Selecting and utilizing wearable devices

Smart wearables have increasingly become valuable tools for monitoring physical activity and other health-related parameters in older adults. Recording and monitoring physical activity plays an important role in everyday life for older adults’ health and functional ability. Physical activity is of particular importance for older adults' physical and mental health. The use of wearable technology and other digital tools have emerged as valuable methods to track health behaviours, assess functional abilities, and provide data-driven feedback for interventions. The use of wearable technology and other digital tools have emerged as valuable methods to track health behaviours, assess functional abilities, and provide data-driven feedback for interventions.

Importance of Recording Physical Activity

Physical activity has long been recognized as a key factor in promoting cardiovascular health, managing body weight, and reducing the risk of chronic conditions like diabetes, hypertension, and osteoporosis. For older adults, regular physical activity also helps prevent sarcopenia (age-related muscle loss), supports joint health, and improves balance, thereby reducing the risk of falls (Jacobson, Smith, Fronterhouse, Kline, & Boolani, 2012). It is suggested that even moderate daily exercise can lead to significant improvements in life expectancy and quality of life. Monitoring physical activity levels is critical for ensuring that older adults are meeting recommended physical activity guidelines. Wearables and activity trackers can provide personalized insights into the amount and intensity of activity, helping individuals and caregivers adjust routines to optimize health outcomes (Frey-Law et al., 2024).

Physical activity also exerts a positive influence on older adults’ mental health. Research findings show positive changes not only in their motor but also in their cognitive function. Regular exercise is associated with a reduced risk of cognitive decline and dementia, as it enhances brain plasticity, promotes neurogenesis, and improves overall mental health (Yan & Zhu, 2009). Systematic participation in physical activity is also associated with improvement in older adults’ mood in general (Kanning & Schlicht, 2010). Recording physical activity can therefore help track patterns that may influence not just physical but also cognitive function. For example, wearable technology can alert caregivers and health professionals to declines in physical activity, which may indicate cognitive changes. Monitoring physical activity levels over time could be a proactive way to detect early warning signs of cognitive impairment, thus allowing for early interventions (Lee & Lee, 2024).

Physical activity is inextricably linked, with a bidirectional association to the functional ability of older adults. In frail older adults, physical functional ability refers to their capacity to carry out activities of daily living, ensuring thus their independent living. Older people usually are classified into different levels of functioning, depending on whether or not they are able to perform:

• activities of daily life (Basic Activities of Daily Living), i.e. basic activities related to hygiene and personal care (e.g. bathing, toileting, eating, dressing, moving around the house),
• instrumental activities of daily living (Instrumental Activities of Daily Living), i.e. activities that are important for integration into society (eg using the telephone, managing money, shopping, cooking, washing, housework),
• advanced activities of daily living (Advanced Activities of Daily Living), a term added a little later and includes all those activities that are not important for survival, but are connected to social, religious or other activities that enrich the lives of the elderly.

Functional assessment of frail older adults is usually done indirectly by self-reports and by observation, as it is not always safe to perform a motor test. In contrast, fit seniors can do much more than activities of daily living and their level of motor functioning is assessed with motor tests, such as the Senior Fitness Test. Physical function tests must aim to the mobility problems of the participant, otherwise there might be ceiling or floor effects. In addition, a study by van Gameren et al. (2024) highlighted the lack of correlation between traditional measures of functional ability, like the Short Physical Performance Battery (SPPB) and actual daily gait quality in older adults. This underscores the need for continuous, real-world activity tracking rather than relying solely on clinical tests, which may not reflect an individual’s true functional ability. By recording physical activity, particularly through the use of accelerometers and wearable devices, it is possible to gain a detailed understanding of how well older adults can manage these tasks in real-world environments. For example, tracking gait patterns, movement intensity, and step counts can provide insights into mobility, balance, and strength.

Recording physical activity allows for personalized and data-driven interventions. Health professionals can use the data from wearables to tailor exercise programs and rehabilitation plans based on real-time information about an individual’s activity patterns. For frail older adults or those recovering from surgery, injury, or illness, these records provide valuable feedback that can enhance recovery outcomes. The continuous monitoring of physical activity levels can also help healthcare providers identify periods of inactivity or a decline in mobility, which could signal underlying health issues. For example, wearable data can reveal when an older adult is becoming more sedentary, potentially prompting early intervention to prevent further decline (Wardi et al., 2024).

Despite the benefits of wearable technology for recording physical activity, a major challenge is the low technological literacy among many older adults. Some may struggle with using wearables or understanding the data provided by these devices. Moreover, older adults with physical impairments may find it difficult to wear or manage these devices consistently. While wearable devices are valuable tools for monitoring health, their design must be inclusive of the needs of older adults. Wearables should be easy to use, with simple interfaces and functionalities, and provide clear, actionable feedback. Studies show that co-designing wearables with older adults can significantly improve adoption rates and user experience (Yan & Guo, 2024).

Another important concern for older adults is data privacy, especially when it comes to sharing personal health information. Wearable devices collect sensitive data, which raises questions about how this data is stored, shared, and protected. Many older users may be hesitant to adopt wearables out of fear that their data may be accessed by unauthorized parties. Addressing privacy concerns through transparent data policies and secure, user-controlled data management systems is essential for increasing older adults’ trust in wearable technology. Clear communication about how data is used and protected will help to alleviate concerns (Yang et al., 2024).

Recording physical activity in older adults is not just a matter of tracking movement; it is an essential tool for promoting health, enhancing functional ability, and preventing decline. Wearable devices and other technological solutions offer unprecedented opportunities to collect real-time data on how older adults live and move in their daily environments. While there are challenges related to technological adoption, privacy, and accessibility, the benefits far outweigh the drawbacks. Through continuous monitoring, personalized interventions, and the integration of AI and healthcare systems, physical activity tracking can significantly contribute to healthier aging populations. Ultimately, the ability to monitor, record, and respond to changes in physical activity patterns holds the promise of improved health outcomes and sustained independence for older adults.

Types of wearables used in healthcare and fitness

Smart wearables offer non-invasive ways to track daily movements, heart rate, sleep patterns, and various physiological metrics. Therefore they are very good tools not only for researchers, but also for health and fitness professionals. The problem with these devices is that they collect a very large amount of data, from various parameters. Exploiting this information requires special training and great expertise in its use. The future of physical activity monitoring lies in the integration of artificial intelligence (AI) and predictive analytics. AI can help process the vast amounts of data generated by wearables to detect patterns and make predictions about health outcomes. For instance, AI-driven models can assess changes in physical activity to predict fall risk or detect early signs of frailty.

AI-based wearables may also contribute to preventive care by identifying deviations from normal activity patterns. This predictive capability can alert healthcare providers to intervene before a serious health issue arises, thereby improving the quality of life for older adults (Pichandi et al., 2024). As healthcare systems increasingly move towards digitalization, the integration of wearable data into electronic health records (EHRs) will become critical. This will allow healthcare professionals to have a holistic view of an older adult’s health, encompassing both clinical data and real-world activity data. Ιntegrating wearable data into EHRs can create a more comprehensive understanding of an older adult’s health status, enabling more personalized and continuous care. This shift toward data-driven healthcare could lead to more proactive management of age-related conditions (Frey-Law et al., 2024) and allow frail older adults to participate in fitness sessions with more safety.

Below is a list of wearables used mainly for healthcare applications and some of them are useful for tracking physical activity too.

Scientific evidence on issues in recording physical activity, using wearables in older adults.

The above expanded list of wearables, is evidence of how technology is evolving to monitor various health metrics and help older adults maintain physical activity and wellness. Focusing on fitness wearables is crucial, especially for older adults, as these devices can help track physical activity, motivate users to stay active, and ensure they are meeting health goals.

There are however, specific issues in recording different types of physical activity, using wearables in older adults. These issues are usually related to the usability, accuracy, and specific health parameters recorded by wearables, when recording physical activity to the certain population group. Several reviews have assessed the use of wearables for older adults. Teixeira et al. (2021) conducted a critical review of wearable devices focusing on their effectiveness in monitoring physical activity and health parameters in older adults. The study identified that devices designed specifically for seniors, with adjustable features and easy data interpretation, provided the best outcomes in terms of health monitoring and physical activity encouragement. Additionally, Vargemidis et al. (2020) conducted a systematic review of wearable physical activity tracking systems for older adults, identifying parameters like ease of use, battery life, and accuracy as key factors in the adoption of these devices.

One of the main challenges identified across multiple studies is the accuracy of data when monitoring older adults with inconsistent physical activity patterns. A study by Paraschiakos et al. (2020) highlighted that inconsistencies in data due to irregular movement patterns can affect the performance of wearable sensors. Nonetheless, advancements in machine learning algorithms can help mitigate such issues, improving the accuracy of activity and health monitoring. Chow and Yang (2020) conducted a validation study on optical heart rate sensing technology in wearable fitness trackers, comparing their accuracy across different age groups. The study found that modern wearables can reliably track heart rate during moderate physical activities in both young and older adults, making them suitable for continuous health monitoring. Moreover, Olmedo-Aguirre et al. (2022) emphasized the importance of wearables in remote health monitoring for the elderly, especially those with chronic conditions. Wearable devices are capable of tracking crucial health metrics such as heart rate variability (HRV), respiratory rate, and activity levels, offering a comprehensive view of an individual’s health status.

Another important concern, when selecting the most appropriate wearables for older adults is usability. As a highly heterogeneous population, older adults may present vast variations in their ability to use devices, something that depends on their previous experience and familiarization with modern technology. A study by Martinato et al. (2021) evaluated the usability and accuracy of smartwatches for elderly users. It found that while wearable devices are effective in measuring physical activity, older adults may experience usability challenges, especially concerning data interpretation and device operation. The research concluded that wearables with simple interfaces and visual feedback mechanisms are more user-friendly for the elderly population. Similarly, Ehn et al. (2018) explored older individuals' experiences with activity monitors, highlighting that providing real-time feedback on health parameters can motivate them to increase their daily physical activity. However, the need for user training and familiarization with the devices remains crucial for widespread adoption among people of old age. Furthermore, wearable technologies for health monitoring must address social acceptance issues among older users. Li et al. (2019) proposed the Smart Wearable Acceptance Model (SWAM), emphasizing the importance of perceived usefulness and ease of use in the successful adoption of these technologies among older populations.

In conclusion, smart wearables offer tremendous potential for monitoring physical activity and other health parameters in older adults. Devices that prioritize usability, accuracy, and simplicity are more likely to be adopted and provide reliable data. The future of smart wearables in healthcare will likely see greater integration with machine learning technologies to enhance data accuracy and offer personalized health recommendations.