Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 1, 2025
Date Accepted: Aug 31, 2026
Enhancing a behavioral intervention using rest/activity rhythm monitoring via a consumer wearable: Feasibility and acceptability study in older dementia caregivers and people with dementia
ABSTRACT
Background:
Despite being an established risk factor for poor mental/brain health outcomes in aging, rest/activity rhythm (RAR) disturbances are not routinely monitored/treated. This is, in part, due to a lack of clinician-friendly RAR monitoring systems.
Objective:
We tested the feasibility of personalizing a six-week behavioral intervention using RAR monitoring from a consumer-wearable device (Apple Watch).
Methods:
Participants were 21 older adults (15 dementia caregivers (mean age=61.8 years, standard deviation (SD)=8.4) and 6 people with dementia (PWD; mean age=81.45 years, SD=8.5)). Feasibility outcomes were: (a) proportion adherent enough to assess RARs (defined as ≥3 consecutive valid days with ≥20 hours/per day); and (b) the total number of valid days.
Results:
All 21 participants obtained the minimum data requirement for measuring RARs. Caregivers averaged 35 valid days and 15/15 were actively monitoring RARs during week six of the trial. In contrast, PWD averaged 30 valid days, and only 2/6 were active at the trial’s end. In 11 caregivers with pre/post measures, we evaluated changes in depression (Patient Health Questionnaire – 9) and insomnia (Insomnia Severity Index) symptoms. There were medium effect size improvements in depression (Hedges’ g=0.67, 95% confidence interval (CI): 0.04-1.28) and large improvements in insomnia (Hedges’ g=0.94, 95% CI: 0.25-1.61) symptoms.
Conclusions:
These findings show older adults without dementia were highly engaged with RAR monitoring, supporting the feasibility of personalizing interventions with RAR monitoring, and RCTs testing if RAR monitoring improves intervention efficiency/efficacy. Measuring RARs with a consumer wearable is possible in PWD, but lower usage indicates there are barriers to longer-term adherence in this group. Clinical Trial: NCT05309577
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