Abstract The integration of cognitive radio with e-healthcare systems assisted by wireless body sensor networks (WBSNs) has been regarded as an enabling approach for a new generation of pervasive healthcare services, to provide differentiated quality of service requirements and avoid harmful electromagnetic interference to primary medical devices (PMDs) over the crowded radio spectrum. Due to the sharing spectrum bands with PMDs in e-healthcare scenario using cognitive WBSNs (CWBSNs), efficient transmit power control and optimization strategies for resource-constrained secondary wearable biosensors (SWBs) play a key role in controlling the inter-network interference and improving the energy efficiency. This paper investigates the problem of dynamic power optimization for SWBs in e-healthcare leveraging CWBSNs with practical limitations, e.g., imperfect spectrum sensing and quality of physiological data sampling. We develop a distributed optimization framework of dynamic power optimization via the theory of differential game, by jointly considering utility maximization and quality of physiological data sampling for every SWB, while satisfying the evolution law of energy consumption in SWB’s battery. With the non-cooperation and cooperation relations for all SWBs in mind, we transform the differential game model into two subproblems, namely, utility maximization problem and total utility maximization problem. Utilizing Bellman’s dynamic programming, we derive a non-cooperative optimal solution for power optimization as a Nash equilibrium point for the utility maximization problem posed by competitive scenario. By exploiting Pontryagin’s maximum principle, a cooperative optimal solution is obtained for the total utility maximization problem, wherein all SWBs fully cooperate to obtain the highest total utilities. Building upon the analytical results, the actual utility distributed to each SWB is compared between the non-cooperative and cooperative schemes. Extensive simulations show that the proposed optimization framework is indeed an efficient and practical solution for power control compared with the benchmark algorithm.