## 5 Conclusions  
The pilot study demonstrated that the HRS had a positive impact on patients' QoL and increased adherence to self-care among chronic patients. The study also found that the HRS was highly usable for different participant groups, including caregivers and healthcare professionals. While the study revealed that the system was generally perceived as consistent and helpful, there is still room for improvement in terms of personalization of recommendations and the inclusion of more complex and deeper recommendations. To further advance the understanding of HRSs, future research should aim to explore the potential benefits and limitations of different types of recommendations and the real-time monitoring of patient vitals via wristband data. It is also crucial to expand the sample size and include different pilots and control groups to ensure the validity of the findings. Patient feedback should be incorporated into the system to iteratively improve the user experience. Despite the limitations of the study, the findings have important implications for the design and implementation of HRSs in sensorial ecosystems. Future research should aim to explore the long-term effects of the system on patients' QoL and identify potential factors that may influence these effects. By doing so, we can gain a better understanding of the potential benefits of HRSs and their applications in different contexts and populations. [PERSON] was the main developer of the code. [PERSON], [PERSON] and [PERSON] supported the health part, recruiting and guidance. [PERSON] and [PERSON] supported on the coordination of the work. All authors have read and agreed to the published version of the manuscript. This work has received funding from the European Commission under the European Union's Horizon 2020 program--grant agreement number 875325 (TeNDER project, afecTive basEd iNtegrateD carE for betteR Quality of Life). The paper solely reflects the views of the authors. The Commission is not responsible for the contents of this paper or any use made thereof. Figure 8: Post-interviews on the recommender satisfaction feedback surveys. **Institutional Review Board Statement:** This study respects the basic ethical principles of autonomy, benefence, justice and nonmaleficence, and its development followed the norms of Good Clinical Practice and the principles enunciated in the latest Declaration of Helsinki (Seoul, 2013). It has obtained a favorable report from the Research Ethics Board of the University Hospital 12 de Octubre and the approval of the Central Research Commission of the Community of Madrid. **Informed Consent Statement:** Informed consent was obtained from all participants involved in the study. No camera recording or any other identification was made. They were included with an anonymous identifier in the data collection logbook. **Data Availability Statement:** All data were processed based on the provisions of the EU General Data Protection Regulation (GDPR) 2016/679 of the European Parliament and of the Council, of 27 April 2016, and the Protection of Personal Data and Guarantee of Digital Rights (LODGDD, its acronym in Spanish) 3/2018, of 5 December. The data are not publicly available due to privacy restrictions. **Acknowledgments:** Participating technical partners and primary care health centers (PCHC) and family physicians (Grupo TeNDER Atencion Primaria). **Conflicts of Interest:** The authors declare no conflict of interest. **Abbreviations**  
The following abbreviations are used in this manuscript:  
QoL Quality of Life  
HRS Health Recommender System  
RS Recommender System  
AD Alzheimer Disease  
PD Parkinson Disease  
CVD Cardiovascular Disease  
AI Artificial Intelligence  
TRS Trustworthy Recommender Systems  
HLS High-Level Subsystem  
LLS Low-Level Subsystem  
EHR Electronic Health Record  
REST API RESTful Application Programming Interface  
**Appendix A. Questionnaire**  
**Table A1. ** Sample list of patient questionnaires.