Conor Heneghan

Girish Narayanswamy, Maxwell A. Xu, A. Ali Heydari et al.

While ubiquitous wearable sensors capture a wealth of behavioral and physiological information, effectively transforming these signals into personalized health insights is challenging. Specifically, converting low-level sensor data into representations capable of characterizing higher-level states is difficult due to high phenotypic diversity and variation in individual baseline health, physiology, and lifestyle factors. Moreover, collecting wearable data paired with health outcome annotations is laborious and expensive, and retrospective annotation remains practically unfeasible, contributing to a scarcity of data with high-quality labels. To overcome these limitations, we propose a foundation model for wearable health that is pretrained on more than one trillion minutes of unlabeled sensor signals drawn from a large cohort of five million participants. We demonstrate that the joint scaling of model capacity and pretraining data volume leads to systematic improvements in performance, as evaluated on a diverse set of 35 health prediction tasks, spanning cardiovascular, metabolic, sleep, and mental health, as well as lifestyle choices and demographic factors. We find that this population scale representation unlocks label-efficient few-shot learning and generative capabilities for robust daily metric estimation. To further leverage this learned representation, we deploy a classroom of LLM agents to autonomously search the space of downstream predictive heads built on the model embeddings, showing broad performance improvements that increase with LLM model capacity. Finally, we show how integrating these downstream predictors into a Personal Health Agent can support model responses that are more relevant, contextually aware, and safe, and we validate this via 1,860 ratings from a cohort of clinicians.

Ahmed A. Metwally, A. Ali Heydari, Daniel McDuff et al.

Insulin resistance, a precursor to type 2 diabetes, is characterized by impaired insulin action in tissues. Current methods for measuring insulin resistance, while effective, are expensive, inaccessible, not widely available and hinder opportunities for early intervention. In this study, we remotely recruited the largest dataset to date across the US to study insulin resistance (N=1,165 participants, with median BMI=28 kg/m2, age=45 years, HbA1c=5.4%), incorporating wearable device time series data and blood biomarkers, including the ground-truth measure of insulin resistance, homeostatic model assessment for insulin resistance (HOMA-IR). We developed deep neural network models to predict insulin resistance based on readily available digital and blood biomarkers. Our results show that our models can predict insulin resistance by combining both wearable data and readily available blood biomarkers better than either of the two data sources separately (R2=0.5, auROC=0.80, Sensitivity=76%, and specificity 84%). The model showed 93% sensitivity and 95% adjusted specificity in obese and sedentary participants, a subpopulation most vulnerable to developing type 2 diabetes and who could benefit most from early intervention. Rigorous evaluation of model performance, including interpretability, and robustness, facilitates generalizability across larger cohorts, which is demonstrated by reproducing the prediction performance on an independent validation cohort (N=72 participants). Additionally, we demonstrated how the predicted insulin resistance can be integrated into a large language model agent to help understand and contextualize HOMA-IR values, facilitating interpretation and safe personalized recommendations. This work offers the potential for early detection of people at risk of type 2 diabetes and thereby facilitate earlier implementation of preventative strategies.

Samy Abdel-Ghaffar, Isaac Galatzer-Levy, Conor Heneghan et al.

The autonomic nervous system (ANS) is activated during stress, which can have negative effects on cardiovascular health, sleep, the immune system, and mental health. While there are ways to quantify ANS activity in laboratories, there is a paucity of methods that have been validated in real-world contexts. We present the Fitbit Body Response Algorithm, an approach to continuous remote measurement of ANS activation through widely available remote wrist-based sensors. The design was validated via two experiments, a Trier Social Stress Test (n = 45) and ecological momentary assessments (EMA) of perceived stress (n=87), providing both controlled and ecologically valid test data. Model performance predicting perceived stress when using all available sensor modalities was consistent with expectations (accuracy=0.85) and outperformed models with access to only a subset of the signals. We discuss and address challenges to sensing that arise in real world settings that do not present in conventional lab environments.

Justin Cosentino, Anastasiya Belyaeva, Xin Liu et al.

In health, most large language model (LLM) research has focused on clinical tasks. However, mobile and wearable devices, which are rarely integrated into such tasks, provide rich, longitudinal data for personal health monitoring. Here we present Personal Health Large Language Model (PH-LLM), fine-tuned from Gemini for understanding and reasoning over numerical time-series personal health data. We created and curated three datasets that test 1) production of personalized insights and recommendations from sleep patterns, physical activity, and physiological responses, 2) expert domain knowledge, and 3) prediction of self-reported sleep outcomes. For the first task we designed 857 case studies in collaboration with domain experts to assess real-world scenarios in sleep and fitness. Through comprehensive evaluation of domain-specific rubrics, we observed that Gemini Ultra 1.0 and PH-LLM are not statistically different from expert performance in fitness and, while experts remain superior for sleep, fine-tuning PH-LLM provided significant improvements in using relevant domain knowledge and personalizing information for sleep insights. We evaluated PH-LLM domain knowledge using multiple choice sleep medicine and fitness examinations. PH-LLM achieved 79% on sleep and 88% on fitness, exceeding average scores from a sample of human experts. Finally, we trained PH-LLM to predict self-reported sleep quality outcomes from textual and multimodal encoding representations of wearable data, and demonstrate that multimodal encoding is required to match performance of specialized discriminative models. Although further development and evaluation are necessary in the safety-critical personal health domain, these results demonstrate both the broad knowledge and capabilities of Gemini models and the benefit of contextualizing physiological data for personal health applications as done with PH-LLM.