Wearable Foundation Models Should Go Beyond Static Encoders

General-purpose wearable foundation models are pretrained on broad sensor streams and populations, but their representations are not organized around women's health. FemWear is a women's wearable foundation model, obtained by parameter-efficiently repurposing a pretrained general multimodal wearable backbone into a specialized representation for women's health. It keeps the pretrained patch projection and Transformer encoder frozen and trains 239,236 encoder parameters - 1.11% of a 21.54M-parameter encoder - through low-rank residual adapters and causal task-family heads, producing one shared longitudinal representation for menstrual, symptom, affective, sleep/recovery, autonomic, activity, and pregnancy outcomes. We evaluate six cohorts with 63 comparable primary metrics, 33 from women's-health cohorts, while retaining the 32-task OpenMHC ability-retention benchmark. On a fixed participant split over three seeds, FemWear improved cycle-phase macro-F1 by 8.15% and reduced mean absolute error for cramps, mood symptoms, and sleep problems by 9.32%, 5.80%, and 9.43%; 24-hour onset AUPRC decreased by 3.40%. A stricter 42-participant nested leave-one-participant-out audit retained positive changes for 24-hour onset (+2.87%), 72-hour onset (+6.35%), and cramps (+2.19%), while phase, mood, and sleep changes were neutral or negative and no endpoint had a strictly positive corrected confidence interval. Capacity-matched experiments beat a latest-day multilayer perceptron but not shared-GRU or multi-gate mixture-of-experts baselines. Train-only calibration reduced onset expected calibration error by 84.2-88.2% with zero temporal-nesting violations. FemWear is therefore a women's wearable foundation model: a reproducible, parameter-efficient specialization delivering targeted transfer across women's-health tasks and coherent probability outputs.

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.

Wearable sensors enable the continuous acquisition of high-resolution physiological waveforms, such as photoplethysmography and accelerometry, under free-living conditions. However, inferring health-related phenotypes from these signals presents significant challenges due to high sampling frequencies, multimodal dependencies, and extreme sequence lengths (e.g., weeks of recordings), compounded by a scarcity of ground-truth labels. To address these challenges, existing self-supervised learning (SSL) methodologies typically follow two paradigms: (1) learning rich morphological representations from short waveform segments while collapsing longitudinal dynamics through simple aggregation, or (2) modeling behavioral patterns from coarse, hand-crafted features (e.g. heart rate, step counts) spanning longer horizons but foregoing subtle, predictive signatures in raw waveforms. To bridge this gap, we propose WavesFM, a foundation model utilizing a two-stage SSL framework for longitudinal physiological data. Specifically, we decompose the learning problem into two stages: first, a segment-level encoder is pretrained to extract local embeddings from short waveforms; subsequently, a temporal encoder is trained to model the sequence of these embeddings across a multi-day horizon. This hierarchical approach overcomes the computational complexity of high-resolution, long-sequence data, allowing the overall model to capture both local signal semantics and the complex circadian and inter-day variations governing physiological dynamics. Pretrained on over 6.8M hours (N=324k individuals) of recordings for the first stage and 5.3M hours (N=10k) for the second stage, WavesFM demonstrates superior performance across 58 diverse tasks spanning demographics, lifestyle, health conditions, and medications.