Systematic review: digital biomarkers of fatigue in chronic diseases, 2025, Aboagye

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Systematic review: digital biomarkers of fatigue in chronic diseases - npj Digital Medicine

This systematic review explores the relationship between digital biomarkers, measured using wearable devices, and fatigue in patients with chronic diseases. Studies included in this review focused on individuals with diseases or conditions in 13 broad categories: multiple sclerosis (MS)...

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• Article
• Open access
• Published: 08 October 2025

Systematic review: digital biomarkers of fatigue in chronic diseases​

• Nana Yaw Aboagye,
• Chloe Hinchliffe,
• Silvia Del Din,
• Wan-Fai Ng,
• Kenneth F. Baker &
• Mark R. Baker

npj Digital Medicine volume 8, Article number: 602 (2025) Cite this article

Abstract​

This systematic review explores the relationship between digital biomarkers, measured using wearable devices, and fatigue in patients with chronic diseases.

Studies included in this review focused on individuals with diseases or conditions in 13 broad categories: multiple sclerosis (MS); rheumatoid arthritis (RA); chronic obstructive pulmonary disease (COPD); long COVID; cancer; chronic fatigue syndrome (CFS); pulmonary sarcoidosis; Parkinson’s disease; chronic stroke; chronic inflammatory rheumatic disease (CIRD); Inflammatory Bowel Diseases (IBD), Primary Sjogren’s Syndrome (PSS), and Systemic Lupus Erythematosus (SLE).

The review synthesizes findings on the correlation between objective digital biomarkers and self-reported fatigue, highlighting the potential for disease-specific digital biomarkers to inform personalized fatigue management.

The results suggest that reduced physical activity, increased sedentary behavior and autonomic dysfunction are associated with fatigue levels across multiple disease conditions included in this review, though the strength of this association and the specific biomarkers involved vary across diseases.

 

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...to inform personalized fatigue management. ​

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The results suggest that reduced physical activity, increased sedentary behavior and autonomic dysfunction are associated with fatigue levels across multiple disease conditions included in this review, though the strength of this association and the specific biomarkers involved vary across diseases.​

No mention of the direction of association?

 

[SNT Gatchaman]

No mention of the direction of association?

Sedentary behavior, characterized by prolonged periods of sitting or lying down, was another important biomarker of fatigue across multiple chronic diseases. Several studies reported that fatigued patients spent significantly more time in sedentary activities and less time engaging in physical movement. This was particularly pronounced in MS and cancer patients. For example, Cederberg et al. found that fatigued MS patients were more sedentary and took fewer steps compared to non-fatigued individuals. Sada et al. observed a similar trend in cancer survivors, where higher fatigue scores were associated with more time spent sitting or lying down, along with less moderate-to-vigorous physical activity (MVPA).

These findings are notable as they suggest a possible bidirectional relationship between fatigue and sedentary behavior: while fatigue may contribute to increased sedentary time, a sedentary lifestyle could, in turn, intensify fatigue. While this may be a logical interpretation, caution is necessary to avoid over-interpretation, as causality cannot be conclusively inferred from these data. This relationship further raises important considerations for designing interventions for patients with chronic diseases, simply encouraging increased physical activity may not be sufficient if prolonged sedentary behavior is left unaddressed. Interventions that break up sedentary time, such as promoting LPA throughout the day, could be more effective in reducing fatigue, likely known as “activity pacing”, explored in some studies as a framework for managing chronic pain and fatigue66.

[66] is Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study (2021)