OBJECTIVE: Although the potential benefits of wearable devices in enhancing the physical activity levels of the elderly have been recognized, the specific effects of these devices on this population have not yet been comprehensively and systematically assessed. The aim of this article is to systematically evaluate the effect of wearable device interventions on various physical activity-related indicators in the elderly, including moderate-to-vigorous physical activity, low-intensity physical activity, total physical activity, daily step count, and sedentary behavior. METHODS: A literature search was conducted through databases including PubMed, EMbase, Scopus, Ovid-Medline, The Cochrane Library, SPORTDiscus, CNKI, VIP, and WanFang from inception to March 10, 2024, to collect randomized controlled trials on the effect of wearable device interventions on physical activity in the elderly. The methodological quality of included studies was assessed using the Cochrane Risk of Bias tool. Data synthesis, subgroup analysis, forest plot creation, sensitivity analysis, publication bias assessment, and univariate meta-regression analysis were performed using Review Manager 5.2 and Stata 12.0 software. RESULT(S): (1) A total of 43 articles, encompassing 5 194 participants, were included in the final analysis. (2) Meta-analysis results indicated that wearable device interventions significantly enhanced the daily step count (SMD 0.48, 95% CI 0.33 to 0.62, P < 0.00001), moderate-to-vigorous physical activity (SMD 0.29, 95% CI 0.20 to 0.38, p < 0.00001), low-intensity physical activity (SMD 0.17, 95% CI 0.02 to 0.32, p = 0.03), and total physical activity (SMD 0.15, 95% CI 0.02 to 0.28, p = 0.02) in the elderly. However, the intervention showed no significant effect on improving sedentary behavior (SMD -0.08, 95% CI -0.21 to 0.05, p = 0.22). (3) Subgroup analysis revealed that comprehensive intervention strategies, interventions lasting <= 12 weeks, and the use of pedometers as intervention devices were more effective in promoting low-intensity physical activity and total physical activity among the elderly. Comprehensive intervention strategies, interventions lasting <= 12 weeks, and the use of accelerometers as intervention devices might be more effective in enhancing daily step count and moderate-to-vigorous physical activity. (4) Meta-regression results suggested that age (p = 0.038) and health status (p = 0.083) could be significant factors influencing heterogeneity in daily step count. CONCLUSIONS: Current evidence suggests that wearable device interventions have a positive role in promoting daily step count, moderate-to-vigorous physical activity, low-intensity physical activity, and total physical activity in the elderly. It is recommended to consider comprehensive intervention approaches, interventions lasting <= 12 weeks, and the selection of appropriate devices based on intervention goals when designing wearable device intervention programs. Nevertheless, further high-quality randomized controlled trials are needed to substantiate the effectiveness of interventions aimed at reducing sedentary behavior.

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