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Lookup NU author(s): Jenny Wales, Dr Chloe HinchliffeORCiD, Professor Alison YarnallORCiD, Dr Silvia Del DinORCiD, Dr Ríona McArdle
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
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 precise nature and extent of SB across cognitive impairments remains unclear; largely due to the reliance on self-report data and lack of synthesized evidence from more accurate methodology such as wearable devices. Wearable device-based methodologies offer reliable, low-burden 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 systematic review aims to synthesize evidence on the volume, patterns, and variability of SB across cognitive impairment and to critically appraise the wearable device-based methodology used to capture SB in this population. Methods: Following PRISMA guidelines, five databases (EMBASE, MEDLINE, PsycInfo, Scopus, Web of Science) were searched up to January 2025 for peer-reviewed English-language studies employing wearable devices to measure SB in community-dwelling or aged residential care residents aged ≥50 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 (e.g., volume, pattern, variability) and methodological characteristics (e.g., device type, placement, SB classification/processing and its corresponding validation). Results: From 2,824 screened records, 17 studies (2016–2025) were included. Most studies (n=11/17, 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 (100%) studies used volume metrics to describe SB, followed by pattern metrics (41%); only one study reported on SB variability. Methodological appraisal found significant heterogeneity: 13 different device models across six body placements were employed. 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 dementia participants 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 crucial need for standardized protocols to enhance the validity and clinical applicability of future research.
Author(s): Wales JL, Hinchliffe C, Falck RS, Yarnall AJ, Del Din S, Mc Ardle R
Publication type: Review
Publication status: Published
Journal: JMIR Aging
Year: 2026
Volume: 9
Online publication date: 26/06/2026
Acceptance date: 28/05/2026
ISSN (electronic): 2561-7605
URL: https://doi.org/10.2196/85361
DOI: 10.2196/85361
Data Access Statement: All data generated or analyzed during this study are included in this published article and its Multimedia Appendices 1-5. All articles included in the review are publicly available online. The complete search strategy, including the search strings used for each database, is provided in Multimedia Appendices 1-5 to facilitate reproducibility.
