Comparing methods to measure wearable device adherence for physical activity monitoring for persons with autism: A prospective observational cohort study.

This was an observational study — researchers watched what happened rather than assigning treatments. It can show that two things happen together, but it cannot show that one caused the other.

It involved only 27 people. Without random assignment, a group this small makes it especially easy for something other than what was studied to explain the difference researchers saw. Treat this as a very early signal rather than an answer.

The study ran for 8-week. That is a short window, so it says nothing about whether the effects last.

The researchers concluded: "Using HR-based measures of adherence may underestimate device use in individuals with ASD, potentially setting unrealistic expectations for continuous wear. Step-based metrics provides a more inclusive and pragmatic approach for assessing WD adherence in this population, with implications for future intervention design and evaluation."

This is a plain-language summary of one paper's abstract, not medical advice. Talk to your child's clinician before changing anything.

Journal: Physiotherapy theory and practice

Year: 2026

Design: Observational Study

Participants: 27

Age range: 14-28 years

Intervention: wearable device physical activity monitoring

Authors: Melissa M Tovin, Sheila B Madden, Kaiwen Wu, Annabel Nunez-Gaunaurd

INTRODUCTION: Individuals with autism spectrum disorder (ASD) have higher rates of obesity and exhibit more sedentary behaviors than neurotypical peers. Use of wearable devices (WD) to target insufficient physical activity (PA) in this population has increased over the past decade. However, standardized methods for assessing WD adherence remain limited among this understudied population. PURPOSE: A prospective observational cohort design was used to compare two methods for determining WD adherence for monitoring PA in adolescents and adults with ASD. METHODS: Subjects were enrolled in an 8-week telehealth program aimed at improving PA among adolescents and adults with ASD. The Fitbit Inspire 3 WD was utilized for PA tracking and self-monitoring. Subject step activity and heart rate (HR) data were collected for an 8-week period via FITABASE management platform. Adherence was calculated using two methods. Method-A was defined as ≥10-hr daily wear-time based on HR monitoring; Method-B was defined as ≥ 500 steps/day. Observational data collected via researcher field notes documented participant-reported factors and/or behaviors that influenced WD adherence. RESULTS: Data from twenty-seven subjects (21 males, 6 females) ages 14 to 28 years (mean: 18.85 years) were analyzed. Adherence was significantly higher when calculated using Method B (mean = 40 days, 5.4 weeks) compared to Method A (mean = 24 days, 2.8 weeks; p < .001). Observational data identified disability-related behaviors that negatively impacted Method A derived adherence. CONCLUSIONS: Using HR-based measures of adherence may underestimate device use in individuals with ASD, potentially setting unrealistic expectations for continuous wear. Step-based metrics provides a more inclusive and pragmatic approach for assessing WD adherence in this population, with implications for future intervention design and evaluation. This study highlights the need to tailor WD adherence definitions to the behavioral and sensory profiles of neurodiverse populations. Further study is warranted.

Physiotherapy theory and practice, 2026

PMID 41578977

DOI 10.1080/09593985.2026.2618078

This record was extracted from the paper's PubMed abstract and metadata. Full-text methods and risk-of-bias details were not reviewed.