The emergence of flexible sensors addresses the limitations of traditional detection equipment, such as large size, high cost, and inconvenient portability. These sensors have significantly advanced the development of wearable electronic devices for applications in electronic skin, energy harvesting, and energy storage. To enhance the sensitivity of flexible sensors, we developed a hierarchical polyvinylidene fluoride (PVDF) nanofiber-based piezoelectric sensor. By utilizing coaxial electrospinning, we fabricated nanofibers with hollow interiors and porous outer walls. Additionally, microstructures were constructed on the fiber membrane surface by modifying the collector’s shape. The resulting microstructured hollow PVDF nanofiber membrane exhibited high β-phase content (91.31 %), excellent flexibility (maximum strain 56.9 %), and high porosity (88.94 %). The sensor demonstrated a sensitivity of 2.7 V/N (1.08 V/kPa) and a maximum output voltage of 10.1 V, approximately three times higher than that of solid PVDF nanofibers without microstructures. Even after 14,400 cycles of impact, the sensor maintained stable output. The sensor was successfully applied to human activity monitoring and gesture recognition, showcasing its ability to monitor various human activities, respond rapidly (60.4 ms), and synchronously control a mechanical palm to perform different gestures. This work highlights the potential of hierarchically structured hollow PVDF nanofibers in advancing the performance and application scope of flexible piezoelectric sensors.