Health foundation models (FMs) learn useful representations from wearable sensors, but interpreting what they encode and transferring that knowledge across modalities after training remains difficult. We present a post-training framework that decomposes frozen embeddings into interpretable directions, referred to as symbols, and use these symbols to align the embedding spaces without retraining. We evaluate the framework on three FMs for photoplethysmography (PPG) and accelerometer data, independently pretrained on ~20M minutes of unlabeled data from ~172K participants, and analyzed on a held-out cohort of 30K subjects. We find that extracted symbols associate selectively with health conditions and physiological attributes, and these associations are partially shared across modalities and architectures. Cross-modal transfer via symbols retains more than 95% of in-domain performance, is nearly symmetric across domain directions, and saturates with limited paired data, together indicating that alignment recovers a shared low-dimensional subspace rich in physiological information. Overall, these results suggest that health FM embeddings contain an interpretable symbolic organization that is shared across modalities and supports cross-domain transfer without joint training.
Foundation models (FMs) trained on large-scale accelerometer data have been proposed as general-purpose feature extractors for health monitoring, but systematic evidence of their advantages is lacking. We present the first comprehensive evaluation of four open-source accelerometer FMs against supervised baselines covering 19 tasks across the domains of activity recognition including activities of daily living, clinical monitoring, and physiological inference. We find task-dependent performance results: supervised models remain competitive with FMs on human action recognition (HAR), with no consistent advantage for either, while selected FMs lead on fall and stress detection and are the most robust to sensor-placement variation. As frozen feature extractors, FMs are strongest for demographic inference, whereas sleep staging performance remains near chance level for all models. The internal FM representations show strong similarity across layers, highlighting potential for future FM improvements. Linear and frozen probing reveals that UniMTS provides the strongest representations and is the only FM that surpasses the supervised baselines without finetuning. Concept discovery analysis shows all models capture high-intensity activities clearly but struggle with sedentary, complex or ambiguous activities. We provide scenario-based deployment recommendations. Furthermore, we identify FM-derived activity profile inference-moving beyond fixed category classification-as a promising research direction.
Alexander Bräuer, Benjamin Cauchi, Nils Strodthoff
Foundation models offer a promising route to compress multi-modal physiological signals into compact representations of human health, with broad applications across sleep medicine, cardiology, neurology and other healthcare domains. Existing models have typically been trained with masked-reconstruction or contrastive objectives. However, masked reconstruction may be poorly suited to the stochastic nature of these signals, while contrastive approaches rely on positive-pair definitions despite the semantic invariances of physiological signals being poorly understood. In this work, we show that next-token prediction is a simple and scalable alternative. We develop Hypnos, a multi-modal sleep foundation model trained using eight different sensing modalities (e.g. EEG, ECG, respiratory signals) drawn from over 20,000 overnight polysomnography recordings. We tokenize each modality into streams of discrete tokens using residual vector quantization, then train a large auto-regressive RQ-Transformer to jointly predict the next token across all modalities in parallel. After training, Hypnos can be applied to continuous streams of sensor data from any subset of supported modalities, generating embeddings for downstream tasks. Across a range of benchmarks, Hypnos significantly outperforms existing foundation models. In sleep stage classification, we match the performance of strong supervised baselines on held-out test sets whilst using 100× less labelled data. Hypnos even generalises to daytime physiology, surpassing a dedicated ECG foundation model at detecting atrial fibrillation. Our results demonstrate that next-token prediction is a strong self-supervised objective for representation learning from multi-modal physiological signals.
Tabular foundation models (TFMs) achieve strong performance on health datasets, but their inference cost and infrastructure requirements limit practical use. We study whether their predictive behavior can be transferred to lightweight tabular models through knowledge distillation. Since in-context TFMs condition on the training set at inference time, naive distillation can introduce context leakage; we address this with stratified out-of-fold teacher labeling. Across 19 healthcare datasets, 6 TFM teachers, 4 student families, and several multi-teacher ensembles, we find that distilled students retain at least 90% of teacher AUC, outperforming teachers in some cases, while running at least 26× faster on CPU and preserving calibration and fairness critical for health applications. Moreover, multi-teacher averaging does not consistently improve over the best single teacher. Leakage-aware distillation is thus a viable route for bringing TFM-quality predictions into inference-constrained health settings.