Recently, research on wearable devices for physiological exercise monitoring has garnered significant attention. Here, we propose a dual wave-structured triboelectric nanogenerator (DW-TENG) integrated with a cotton cloth, developed for smart running applications. The DW-TENG sensor leverages a flexible wave triboelectric layer composed of polydimethylsiloxane and silicone, with a copper electrode layer between them for sensing. This structure allows for customizable pressure sensitivity by adjusting the silicone hardness. Experimental results show that the DW-TENG achieves a sensitivity of 0.4 V kPa−1, with response and recovery times of 75 and 90 ms, respectively. The sensor effectively measures heart rate changes during various physical activities, including walking, running, and jumping. Electrical performance tests reveal that the DW-TENG’s output is significantly influenced by the silicone hardness, operational frequency, and microstructure height. The DW-TENG sensor demonstrates high durability and stability, maintaining consistent voltage output over 40 000 cycles. This research highlights the potential of the DW-TENG in multifunctional physiological and physical activity monitoring, providing real-time data on respiratory patterns, heart rate, and movement dynamics, thus enhancing athletic training, performance assessment, and health monitoring.