reflective behavior skills only fully develop towards the end of adolescence and challenging behaviors and risk-taking tend to diminish in the post pubertal phase. Within this context, certain studies suggest physical activity is greater in the final phase of adolescence, when neurophysiological and psychological conditions are fully developed and adolescents are better prepared to take care of their body and their physical health²⁴24 Fawkner S, Henretty J, Knowles AM, Nevill A, Niven A. The influence of maturation, body size and physical self-perceptions on longitudinal changes in physical activity in adolescent girls. J Sports Sciences 2014; 32(4): 392-401.^,3333 Lätt E, Mäestu J, Rääsk T, Purge P, Jürimäe T, Jürimäe J. Maturity-related differences in moderate, vigorous, and moderate-to-vigorous physical activity in 10-14-year-old boys. Percept Mot Skills 2015; 120(2): 659-670.^,6262 Johnson SB, Blum RW, Giedd JN. Adolescent Maturity and the Brain: the promise and pitfalls of neuroscience research in adolescent health policy. J Adoles Health 2009; 45(3): 216-221.^,6363 Barbosa PV, Wagner A. A autonomia na adolescência: revisando conceitos, modelos e variáveis. Est Psicol 2013; 18(4): 639-648..

Dopamine is a neurotransmitter that is capable of altering normal motor activity. The number of dopamine receptors decreases during adolescence, suggesting a decline in daily physical activity in this phase. Similarly, changes occur in the reward and motivation system of the adolescent’s brain. Activities that in childhood provided pleasure become boring during adolescence, leading the adolescent to seek new behaviors, rewards, and experiences, and therefore require greater stimulus to achieve the levels of pleasure experienced in the prepubertal phase⁶⁰60 Giedd N. Maturação do cérebro adolescente. Enciclopédia sobre o Desenvolvimento na Primeira Infância. 2013; p. 1-5.

61 Soares HLR, Gonçalves HCB, Werner JJ. Cérebro e o uso de drogas na infância e adolescência. Rev Psicol 2010; 22(3): 639-640.

62 Johnson SB, Blum RW, Giedd JN. Adolescent Maturity and the Brain: the promise and pitfalls of neuroscience research in adolescent health policy. J Adoles Health 2009; 45(3): 216-221.

63 Barbosa PV, Wagner A. A autonomia na adolescência: revisando conceitos, modelos e variáveis. Est Psicol 2013; 18(4): 639-648.^-6464 Arain M, Haque M, Johal L, Mathur P, Nel W, Rais A, Sandhu R, Sharma S. Maturation of the adolescent brain. Neuropsyc dis treat 2013; 9 (nº padrão): 449-461..

One of the limitations of this study is the dearth of articles on this topic. The absence of national studies, lack of unification of protocols, criteria, and standardized instruments for measuring sexual maturation and level of physical activityin the selected studies, and the varying concepts of adolescence in the literature, are factors that hinder the formation of a consensus regarding the association between sexual maturation and physical activity. Further research is therefore needed to gain a deeper understanding of this association.

Conclusion

The findings show that there is no consensus about the association between sexual maturation and physical activity with in the current literature and further research is there fore required to investigate possible associations. New knowledge in this area is important to enable professionals involved in healthcare for adolescents to take effective steps to tackle physical inactivity.

Acknowledgements

This study was supported by the Coordination of Improvement of Higher Education Personnel (CAPES).

We are also grateful to the Post-graduate Program in Health Sciences at the Federal University of São João del-Rei.

References

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