JMIR Publications

ABSTRACT

Background:

Sedentary behaviour (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 the spectrum of cognitive impairment remains unclear; largely due to the reliance on self-report data and lack of synthesised 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 synthesise evidence on the volume, patterns, and variability of SB across the spectrum of 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 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 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 standardised protocols to enhance the validity and clinical applicability of future research. Clinical Trial: PROSPERO CRD42024616523; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024616523