Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real-life, as opposed to laboratory settings. Objective: This study explored the performance of two wrist-worn trackers (Fitbit Charge2 and Garmin Vivo Smart HR+) estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (TST and WASO) against gold-standard technologies in a cohort of healthy older adults in free-living environment. Methods: Overall, 20 subjects (> 65 years) took part in the study. The devices were worn by the subjects for 24 hours, and the results were compared against validated technology (ActiGraph and New Lifestyles NL-2000i). Mean error, MAPE, ICC and Bland-Altman plots were computed for all the parameters considered. Results: Regarding step-counting, all the trackers are highly correlated with each other (ICCs > 0.89). While Fitbit tends to over-count steps (MPE: 12.36%), Garmin and ActiGraph under-count with a MPE of 9.36% and 11.53%. Garmin had poor ICC values when considering energy expenditure compared against the criterion. Fitbit has moderate-to-good ICCs when compared against the other activity trackers, and showed the best results (MAPE: 12.25%) even if underestimated the amount of calories burnt. For MVPA levels estimation, the wristband trackers were highly correlated (ICC = 0.96), however, were moderately correlated against the criterion and over-estimated the minutes of MVPA activity. When analyzing the sleep parameters, the ICCs were poor for all cases, except when comparing Fitbit with the criterion, which showed a moderate agreement. TST is slightly over-estimated with the Fitbit, although providing good results with an average MAPE equal to 10.13%. On the other hand, WASO estimation was poorer and was over-estimated by Fitbit but under-estimated by Garmin. Again, Fitbit was the most accurate, with an average MAPE of 49.7%. Conclusions: Results suggest that the tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, while clinicians should be cautious in considering other parameters for clinical and research purposes.