Use of Wearable Technology for Measuring and Characterizing Sedentary Behavior in People With Mild Cognitive Impairment and Dementia: Systematic Review

Clinical Snapshot

Key Findings

• P Value: Not pooled; individual study-level statistics not synthesised

• Effect Size: No pooled effect size calculable; narrative synthesis only. Qualitative consistency observed for SB bout pattern differences in dementia across multiple studies.

• Primary Outcome: Individuals with dementia consistently exhibited a unique sedentary behavior pattern characterised by significantly fewer but longer sedentary bouts compared to individuals with MCI and cognitively healthy controls. Evidence for differences in total sedentary behavior volume across cognitive impairment groups was inconsistent across studies.

• Nnt Or Sensitivity: Not applicable for this observational systematic review; no diagnostic accuracy or therapeutic NNT calculable. Key methodological finding: 100% of studies reported SB volume metrics; only 41% reported pattern metrics; only 1 study (6%) reported SB variability metrics.

• Confidence Interval: Not reported; meta-analysis was not performed due to methodological heterogeneity

Clinical Application

Wearable device deployment in cognitively impaired populations is feasible based on the included studies, though compliance, device tolerance, and caregiver burden for device management require consideration. Standardised protocols do not yet exist, limiting immediate clinical implementation. The heterogeneity of devices and thresholds means no single wearable platform can currently be recommended for clinical SB monitoring in this population. In Australia, sedentary behavior in older adults with cognitive impairment is a recognised concern within RACGP dementia care guidelines and the National Dementia Action Plan. Residential aged care facilities regulated under the Aged Care Quality Standards are increasingly expected to promote physical activity and reduce sedentary time. However, no TGA-approved wearable device is currently indicated specifically for SB monitoring in dementia. The PBS does not subsidise wearable activity monitors. Australian memory clinics and geriatric services may find the review's methodological appraisal useful for designing future research protocols. The My Aged Care framework and NDIS (for younger-onset dementia) could potentially incorporate wearable SB monitoring as a care planning tool once standardised protocols are established. RACGP's Silver Book and dementia-specific resources do not currently provide specific guidance on wearable SB monitoring thresholds for this population. Adults aged ≥50 years with MCI or dementia in community or residential aged care settings. Findings are most relevant to those with established dementia diagnoses where the SB bout pattern signal was most consistent.

Abstract

BACKGROUND: Sedentary behavior (SB) is a critical, modifiable risk factor for adverse health outcomes. Evidence suggests that SB is higher among individuals with cognitive impairment relative to their cognitively healthy peers. However, the nature and extent of SB across cognitive impairments remains unclear, largely due to the reliance on self-report data and the lack of synthesized evidence from more accurate methodology, such as wearable devices. Wearable device-based methodologies offer a reliable means of capturing SB in real-world settings, circumventing the recall bias inherent to self-report methods. Continuous remote monitoring of SB, via wearable devices, may provide nuanced insights important for understanding SB's contribution to cognitive impairment and health consequences. OBJECTIVE: This review aims to synthesize evidence on the volume, patterns, and variability of SB across cognitive impairment and critically appraise the wearable device-based methodology used to capture SB in this population. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 5 databases (Embase, MEDLINE, PsycInfo, Scopus, and Web of Science) up to January 2025 for peer-reviewed English-language studies using wearable devices to measure SB in community-dwelling or aged residential care residents aged 50 years or older with cognitive impairment (PROSPERO: CRD42024616523). Study quality was assessed using an adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were extracted on SB outcomes (eg, volume, pattern, and variability) and methodological characteristics (eg, device type, placement, SB classification/processing, and its corresponding validation). RESULTS: From 2824 screened records, 17 studies (2016-2025) were included. Most studies (n=11, 65%) were of "good" quality (scoring ≥5 on bias assessment). Synthesis revealed inconsistent evidence for differences in SB volume across cognitive impairment. However, individuals with dementia consistently exhibited a unique SB pattern, engaging in significantly fewer but longer sedentary bouts than other forms of cognitive impairment and cognitively intact controls. All (n=17, 100%) studies used volume metrics to describe SB, followed by pattern metrics (n=7, 41%); only 1 study reported on SB variability. Methodological appraisal found significant heterogeneity: 13 different device models across 6 body placements were used. Most studies quantified SB using count-based thresholds (counts per minute), which were largely unvalidated in cognitively impaired or older adult populations. CONCLUSIONS: This review found that participants with dementia consistently exhibited a unique pattern of SB compared to other forms of cognitive impairment and healthy controls, while evidence for differences in SB volume was inconsistent. This may indicate that differences in SB volume are not inherent to dementia pathology but may be mediated by other factors, such as neuropsychiatric symptoms or environmental influences. Furthermore, methodological heterogeneity and unvalidated thresholds were observed throughout the review, highlighting a need for standardized protocols to enhance the validity and clinical applicability of future research. TRIAL REGISTRATION: PROSPERO CRD42024616523; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024616523.

References

1. 1.Wales, J. L., Hinchliffe, C., Falck, R. S., Del Din, S., Yarnall, A. J., & Mc Ardle, R. (2026). Use of wearable technology for measuring and characterizing sedentary behavior in people with mild cognitive impairment and dementia: Systematic review. JMIR Aging. https://doi.org/10.2196/85361