Wearables are widely used for mobile health monitoring, and photoplethysmography (PPG) is a key sensing modality for heart rate and related physiological measurements. However, public in-the-wild PPG datasets remain largely wrist-centric or limited to short, controlled studies, constraining research on emerging wearable form factors. We present Multi-site PPG, an in-the-wild physiological dataset collected from four custom-developed unobtrusive wearables: a smart earring, ring, watch, and necklace. Each device records green and infrared reflective PPG, 3-axis acceleration, and temperature with timestamps for cross-device alignment, while a Polar H10 chest strap provides reference electrocardiogram (ECG). Participants wore the devices for multiple days during daytime activities while continuing their normal routines. The dataset contains over 350 hours of raw data and 230-290 hours of modeling-ready 8-second windows per wearable. We benchmark heuristic, supervised, and self-supervised heart-rate estimation methods, showing substantial body-site differences: the best methods achieve mean absolute errors (MAEs) of 2.30 bpm on the earring, 5.13 bpm on the ring, 8.37 bpm on the watch, and 8.68 bpm on the necklace. We further analyze motion effects and evaluate multi-site and PPG-accelerometer fusion, demonstrating the dataset's value for robust physiological sensing across emerging wearable form factors.
Photoplethysmography (PPG), a non-invasive measure of changes in blood volume, is widely used in both wearable devices and clinical settings. Recent PPG foundation models either use open-source ICU datasets with pretraining paradigms that require curated data and thus complicate generalization to field-like data, or use closed-source field-like PPG data. In contrast, we propose a PPG foundation model that does not require high-quality or field-like pretraining data, and instead leverages accompanying electrocardiogram and respiratory signals in ICU datasets to select contrastive samples during pretraining. Our approach allows the model to retain and learn from noisy PPG segments, improving robustness at inference. Our model, pretrained on 3x fewer subjects than existing state-of-the-art approaches, achieves performance improvements on 14 out of 15 diverse downstream tasks, including field-like daily activity and heart rate prediction. Our results demonstrate that multimodal supervision can integrate complementary physiological information to improve the robustness of PPG foundation models and enhance their generalization to consumer-grade data.
Photoplethysmography (PPG) plays a central role in wearable health monitoring and clinical decision support. Yet existing approaches to universal PPG representation learning largely focus on signal-level objectives and often overlook patient-level health context, which limits generalization to complex clinical tasks and heterogeneous cohorts. To address this gap, we construct a large-scale paired PPG-EHR multimodal dataset by distilling fragmented medical histories and clinical records into cohesive, patient-level electronic health records (EHR). Building on this resource, we propose Clinical Anchored Pretraining for PPG (CAP). During pretraining, CAP performs cross-modal contrastive alignment that anchors PPG representations to patient-level clinical semantics, guiding the encoder beyond waveform fitting toward modeling consistency in a patient's overall physiological state. During downstream adaptation, the pretrained PPG encoder provides clinically grounded representations that strengthen inductive bias and improve robustness and transferability. Experiments demonstrate that CAP consistently outperforms strong baselines on four diverse downstream tasks. CAP achieves a particularly large gain on respiratory rate prediction (up to +87.6% relative improvement over the state-of-the-art baseline) and delivers an average relative +26.7% across all tasks. We further enhance the interpretability of our approach through comprehensive analyses, including ablations and multiple complementary visualizations of the learned representations. The code for our experiments is available at: https://github.com/gody123gody/CAP .
Remote photoplethysmography (rPPG) enables non-contact heart-rate estimation from facial videos, but its weak physiological signal is easily corrupted by motion, illumination changes, occlusion, skin-appearance variation, and device noise. Existing rPPG methods typically rely on a single model to directly predict heart rate or recover pulse waveforms, while different strong estimators may produce conflicting yet individually plausible candidates for the same video. To resolve these conflicts, we propose PhysAgent, an inference-time multi-agent candidate-verification framework. Unlike direct prediction approaches, PhysAgent neither trains a new base rPPG model nor asks Multimodal Large Language Models (MLLMs) to output heart rate directly. In contrast, it treats outputs from multiple base estimators as physiological hypotheses to be verified and uses a lightweight 4B MLLM, Qwen3-VL-4B, to drive multi-agent reasoning over video conditions, signal reliability, and candidate disagreement. A deterministic physiological verifier checks the fusion proposal, and a reproducible numerical fusion process produces the final heart rate. Experimental results on multiple public rPPG benchmarks show that PhysAgent improves fusion stability and reliability across different datasets and source-domain settings, while avoiding the irreproducibility and physiological inconsistency of direct MLLM prediction or unconstrained ensemble fusion. The code will be released soon.