Physical activity (PA) is an important predictor for active and healthy aging; yet, few older adults meet the recommended levels of PA [1]. Wearable devices with real-time feedback (WRFs) having sensors provide increasing opportunities to enhance PA through collecting and processing health-related data [2,3]. Despite their potential, the long-term user engagement with wearables remains a challenge [4-6]. In particular, age-specific characteristics in the user engagement with interactive wearables with real-time feedback (RTF) have remained largely unexplored.

This study explores the use of wearables with and without RTF to uncover the lived experiences of older adults in their engagement with interactive wearables. WRFs can be defined as body-worn technologies that implement technologies, such as sensors, to measure biomedical information, combined with modalities, such as haptic or auditory feedback, that help users to adjust the movement to improve the performance in PA [7]. Rhythmic activity can be defined as a form of PA that incorporates elements such as auditory feedback, music, and social interaction, which involve coordinated movements synchronized with music [8-10]. In this study, we define rhythmic activity as a step-by-step movement (eg, walking or running) that is mediated by a device-guided synchronization of step and heart rate.

Older adults, defined as an age group of 65 years and older, are considered an important user group of WRFs due to the potential of wearables to improve PA, rehabilitation, and cardiovascular health [1,11-14]. Due to demographic changes accompanied by population aging, wearables as digital health interventions are expected to contribute to health promotion and prevention of disease among this demographic [15]. However, the adherence with these interventions still remains a challenge [4-6]. Older adults’ adherence with wearables is mediated by their health, motivations for PA, and digital skill literacy, which can impact the use of wearables that require dexterity, mobility, or vision [16,17]. Older adults emphasize enjoyment of social interaction as a motivation to be physically active [1], and wearables can enhance this through the provision of visual or auditory feedback [12]. The perceived appeal of visual or auditory feedback, however, is individual and mediated by the lived experiences in later life. This suggests that affordances embedded in wearables are not directed only toward improving performance, but also delivering a sense of self-awareness [13]. Considering the individual differences in older adults’ motivations, it becomes important to recognize their lived experiences when exploring their adherence to WRFs.

The aim of this study is to explore the lived experiences of older adults using wearables with RTF in rhythmic activity. The study explores narratives that older adults articulate in their previous use of wearables for PA, their experiences with WRFs during rhythmic activity, and their meaning-making of the interactive features enhancing the synchronization of the movement during rhythmic activity.

Wearable technologies are designed and used for enhancing PA in health promotion, preventative health, and treatment of health conditions [18]. As self-care technologies, wearables allow the user to take responsibility for managing their own health independently, without external intervention from the health care provider [15,19,20]. As a medical technology, wearables can be used before medical diagnosis to monitor PA levels, and detect and predict the onset of clinical conditions [21].

Wearable technologies include a variety of applications, such as smart watches and chest bands, and these technologies integrate features, such as instructions, self-monitoring, and reminders, along with customizable options [22,23]. These interactive features, such as goal setting, feedback provision, and motivation tracking, are increasingly implemented in day-to-day applications [23]. RTF refers to an interaction mechanism that provides haptic, auditory, or visual feedback to the user simultaneously with the user’s movement, instead of after the movement or activity has ended [2,3]. Machine learning techniques have enabled accurate and rapid human gesture recognition, providing RTF to users [24]. WRFs have been investigated among athletes in the prevention of injuries, improvements of performance [2,25], as well as in rehabilitation [26]. For older adults, RTF has been shown as a preferred feature in wearables [11]. In comparison to other interactive features, RTF, as a rather novel feature, has nevertheless been less implemented in commercially available wearables [2].

RTF enables reactions from the user while the action or movement is ongoing. Auditory feedback allows users to be observant of the environment and fits into more dynamic settings compared with both visual and tactile guidance [27]. Through sound interaction, users can coordinate and stabilize movements with internal or external imposed rhythms [28]. Auditory feedback can be used in a variety of physical activities, ranging from guiding speed to correct movements [25], supporting coupling steps and breathing in day-to-day running exercises [27], to guiding static breathing exercises [29]. Beat-by-beat stepping to the heart rate has shown improved heart function in athletes; however, without assessing motivational aspects of this interaction [30]. As an alternative to the auditory cues, the use of music can increase motivation and engagement in cardiovascular rehabilitation [31].

Wearables are accessible and easy to use, but the adherence, defined as long-term user acceptance and engagement with the device, remains a challenge [4-6]. The ownership of wearables is defined by sociodemographic factors, such as age and gender. Younger groups with higher levels of education and full-time employment are more likely to own a wearable compared with other demographic groups [32]. Older adults’ motivations for using a wearable may also significantly differ from other age cohorts regarding the perceived value and ease-of-use of the device [11,14,33-35].

Long-term adherence to wearables is determined by a combination of individual motivation, ease-of-use, and perceived value of the wearable, which subsequently predicts whether or not the device will be integrated into the user’s life [11,33]. Older adults must be motivated by the usefulness of the device and its added value to PA [11,36]. Formal and informal support and guidance in having access to the device and continuing its use are connected to long-term adoption [37]. These individual factors are expected to differ between older adults, resulting in heterogeneous use of wearables depending on various individual and social determinants [10,16,17].

Emotional, sensory, and social influences also impact the user engagement with wearables [13,38,39]. Long-term attachment with wearables requires that these devices elicit positive emotional responses among users [40]. When wearables are framed as an assistive technology that aims to compensate for age-related functional or cognitive losses, older adults might abandon these devices due to (negative) user images [36]. Wearable devices can be perceived as motivating or condescending depending on how freely older adults can make autonomous choices about PA [34].

Accordingly, older adults face barriers to wearable adoption, including issues about usability, affordability, and accessibility, which can lead to social isolation and marginalization from digital health innovations [41]. At the same time, digital technologies offer significant opportunities for older adults, who often have more leisure time and are financially independent, to seek health-related information and maintain self-care [15,42]. Fewer phenomenological studies are focused on exploring older adults’ experiences with rather novel wearable technologies in their home environments. This methodological approach allows us to capture the essence of subjective experiences and the perceived value they derive from using wearables through first-person descriptions [41-44] and the meanings they attribute to the interactions with wearables [15,45]. The research questions (RQs) are the following:

This study consisted of three stages: (1) semistructured interview and a questionnaire before using WRF, (2) a 3-week use of WRF for PA (referred to as in-situ study), and (3) a semistructured interview after using WRF. Figure 1 presents the method and duration of each stage.

In the first stage, we conducted a semistructured interview for participants to investigate their motivation for PA, self-perceived health and well-being, previous experience with technologies, and previous interactions with wearables for PA. Participants were also given a questionnaire measuring their PA level, self-perceived health, and sociodemographic characteristics.

In the second stage, participants were asked to use a WRF for a 3-week period in their home environment. They were asked to use the device at least 3 times per week during their PA routines, including any rhythmic activity, such as walking, running, or jogging. Each participant was shown how to use the device, and the device was set up and connected to their mobile phones. They also received detailed written instructions for using the device. A 3-week period for in-situ study was selected to ensure the feasibility of the procedure as a common period in digital health intervention studies [46].

In the third stage, we conducted semi-interviews to explore participants’ lived experiences with the device, focusing on their self-perceived perceptions of the device and its impact on motivation and adherence with rhythmic activity.

Participants in this study were recruited through convenience sampling at the Swedish School of Sport and Health Sciences. An open invitation was distributed to those who attended the physical exercise sessions 3 times a week at the Swedish School of Sport and Health Sciences. Since the WRF device was originally designed for athletes to improve their performance, we recruited physically active older adults to ensure that the device was considered meaningful and safe for the user group to allow a phenomenological approach to their experiences [47,48]. Other inclusion criteria were (1) participants aged older than 65 years, (2) able to exercise independently without assistive devices, (3) own a mobile phone that can download the app and could carry the phone during PA, (4) able to adequately see and hear (with or without a hearing aid) the wearable devices’ RTF, and (5) able to read and speak English to follow the WRF’s instructions.

In total, 21 older adults were recruited, and 18 of them completed all 3 stages in the study. The sample size was determined based on the principles of qualitative research and purposive sampling, where having 20 participants is often considered a saturation point after which little or no new information is generated from 1 participant group [49].

This study used a phenomenologically informed qualitative approach, drawing on the principles of interpretative phenomenological analysis (IPA) [47,59] to explore how older adults make sense of their experiences with wearable technology in PA. IPA is particularly suited to examining how individuals interpret, reflect on, and assign meaning to personally significant experiences, with an emphasis on embodiment, temporality, and the situated nature of meaning-making.

While the early stages of the analysis were guided by a thematic analysis conducted by 3 researchers to navigate a rather large and diverse dataset [60,61], the final interpretative process was anchored in phenomenological inquiry. The goal was not simply to identify recurring patterns but to understand participants’ lived experiences in depth, including how they perceived, emotionally responded to, and negotiated the role of wearable devices in their embodied PA routines.

The analysis followed a recursive and idiographic process, beginning with repeated readings of each interview transcript to immerse in the participants’ narratives. After preliminary notes were made, segments that revealed how participants made sense of their relationship with WRF were identified and grouped. These segments were later interpreted within the broader biographical, social, and emotional context, maintaining an interpretative stance that sought to balance empathic understanding with critical reflection, a process central to IPA’s double hermeneutic process. Although initial thematic groupings were constructed, these were reevaluated through a phenomenological lens to ensure that the final themes captured the depth, nuance, and individuality of participants’ meaning-making. Particular attention was paid to heterogeneity among the narratives articulated by older adults, not as demographic variance, but as diverse experiential positions shaped by bodily awareness, social scaffolding, emotional responses, and contextual life circumstances. The final themes represent not only recurring patterns but rich, interpretative accounts of how wearable technologies were encountered, negotiated, incorporated, or even resisted in older adults’ daily lives.

The research has been approved by the Swedish Ethical Review Authority (references 2023-00426-01 and 2024-06934-01). All participants gave informed verbal and written consent for participation in the study and for publication of anonymized extractions from the data. Before participants signed the informed consent, they were given both written and verbal information about the effects of adapting this device in their PA routines and potential risks in participating in the study. Participants were given the possibility to ask questions and withdraw from the study at any time. The privacy and confidentiality of participants were protected by giving all participants a pseudonym (numeric ID) that was used in the analysis and reporting of the results. Participants were given a small financial compensation of a gift card worth 500 SEK (US $54) after they completed their participation in the study. The amount of financial compensation was not specified in the recruitment material.

The analysis revealed four superordinate themes: (1) use of wearable technologies without RTF in daily life, (2) embodied rhythmic negotiation with RTF, (3) interpretation of health data with RTF, and (4) temporal trajectories of device engagement with RTF (Table 2). The results capture the embodied, temporal, and situated nature of participants’ meaning-making processes, revealing how relationships with technology evolved. A detailed analysis table can be found in Multimedia Appendix 4. The findings demonstrate the depth and heterogeneity of lived experiences, showing how wearable adoption is deeply personal and contextual, shaped by participants’ ongoing negotiation between technological mediation and their intuitive, embodied understanding of PA.

All participants who engaged with the device for extended periods (≥333% of the recommended dosage, ie, over 900 minutes approximately) developed strategies and demonstrated discipline when interacting with it, creating a nearly self-training process.

P16 (348%) expresses that she put in intense focus, which demanded a withdrawal from environmental engagement:

Her experience revealed the demanding nature of long-term synchronization, requiring a narrowing of perceptual attention.

P7 (567%) experienced the longest engagement with the device and developed a profoundly different relationship with the technology. For him, extended usage transformed the device from a demanding technological interface into a meditative companion:

His extended temporal engagement allowed for the emergence of a peaceful relationship with a familiar, internalized synchronization process.

In this study, we have explored the lived experiences of physically active older adults in using wearables for rhythmic activity, with a specific attention to RTF as an interaction modality. The study explored older adults’ previous use of wearables to track their PA, adherence with WRF during rhythmic activity, and the interactive features of WRF in enhancing the synchronization between step rate and heart rate. The study identified four main themes characterizing older adults’ lived experiences with wearables that are (1) use of wearable technologies without RTF in daily life, (2) embodied rhythmic negotiation with RTF, (3) interpretation of health data with RTF, and (4) temporal trajectories of device engagement with RTF.

While previous studies on wearables with older adults have recognized diverse motivations for adoption [11,12,33-35], this study reveals the specific mechanisms underlying this diversity in the context of real-time rhythmic guidance. Rather than treating heterogeneity as a static characteristic, we demonstrate how varied engagement patterns emerge through the dynamic intersection of personal values, embodied experiences, and technological demands. This study’s contribution extends beyond documenting diversity to explaining how older adults’ relationships with wearable technology are fundamentally shaped by their commitment to preserving authentic bodily experiences, their reliance on social networks for technology validation, and their need for contextually adaptive feedback systems that respect individual rhythmic patterns.

The study shows that the discontinuous use of wearables, accompanied by self-reported challenges in the device-guided synchronization, can be partly explained by the mismatch between technological capabilities and older adults’ inherent values and aspirations in later life. Factors such as comparison, competition, and goal setting that are often inherently built into commercial wearables [62] are less important for this demographic, for whom it is often more important to maintain the existing PA level through inner self-motivation. Simultaneously, device-guided synchronization requires older adults to change their natural walking rhythm and pace, which may result in a sense of discomfort and frustration. These age-specific requirements for achieving device-guided synchronization have largely remained unexplored in previous studies [30,58]. To overcome these challenges, the study proposes that interaction modalities that guide users to increase their bodily awareness may help older adults to find the right walking pace authentically.

The study addresses that older adults’ desire to use wearable devices stems mostly from their health-related goals and preferences, rather than their need for constant digital monitoring. These personal goals and preferences may show high variance in later life, which can partly explain the heterogeneity in driving factors to use wearables. Importantly, the findings reveal more than simple disuse but an intentional distancing from technology. This distancing aligns with research showing that older adults may abandon wearables when they are framed as assistive technologies that compensate for age-related losses, leading to negative user images [36]. Moreover, wearables can be perceived as motivating or condescending depending on how freely older adults are able to make autonomous choices about PA [34]. As a result, technology adoption among older adults involves complex value-based decision-making processes that prioritize the preservation of unmediated bodily experience over external validation.

Individuals’ readiness to accept wearable technology varies depending on their interests, experiences, and sociocultural background [32,63]. This study indicates that personal goals, often focused on the enjoyment of PA, were stated as the primary motivator to use wearables. These personal goals may sometimes contradict the device-related features that emphasize self-monitoring or goal setting in PA [34], which may partly explain the low or limited use of wearables in PA among older adults.

Previous research has explored the use of wearables by focusing on older adults’ motivations and driving factors at the individual level or from the device-centric perspective [11,33,35]. The study adds to this line of research by demonstrating the social aspects and motivations in the use of wearables for PA. The results demonstrate that technology adoption emerged not as an individual consumer choice, but as a socially embedded practice mediated through relationships, community connections, and shared experiences. This relational orientation, evidenced through participants’ learning via community seminars, family introductions, and the emotional significance attached to devices, challenges dominant narratives that frame wearable technology use as primarily self-directed and autonomous. This finding supports previous research indicating that formal and informal support and guidance in accessing and continuing device use are connected to long-term adoption [37]. The relational dimension extends beyond initial adoption to ongoing meaning-making, where device data interpretation requires dialogical engagement with professionals or trusted others. The combination of individual motivation, ease-of-use, and perception of added value ultimately determines whether devices will be integrated into users’ lives [11,33]. This shows that the role of family members or friends, also known as “warm experts” [17], remains significant in the uptake of wearables. Consequently, social support in the uptake of wearables, which is often unequally distributed in later life [64], could further diversify the heterogeneous use of wearables in PA.

The negative narratives we observed serve as a vital reminder that technology and health data can alter participants’ relationships with their bodies, shifting their view from an intuitive and instinctive feeling to one of external judgment and evaluation. The fact that decreased activity levels led to stress, rather than simply providing information or motivation, suggests that when technology introduces an evaluative aspect to PA, it might be emotionally challenging if not carefully designed. This emotional dimension is critical, as research demonstrates that long-term attachment with wearables requires devices to elicit positive emotional responses among users [40], and that emotional, sensory, and social influences significantly impact user engagement with wearables [13,38,39]. A long-term, motivating engagement with wearables also requires participants to develop strategies for managing the emotional impact, involving selective engagement and conscious boundary-setting around metrics. Fostering personalized approaches that preserve their sense of agency will be the key to selectively engaging with technologies that align with their values and needs.

The study reveals the significant age-related variations in user experience and adaptation to the wearable with RTF. Central to these findings is the recognition that rhythmic synchronization is deeply contextual, shaped by the interplay between bodily capacity, environmental demands, and technological requirements. The results demonstrate how synchronization challenges were not uniform technical difficulties but varied significantly based on environmental factors (flat terrain vs stairs and uneven surfaces), individual bodily characteristics (natural walking pace and heart rate variability), and temporal factors (time needed for adaptation). This aligns with research showing that through sound interaction, users can coordinate and stabilize movements with internal or external imposed rhythms [28], and that auditory feedback allows users to be observant of the environment and fits into more dynamic settings compared with visual and tactile guidance [27]. This contextual nature means that synchronization cannot be understood as a purely technical challenge, but rather as a complex negotiation between multiple intersecting factors that are dynamically configured in each exercising session.

Regarding synchronization challenges, older adults encountered difficulties synchronizing their steps to the audio feedback designed to align with their heartbeats. These challenges stemmed from a mismatch between the device’s requirements and the cognitive load, as well as from environmental constraints. Participants reported that synchronizing often required them to walk at an unnaturally slow pace, which conflicted with their habitual walking styles. This resulted in a perception that the device’s requirements were intrusive and disruptive to the natural flow of walking. Despite these challenges, older adults demonstrated an ability to improve their synchronization over time. This improvement, however, was not uniform across participants and appeared to depend on the individual’s personal exercise routines.

The study indicates that device-guided synchronization in rhythmic activity can be associated with older adults’ previous routines and rhythms, and thus connected to temporalities of PA. These insights suggest that while initial engagement with the device may be frustrating, persistence and strategic adjustments could enhance the experience of synchronization for some users. These adjustments, however, require “bodily knowledge and know-how” [65] to be able to adapt the device to already existing exercise routines. As Phoenix and Bell [66] highlight, disruptions in the natural movement rhythms may be associated with bodily discomfort and emotions, including symptoms associated with chronic health conditions connected to aging. These findings highlight that the device-guided synchronization, despite being a physiological mechanism between heart and gait cycles [30,58], is always connected to wider routines, rhythms, and temporalities in PA, as well as older adults’ previous exercise background and physical capabilities. In this study, the interconnectedness of synchronization challenges in relation to the environmental or activity-related factors was repeatedly pronounced in participants’ statements. This interconnectedness between synchronization and contextual and environmental factors may explain the reason for participants’ frequent statements of synchronization challenges, despite the fact that the device itself was considered relatively easy to use.

Overall, the device created both disruption and possibility, disrupting established movement patterns while opening space for new forms of bodily awareness and rhythmic experience. The challenge of synchronization revealed the depth of participants’ disconnection from their internal rhythms and their capacity for developing integration when given appropriate support and practice. This dual nature is inherent to RTF mechanisms, which provide haptic, auditory, or visual feedback simultaneously with user movement rather than after the activity has ended [2,3]. Notably, RTF has been identified as a preferred feature among older adults in wearable technologies [11]. In this sense, wearable devices with RTF function not merely as monitoring tools, but as mediators that can either fragment or enhance the relationship between consciousness and embodied movement, depending on how they are designed and implemented.

The meanings associated with the interactive features of WRFs extended beyond functional utility. The study addresses the potential of real-time audio feedback to help older adults overcome synchronization challenges and adapt to device-related functionalities over time.

First, RTF in auditory format can help older adults to reduce cognitive load in synchronization, which was considered to require an intense focus on finding and maintaining the right walking pace. Previous studies, respectively, have explored the auditory feedback in relation to increasing the enjoyment in walking activity, and showed that auditory cues could enhance the health benefit from walking among older adults through acting as a positive reinforcement to a rhythmic stepping pattern [67]. However, the degree of adherence to these feedback modalities depends strongly on individual characteristics, such as technological familiarity, cognitive capacity, and even sensory limitations. According to this study, older adults with more previous experience with technology tend to engage more easily with both visual and auditory feedback.

Second, the study shows that compound feedback, which combines visual and aural cues, improves synchronization and has a positive impact on the overall experience. Although its effectiveness may vary depending on individual needs and preferences, this strategy is especially helpful in fostering positive emotions like motivation and enjoyment. In order to accommodate a greater range of sensory abilities and preferences, wearable device design must be adaptive to an individual’s skills and capabilities. For example, older adults with hearing impairments may find auditory feedback less effective, while those with visual impairments may prefer larger visual cues.

Finally, temporal engagement with the device was not merely quantitative but fundamentally shaped the qualitative nature of participants’ lived experiences. Shorter engagements were characterized by disruption and effortful adaptation, while extended engagements allowed for the development of more integrated, contemplative, or mastery-oriented relationships with the technology. The duration of usage emerged as a critical factor in determining whether participants experienced the device as a disruptive intervention or as an integrated tool for embodied self-awareness, and potentially a natural component in PA. This temporal dimension is particularly significant given that adherence, defined as long-term user acceptance and engagement with devices, remains a persistent challenge in wearable technology research [4-6]. The individual factors of motivation, ease-of-use, and perceived added value that determine device integration into users’ lives [11,33] appear to require extended time periods for meaningful development. To sum up, technology adoption among older adults requires sufficient time for the development of new embodied competencies and the gradual integration of technological feedback into existing movement practices. The transformation from initial resistance or struggle to potential acceptance suggests that wearable technology design should accommodate extended adaptation periods rather than expecting immediate integration.

The study gathered older adults with relatively high levels of PA and high satisfaction with their physical health. Therefore, their user experience with the device could potentially be influenced by their previous PA level. The participants used the device only for a 3-week period, and the long-term user engagement remained unexplored. Despite these limitations, this study has extended previous research by considering the lived experiences of older adults in device-guided rhythmic activity, with a specific focus on audio feedback during synchronization of step and heart rate. Future research should explore device-guided synchronization and adherence to RTF with a more diverse group of older adults. This would ensure that wearable technologies for self-monitoring can reach their expected health benefits for those older adults who are at risk of cardiovascular disease.

This study reveals that older adults’ engagement with wearable devices for rhythmic activity is characterized by 4 fundamental dimensions that challenge conventional assumptions about technology adoption in later life. First, rather than simple disuse, older adults demonstrate intentional distancing from wearable technologies, actively resisting digital mediation to preserve authentic relationships with PA. Second, their engagement is fundamentally relational rather than individualistic, emerging through trusted social networks and requiring ongoing dialogical support for meaningful data interpretation. Third, the experience of rhythmic alignment is deeply contextual, shaped by dynamic negotiations between bodily capacity, environmental demands, and technological requirements that vary significantly across individuals and situations. Fourth, temporal trajectories of engagement reveal that meaningful relationships with wearable technology develop through extended interaction periods, with different engagement durations producing qualitatively distinct experiences ranging from disruption to integration.

These findings extend previous research on wearable technology use among older adults by moving beyond motivational factors to reveal the underlying experiential mechanisms that shape engagement patterns. The study demonstrates that device-guided synchronization creates both disruption and possibility, requiring extended temporal engagement for participants to develop integrated relationships with technological feedback. While RTF shows potential for enhancing bodily awareness, its effectiveness depends on designs that accommodate older adults’ commitment to embodied autonomy, their relational approach to technology validation, and the contextual nature of their rhythmic experiences. Future wearable technologies must therefore prioritize adaptive, socially embedded, and temporally sensitive design approaches that respect rather than override older adults’ established movement practices and values.