Every wearable monitoring protocol has the same problem. Compliance is strong in week one, wobbles in week two, and falls off a cliff somewhere around week three. The behavior is consistent enough across programs that most teams have stopped fighting it.
The University Hospitals Cleveland Medical Center sports medicine program wanted to understand why — and whether device design, not athlete motivation, was the actual variable.
The answer, across two years of continuous wear-time data, is clear.
The study
UH Hospitals partnered with Notus Labs on a multi-sport adherence research program spanning collegiate, high school, and post-surgical cohorts. All athletes wore the Notus Labs armband across full competitive or rehabilitation seasons.
The study measured continuous wear time, sync reliability, and self-reported friction events against clinical and behavioral baselines. No intervention on athlete behavior — the goal was to observe what held compliance up, and what broke it down.
What we measured
Daily wear hours, session-level sync success, charge-cycle compliance, and athlete-reported wear friction events. All data streamed through the standard Notus Labs research pipeline.
Athletes also completed brief weekly check-ins on device comfort, visibility during activity, and whether the data had been reviewed with a clinician that week.
The goal was a full picture of what athletes actually did — not what they said they did.
What the data is showing
Across the cohort, average daily wear time held at 17 hours plus through the full season. Compliance did not show the typical week-three cliff that appears in almost every other wearable protocol on record.
The strongest predictor of sustained adherence wasn't injury severity, sport type, or demographics. It was whether athletes reviewed their own data with a clinician at least once every two weeks.
The second strongest predictor was device friction — specifically, whether the band caught on pads during contact sessions. In UH's program, it didn't.
Adherence isn't discipline. It's the difference between what the device asks for and what it gives back.
What the UH adherence study revealed:
- Adherence tracked closely with athlete visibility into their own data
- Device form factor mattered more than expected across contact sports
- Sync failures had outsized psychological effect on wear rates
- Two-week clinician review cadence sustained engagement through full seasons
- Self-reported compliance overstated actual wear by 15 to 20 percent on average
The findings reshaped how UH designs monitoring protocols across the broader sports medicine program — and continue to inform how we think about adherence across every deployment on the Notus Labs platform.
High compliance isn't a sign of exceptional athletes. It's a sign of a device and workflow that don't ask them to be exceptional.
