{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T12:35:41Z","timestamp":1778589341177,"version":"3.51.4"},"reference-count":75,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"NIHR Newcastle Biomedical Research Centre, United Kingdom"},{"name":"Innovative Medicines Initiative 2 Joint Undertaking (IMI2 JU) project IDEA-FAST","award":["853981"],"award-info":[{"award-number":["853981"]}]},{"name":"Innovative Medicines Initiative 2 Joint Undertaking (IMI2 JU) project IDEA-FAST","award":["853981"],"award-info":[{"award-number":["853981"]}]},{"name":"Innovative Medicines Initiative 2 Joint Undertaking (IMI2 JU) project IDEA-FAST","award":["853981"],"award-info":[{"award-number":["853981"]}]},{"DOI":"10.13039\/100010414","name":"Health Research Board","doi-asserted-by":"publisher","award":["CRFC-2021-005"],"award-info":[{"award-number":["CRFC-2021-005"]}],"id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["EP\/X036146\/1"],"award-info":[{"award-number":["EP\/X036146\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR303620"],"award-info":[{"award-number":["NIHR303620"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["COV-LT2-022"],"award-info":[{"award-number":["COV-LT2-022"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>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\u2019s disease; chronic stroke; chronic inflammatory rheumatic disease (CIRD); Inflammatory Bowel Diseases (IBD), Primary Sjogren\u2019s 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.<\/jats:p>","DOI":"10.1038\/s41746-025-01939-x","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T05:22:13Z","timestamp":1759900933000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Systematic review: digital biomarkers of fatigue in chronic diseases"],"prefix":"10.1038","volume":"8","author":[{"given":"Nana Yaw","family":"Aboagye","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chloe","family":"Hinchliffe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Del Din","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan-Fai","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth F.","family":"Baker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R.","family":"Baker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"1939_CR1","first-page":"2461","volume":"23","author":"LN Saligan","year":"2015","unstructured":"Saligan, L. N. et al. The biology of cancer-related fatigue: a review of the literature. Support Care Cancer 23, 2461\u20132478 (2015).","journal-title":"Support Care Cancer"},{"key":"1939_CR2","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.eplepsyres.2011.03.010","volume":"95","author":"L Hernandez-Ronquillo","year":"2011","unstructured":"Hernandez-Ronquillo, L., Moien-Afshari, F., Knox, K., Britz, J. & Tellez-Zenteno, J. F. How to measure fatigue in epilepsy? The validation of three scales for clinical use. Epilepsy Res. 95, 119\u2013129 (2011).","journal-title":"Epilepsy Res."},{"key":"1939_CR3","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1038\/s41584-021-00692-1","volume":"17","author":"K Davies","year":"2021","unstructured":"Davies, K., Dures, E. & Ng, W.-F. Fatigue in inflammatory rheumatic diseases: current knowledge and areas for future research. Nat. Rev. Rheumatol. 17, 651\u2013664 (2021).","journal-title":"Nat. Rev. Rheumatol."},{"key":"1939_CR4","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3389\/fped.2017.00121","volume":"5","author":"PC Rowe","year":"2017","unstructured":"Rowe, P. C. et al. Myalgic encephalomyelitis\/chronic fatigue syndrome diagnosis and management in young people: a primer. Front. Pediatr. 5, 121 (2017).","journal-title":"Front. Pediatr."},{"key":"1939_CR5","doi-asserted-by":"publisher","first-page":"225","DOI":"10.2165\/00023210-200317040-00002","volume":"17","author":"LB Krupp","year":"2003","unstructured":"Krupp, L. B. Fatigue in multiple sclerosis. CNS Drugs 17, 225\u2013234 (2003).","journal-title":"CNS Drugs"},{"key":"1939_CR6","doi-asserted-by":"publisher","first-page":"591","DOI":"10.3390\/clinpract12040062","volume":"12","author":"WR Dar","year":"2022","unstructured":"Dar, W. R., Mir, I. A., Siddiq, S., Nadeem, M. & Singh, G. The assessment of fatigue in rheumatoid arthritis patients and its impact on their quality of life. Clin. Pract. 12, 591\u2013598 (2022).","journal-title":"Clin. Pract."},{"key":"1939_CR7","doi-asserted-by":"publisher","first-page":"e021745","DOI":"10.1136\/bmjopen-2018-021745","volume":"8","author":"YMJ Goertz","year":"2018","unstructured":"Goertz, Y. M. J. et al. Fatigue in patients with chronic obstructive pulmonary disease: protocol of the Dutch multicentre, longitudinal, observational FAntasTIGUE study. BMJ Open 8, e021745 (2018).","journal-title":"BMJ Open"},{"key":"1939_CR8","first-page":"135","volume":"65","author":"JE Freal","year":"1984","unstructured":"Freal, J. E., Kraft, G. H. & Coryell, J. K. Symptomatic fatigue in multiple sclerosis. Arch. Phys. Med Rehabil. 65, 135\u2013138 (1984).","journal-title":"Arch. Phys. Med Rehabil."},{"key":"1939_CR9","doi-asserted-by":"publisher","first-page":"e34384","DOI":"10.2196\/34384","volume":"10","author":"S Huhn","year":"2022","unstructured":"Huhn, S. et al. The impact of wearable technologies in health research: scoping review. JMIR Mhealth Uhealth 10, e34384 (2022).","journal-title":"JMIR Mhealth Uhealth"},{"key":"1939_CR10","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1016\/j.bbi.2023.08.008","volume":"113","author":"LG Roos","year":"2023","unstructured":"Roos, L. G. & Slavich, G. M. Wearable technologies for health research: opportunities, limitations, and practical and conceptual considerations. Brain Behav. Immun. 113, 444\u2013452 (2023).","journal-title":"Brain Behav. Immun."},{"key":"1939_CR11","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1159\/000502000","volume":"3","author":"LM Babrak","year":"2019","unstructured":"Babrak, L. M. et al. Traditional and digital biomarkers: two worlds apart?. Digit. Biomark. 3, 92\u2013102 (2019).","journal-title":"Digit. Biomark."},{"key":"1939_CR12","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1038\/s41746-019-0090-4","volume":"2","author":"A Coravos","year":"2019","unstructured":"Coravos, A., Khozin, S. & Mandl, K. D. Developing and adopting safe and effective digital biomarkers to improve patient outcomes. NPJ Digit. Med. 2, 14, https:\/\/doi.org\/10.1038\/s41746-019-0090-4 (2019).","journal-title":"NPJ Digit. Med."},{"key":"1939_CR13","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.trci.2018.04.003","volume":"4","author":"M Gold","year":"2018","unstructured":"Gold, M. et al. Digital technologies as biomarkers, clinical outcomes assessment, and recruitment tools in Alzheimer\u2019s disease clinical trials. Alzheimer\u2019s Dement. Transl. Res. Clin. Interv.4, 234\u2013242, https:\/\/doi.org\/10.1016\/j.trci.2018.04.003 (2018).","journal-title":"Alzheimer\u2019s Dement. Transl. Res. Clin. Interv."},{"key":"1939_CR14","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1159\/000510820","volume":"4","author":"J Robin","year":"2020","unstructured":"Robin, J. et al. Evaluation of speech-based digital biomarkers: review and recommendations. Digit. Biomark. 4, 99\u2013108, https:\/\/doi.org\/10.1159\/000510820 (2020).","journal-title":"Digit. Biomark."},{"key":"1939_CR15","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-019-0078-0","volume":"2","author":"NC Jacobson","year":"2019","unstructured":"Jacobson, N. C., Weingarden, H. & Wilhelm, S. Digital biomarkers of mood disorders and symptom change. NPJ Digital Med. 2, 3. https:\/\/doi.org\/10.1038\/s41746-019-0078-0 (2019).","journal-title":"NPJ Digital Med."},{"key":"1939_CR16","doi-asserted-by":"publisher","first-page":"104394","DOI":"10.1016\/j.msard.2022.104394","volume":"68","author":"A Torchio","year":"2022","unstructured":"Torchio, A. et al. Objective and subjective measures of daily physical activity in persons with Multiple Sclerosis beginning a rehabilitation regime: a cross-sectional study. Mult. Scler. Relat. Disord. 68, 104394 (2022).","journal-title":"Mult. Scler. Relat. Disord."},{"key":"1939_CR17","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.apmr.2014.08.023","volume":"96","author":"LJ Blikman","year":"2015","unstructured":"Blikman, L. J. et al. Is physical behavior affected in fatigued persons with multiple sclerosis?. Arch. Phys. Med. Rehabil. 96, 24\u201329 (2015).","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"1939_CR18","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.jpainsymman.2008.08.004","volume":"38","author":"RW Motl","year":"2009","unstructured":"Motl, R. W. & McAuley, E. Symptom cluster as a predictor of physical activity in multiple sclerosis: preliminary evidence. J. Pain. Symptom. Manag. 38, 270\u2013280 (2009).","journal-title":"J. Pain. Symptom. Manag."},{"key":"1939_CR19","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.jpeds.2016.08.104","volume":"179","author":"SA Grover","year":"2016","unstructured":"Grover, S. A. et al. Physical activity and its correlates in youth with multiple sclerosis. J. Pediatr. 179, 197\u2013203.e2 (2016).","journal-title":"J. Pediatr."},{"key":"1939_CR20","doi-asserted-by":"publisher","first-page":"108965","DOI":"10.1016\/j.isci.2024.108965","volume":"27","author":"M Moebus","year":"2024","unstructured":"Moebus, M. et al. Meaningful digital biomarkers derived from wearable sensors to predict daily fatigue in multiple sclerosis patients and healthy controls. iScience 27, 108965 (2024).","journal-title":"iScience"},{"key":"1939_CR21","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1038\/s41746-024-01025-8","volume":"7","author":"S Gashi","year":"2024","unstructured":"Gashi, S. et al. Modeling multiple sclerosis using mobile and wearable sensor data. npj Digit Med. 7, 64 (2024).","journal-title":"npj Digit Med."},{"key":"1939_CR22","doi-asserted-by":"publisher","first-page":"2522","DOI":"10.1080\/09638288.2023.2225876","volume":"46","author":"CD Jones","year":"2024","unstructured":"Jones, C. D. et al. Do fatigue and depression have a bivariate association with device-measured physical activity behavior in persons with multiple sclerosis?. Disabil. Rehabil. 46, 2522\u20132527 (2024).","journal-title":"Disabil. Rehabil."},{"key":"1939_CR23","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1093\/abm\/kay018","volume":"53","author":"AL Kratz","year":"2019","unstructured":"Kratz, A. L. et al. Daily temporal associations between physical activity and symptoms in multiple sclerosis. Ann. Behav. Med. 53, 98\u2013108 (2019).","journal-title":"Ann. Behav. Med."},{"key":"1939_CR24","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1080\/21641846.2021.1923995","volume":"9","author":"K Eldemir","year":"2021","unstructured":"Eldemir, K. et al. Associations between fatigue and physical behavior in patients with multiple sclerosis with no or minimal disability. Fatigue Biomed. Health Behav. 9, 69\u201378 (2021).","journal-title":"Fatigue Biomed. Health Behav."},{"key":"1939_CR25","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1016\/j.apmr.2021.12.022","volume":"103","author":"KLJ Cederberg","year":"2022","unstructured":"Cederberg, K. L. J. et al. Physical activity and sedentary behavior timing in fatigued and nonfatigued adults with multiple sclerosis. Arch. Phys. Med. Rehabil. 103, 1758\u20131765 (2022).","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"1939_CR26","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1080\/13548500802241902","volume":"14","author":"RW Motl","year":"2009","unstructured":"Motl, R. W. et al. Physical activity and quality of life in multiple sclerosis: intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol. Health Med. 14, 111\u2013124 (2009).","journal-title":"Psychol. Health Med."},{"key":"1939_CR27","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.3390\/jcm10061160","volume":"10","author":"G Abbadessa","year":"2021","unstructured":"Abbadessa, G. et al. Assessment of multiple sclerosis disability progression using a wearable biosensor: a pilot study. J. Clin. Med 10, 1160 (2021).","journal-title":"J. Clin. Med"},{"key":"1939_CR28","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.1088\/0967-3334\/33\/12\/2033","volume":"33","author":"F Yu","year":"2012","unstructured":"Yu, F. et al. A wireless body measurement system to study fatigue in multiple sclerosis. Physiol. Meas. 33, 2033\u20132048 (2012).","journal-title":"Physiol. Meas."},{"key":"1939_CR29","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1007\/s00415-016-8334-6","volume":"264","author":"VJ Block","year":"2017","unstructured":"Block, V. J. et al. Continuous daily assessment of multiple sclerosis disability using remote step count monitoring. J. Neurol. 264, 316\u2013326 (2017).","journal-title":"J. Neurol."},{"key":"1939_CR30","doi-asserted-by":"publisher","first-page":"1912","DOI":"10.1007\/s00415-020-09759-7","volume":"267","author":"S Shema-Shiratzky","year":"2020","unstructured":"Shema-Shiratzky, S. et al. A wearable sensor identifies alterations in community ambulation in multiple sclerosis: contributors to real-world gait quality and physical activity. J. Neurol. 267, 1912\u20131921 (2020).","journal-title":"J. Neurol."},{"key":"1939_CR31","doi-asserted-by":"publisher","first-page":"103941","DOI":"10.1016\/j.msard.2022.103941","volume":"64","author":"E Gervasoni","year":"2022","unstructured":"Gervasoni, E. et al. Physical activity in non-disabled people with early multiple sclerosis: a multicenter cross-sectional study. Mult. Scler. Relat. Disord. 64, 103941 (2022).","journal-title":"Mult. Scler. Relat. Disord."},{"key":"1939_CR32","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.3390\/s21113617","volume":"21","author":"Y Sagawa","year":"2021","unstructured":"Sagawa, Y. et al. Physical activity during weekdays and weekends in persons with multiple sclerosis. Sensors 21, 1170\u20131182 (2021).","journal-title":"Sensors"},{"key":"1939_CR33","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.dhjo.2016.10.006","volume":"10","author":"SL Kasser","year":"2017","unstructured":"Kasser, S. L. et al. Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: understanding patterns and time-bound relationships. Disabil. Health J. 10, 207\u2013213 (2017).","journal-title":"Disabil. Health J."},{"key":"1939_CR34","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.1109\/TNSRE.2023.3271601","volume":"31","author":"T VanDyk","year":"2023","unstructured":"VanDyk, T. et al. Digital phenotypes of instability and fatigue derived from daily standing transitions in persons with multiple sclerosis. IEEE Trans. Neural Syst. Rehabil. Eng. 31, 2279\u20132286 (2023).","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"1939_CR35","first-page":"205521732211034","volume":"8","author":"M Hilty","year":"2022","unstructured":"Hilty, M. et al. Continuous monitoring with wearables in multiple sclerosis reveals an association of cardiac autonomic dysfunction with disease severity. Mult. Scler. J. Exp. Transl. Clin. 8, 20552173221103436 (2022).","journal-title":"Mult. Scler. J. Exp. Transl. Clin."},{"key":"1939_CR36","first-page":"205521732097518","volume":"6","author":"CM Stuart","year":"2020","unstructured":"Stuart, C. M. et al. Physical activity monitoring to assess disability progression in multiple sclerosis. Mult. Scler. J. Exp. Transl. Clin. 6, 2055217320975185 (2020).","journal-title":"Mult. Scler. J. Exp. Transl. Clin."},{"key":"1939_CR37","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1097\/00005768-199704000-00014","volume":"29","author":"AV Ng","year":"1997","unstructured":"Ng, A. V. & Kent-Braun, J. A. Quantitation of lower physical activity in persons with multiple sclerosis. Med. Sci. Sports Exerc. 29, 517\u2013523 (1997).","journal-title":"Med. Sci. Sports Exerc."},{"key":"1939_CR38","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12984-019-0573-1","volume":"16","author":"HEM Braakhuis","year":"2019","unstructured":"Braakhuis, H. E. M. et al. Three distinct physical behavior types in fatigued patients with multiple sclerosis. J. Neuroeng. Rehabil. 16, 105 (2019).","journal-title":"J. Neuroeng. Rehabil."},{"key":"1939_CR39","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1037\/a0015985","volume":"28","author":"RW Motl","year":"2009","unstructured":"Motl, R. W. & McAuley, E. Pathways between physical activity and quality of life in adults with multiple sclerosis. Health Psychol. 28, 682\u2013689 (2009).","journal-title":"Health Psychol."},{"key":"1939_CR40","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1177\/1545968320916159","volume":"34","author":"WN Neal","year":"2020","unstructured":"Neal, W. N. et al. Is symptomatic fatigue associated with physical activity and sedentary behaviors among persons with multiple sclerosis?. Neurorehabil. Neural Repair 34, 505\u2013511 (2020).","journal-title":"Neurorehabil. Neural Repair"},{"key":"1939_CR41","doi-asserted-by":"publisher","first-page":"105025","DOI":"10.1016\/j.msard.2023.105025","volume":"79","author":"S Stephens","year":"2023","unstructured":"Stephens, S. et al. Sleep, physical activity, and psychological outcomes in children and adolescents with pediatric onset multiple sclerosis. Mult. Scler. Relat. Disord. 79, 105025 (2023).","journal-title":"Mult. Scler. Relat. Disord."},{"key":"1939_CR42","doi-asserted-by":"publisher","first-page":"104908","DOI":"10.1016\/j.msard.2023.104908","volume":"78","author":"M Luostarinen","year":"2023","unstructured":"Luostarinen, M. et al. Correlation of fatigue with disability and accelerometer-measured daily physical activity in patients with relapsing-remitting MS. Mult. Scler. Relat. Disord. 78, 104908 (2023).","journal-title":"Mult. Scler. Relat. Disord."},{"key":"1939_CR43","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.3390\/curroncol28020113","volume":"28","author":"T Martin","year":"2021","unstructured":"Martin, T. et al. The relationship between fatigue and actigraphy-derived sleep and rest-activity patterns in cancer survivors. Curr. Oncol. 28, 1170\u20131182 (2021).","journal-title":"Curr. Oncol."},{"key":"1939_CR44","doi-asserted-by":"publisher","first-page":"e0246101","DOI":"10.1371\/journal.pone.0246101","volume":"16","author":"YH Sada","year":"2021","unstructured":"Sada, Y. H. et al. Harnessing digital health to objectively assess cancer-related fatigue: the impact of fatigue on mobility performance. PLoS ONE 16, e0246101 (2021).","journal-title":"PLoS ONE"},{"key":"1939_CR45","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1002\/cncr.34531","volume":"129","author":"JK Vallance","year":"2023","unstructured":"Vallance, J. K. et al. Associations of device-measured physical activity and sedentary time with quality of life and fatigue in newly diagnosed breast cancer patients: baseline results from the AMBER cohort study. Cancer 129, 296\u2013306 (2023).","journal-title":"Cancer"},{"key":"1939_CR46","doi-asserted-by":"publisher","first-page":"e0280343","DOI":"10.1371\/journal.pone.0280343","volume":"18","author":"C Burton","year":"2023","unstructured":"Burton, C. et al. Within and between-day variation and associations of symptoms in Long Covid: Intensive longitudinal study. PLoS ONE 18, e0280343 (2023).","journal-title":"PLoS ONE"},{"key":"1939_CR47","doi-asserted-by":"publisher","first-page":"e15912","DOI":"10.14814\/phy2.15912","volume":"12","author":"MH Haischer","year":"2024","unstructured":"Haischer, M. H. et al. Heart rate variability is reduced in COVID-19 survivors and associated with physical activity and fatigue. Physiol. Rep. 12, e15912 (2024).","journal-title":"Physiol. Rep."},{"key":"1939_CR48","doi-asserted-by":"crossref","unstructured":"Burton, C., Dawes, H., Goodwill, S., Thelwell, M. & Dalton, C. Symptom variation, correlations, and relationship to physical activity in Long Covid: intensive longitudinal study. https:\/\/www.medrxiv.org\/content\/10.1101\/2022.05.31.22275746v1 (2022).","DOI":"10.1101\/2022.05.31.22275746"},{"key":"1939_CR49","first-page":"34","volume":"9","author":"CN Driver","year":"2022","unstructured":"Driver, C. N., Novotny, P. J. & Benzo, R. P. Differences in sedentary time, light physical activity, and steps associated with better COPD quality of life. Chronic Obstr. Pulm. Dis. 9, 34\u201344 (2022).","journal-title":"Chronic Obstr. Pulm. Dis."},{"key":"1939_CR50","doi-asserted-by":"publisher","first-page":"107424","DOI":"10.1016\/j.rmed.2023.107424","volume":"219","author":"A Blondeel","year":"2023","unstructured":"Blondeel, A. et al. Factors associated to physical activity in patients with COPD: an ecological approach. Respir. Med. 219, 107424 (2023).","journal-title":"Respir. Med."},{"key":"1939_CR51","doi-asserted-by":"publisher","first-page":"110417","DOI":"10.1016\/j.jpsychores.2021.110417","volume":"144","author":"K Vergauwen","year":"2021","unstructured":"Vergauwen, K. et al. An exploratory study of discrepancies between objective and subjective measurement of the physical activity level in female patients with chronic fatigue syndrome. J. Psychosom. Res 144, 110417 (2021).","journal-title":"J. Psychosom. Res"},{"key":"1939_CR52","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.jpsychores.2011.04.004","volume":"71","author":"RM Evering","year":"2011","unstructured":"Evering, R. M., T\u00f6nis, T. M. & Vollenbroek-Hutten, M. M. Deviations in daily physical activity patterns in patients with the chronic fatigue syndrome: a case control study. J. Psychosom. Res. 71, 129\u2013135 (2011).","journal-title":"J. Psychosom. Res."},{"key":"1939_CR53","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-45387-7","volume":"13","author":"V Hamy","year":"2023","unstructured":"Hamy, V. et al. Patient-centric assessment of rheumatoid arthritis using a smartwatch and bespoke mobile app in a clinical setting. Sci. Rep. 13, 18311 (2023).","journal-title":"Sci. Rep."},{"key":"1939_CR54","doi-asserted-by":"publisher","first-page":"4548","DOI":"10.1093\/rheumatology\/keab029","volume":"60","author":"CM O\u2019Brien","year":"2021","unstructured":"O\u2019Brien, C. M. et al. Pain and fatigue are longitudinally and bi-directionally associated with more sedentary time and less standing time in rheumatoid arthritis. Rheumatology 60, 4548\u20134557 (2021).","journal-title":"Rheumatology"},{"key":"1939_CR55","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1002\/acr.24207","volume":"73","author":"H O\u2019Leary","year":"2021","unstructured":"O\u2019Leary, H. et al. Relationship between pain and sedentary behavior in rheumatoid arthritis patients: a cross-sectional study. Arthritis Care Res. 73, 990\u2013997 (2021).","journal-title":"Arthritis Care Res."},{"key":"1939_CR56","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12969-016-0125-1","volume":"14","author":"W Armbrust","year":"2016","unstructured":"Armbrust, W. et al. Fatigue in patients with Juvenile Idiopathic Arthritis: relationship to perceived health, physical health, self-efficacy, and participation. Pediatr. Rheumatol. 14, 65 (2016).","journal-title":"Pediatr. Rheumatol."},{"key":"1939_CR57","doi-asserted-by":"publisher","first-page":"968185","DOI":"10.3389\/fphys.2022.968185","volume":"13","author":"E Antikainen","year":"2022","unstructured":"Antikainen, E. et al. Assessing fatigue and sleep in chronic diseases using physiological signals from wearables: a pilot study. Front. Physiol 13, 968185 (2022).","journal-title":"Front. Physiol"},{"key":"1939_CR58","doi-asserted-by":"publisher","first-page":"3944","DOI":"10.3390\/ijerph20053944","volume":"20","author":"AJ Pinto","year":"2023","unstructured":"Pinto, A. J. et al. Increased prolonged sitting in patients with rheumatoid arthritis during the COVID-19 pandemic: a within-subjects, accelerometer-basedstudy. Int. J. Environ. Res. Public Health 20, 3944 (2023).","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"1939_CR59","doi-asserted-by":"publisher","first-page":"1279722","DOI":"10.3389\/fnagi.2023.1279722","volume":"15","author":"A Pilotto","year":"2023","unstructured":"Pilotto, A. et al. Unsupervised but not supervised gait parameters are related to fatigue in Parkinsonas disease: a pilot study. Front. Aging Neurosci 15, 1279722 (2023).","journal-title":"Front. Aging Neurosci"},{"key":"1939_CR60","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.3390\/jcm10061320","volume":"10","author":"ML S\u00e1nchez-S\u00e1nchez","year":"2021","unstructured":"S\u00e1nchez-S\u00e1nchez, M. L. et al. Association of barriers, fear of falling and fatigue with objectively measured physical activity and sedentary behavior in chronic stroke. J. Clin. Med. 10, 1170\u20131182 (2021).","journal-title":"J. Clin. Med."},{"key":"1939_CR61","doi-asserted-by":"publisher","first-page":"1099456","DOI":"10.3389\/fdgth.2023.1099456","volume":"5","author":"C Rao","year":"2023","unstructured":"Rao, C. et al. Association of digital measures and self-reported fatigue: a remote observational study in healthy participants and participants with chronic inflammatory rheumatic disease. Front. Digit. Health 5, 1099456 (2023).","journal-title":"Front. Digit. Health"},{"key":"1939_CR62","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s00408-019-00215-6","volume":"197","author":"PSP Cho","year":"2019","unstructured":"Cho, P. S. P. et al. Physical inactivity in pulmonary sarcoidosis. Lung 197, 285\u2013293 (2019).","journal-title":"Lung"},{"key":"1939_CR63","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1177\/1545968312437943","volume":"26","author":"RW Motl","year":"2012","unstructured":"Motl, R. W. et al. Energy cost of walking and its association with gait parameters, daily activity, and fatigue in persons with mild multiple sclerosis. Neurorehabil. Neural Repair 26, 1015\u20131021 (2012).","journal-title":"Neurorehabil. Neural Repair"},{"key":"1939_CR64","doi-asserted-by":"publisher","first-page":"e38495","DOI":"10.2196\/38495","volume":"9","author":"P Chikersal","year":"2022","unstructured":"Chikersal, P. et al. Predicting multiple sclerosis outcomes during the COVID-19 stay-at-home period: observational study using passively sensed behaviors and digital phenotyping. JMIR Ment. Health 9, e38495 (2022).","journal-title":"JMIR Ment. Health"},{"key":"1939_CR65","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1002\/art.11384","volume":"49","author":"B Str\u00f6mbeck","year":"2003","unstructured":"Str\u00f6mbeck, B. et al. Physical capacity in women with primary Sj\u00f6gren\u2019s syndrome: a controlled study. Arthritis Rheum. 49, 681\u2013688 (2003).","journal-title":"Arthritis Rheum."},{"key":"1939_CR66","doi-asserted-by":"publisher","first-page":"e045398","DOI":"10.1136\/bmjopen-2020-045398","volume":"11","author":"D Antcliff","year":"2021","unstructured":"Antcliff, D. et al. Testing a newly developed activity pacing framework for chronic pain\/fatigue: a feasibility study. BMJ Open 11, e045398 (2021).","journal-title":"BMJ Open"},{"key":"1939_CR67","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1016\/j.jbmt.2024.10.043","volume":"40","author":"M Sharafkhah","year":"2024","unstructured":"Sharafkhah, M., Moayedi, F., Alimi, N., Haghighi Fini, Z. & Massoudifar, A. Motor and non-motor predictors of freezing of gait in Parkinson\u2019s disease: a retrospective cohort study. J. Bodyw. Mov. Ther. 40, 1774\u20131781, https:\/\/doi.org\/10.1016\/j.jbmt.2024.10.043 (2024).","journal-title":"J. Bodyw. Mov. Ther."},{"key":"1939_CR68","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.clinph.2007.09.126","volume":"119","author":"MJ Zwarts","year":"2008","unstructured":"Zwarts, M. J., Bleijenberg, G. & van Engelen, B. G. Clinical neurophysiology of fatigue. Clin. Neurophysiol. 119, 2\u201310, https:\/\/doi.org\/10.1016\/j.clinph.2007.09.126 (2008).","journal-title":"Clin. Neurophysiol."},{"key":"1939_CR69","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1093\/qjmed\/hcm057","volume":"100","author":"JL Newton","year":"2007","unstructured":"Newton, J. L. et al. Symptoms of autonomic dysfunction in chronic fatigue syndrome. QJM 100, 519\u2013526 (2007).","journal-title":"QJM"},{"key":"1939_CR70","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.1136\/annrheumdis-2011-201009","volume":"71","author":"JL Newton","year":"2012","unstructured":"Newton, J. L. et al. Autonomic symptoms are common and are associated with overall symptom burden and disease activity in primary Sj\u00f6gren\u2019s syndrome. Ann. Rheum. Dis. 71, 1973 (2012).","journal-title":"Ann. Rheum. Dis."},{"key":"1939_CR71","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1093\/qjmed\/hcs172","volume":"105","author":"WF Ng","year":"2012","unstructured":"Ng, W. F. et al. Primary Sj\u00f6gren\u2019s syndrome is associated with impaired autonomic response to orthostasis and sympathetic failure. QJM 105, 1191\u20131199 (2012).","journal-title":"QJM"},{"key":"1939_CR72","doi-asserted-by":"publisher","first-page":"102097","DOI":"10.1016\/j.eujim.2021.102097","volume":"49","author":"MK Hyun","year":"2022","unstructured":"Hyun, M. K. How fatigue level is related to sleep disturbances: a large cross-sectional community study. Eur. J. Integr. Med. 49, 102097, https:\/\/doi.org\/10.1016\/j.eujim.2021.102097 (2022).","journal-title":"Eur. J. Integr. Med."},{"key":"1939_CR73","doi-asserted-by":"publisher","first-page":"R1980","DOI":"10.1152\/ajpregu.00925.2007","volume":"294","author":"A Kishi","year":"2008","unstructured":"Kishi, A., Struzik, Z. R., Natelson, B. H., Togo, F. & Yamamoto, Y. Dynamics of sleep stage transitions in healthy humans and patients with chronic fatigue syndrome. Am. J. Physiol. Regul. Integr. Comp. Physiol. 294, R1980\u2013R1987, https:\/\/doi.org\/10.1152\/ajpregu.00925.2007 (2008).","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"1939_CR74","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71 (2021).","journal-title":"BMJ"},{"key":"1939_CR75","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1136\/jech.52.6.377","volume":"52","author":"SH Downs","year":"1998","unstructured":"Downs, S. H. & Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J. Epidemiol. Community Health 52, 377 (1998).","journal-title":"J. Epidemiol. Community Health"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01939-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01939-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01939-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T07:04:10Z","timestamp":1759907050000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01939-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":75,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1939"],"URL":"https:\/\/doi.org\/10.1038\/s41746-025-01939-x","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,8]]},"assertion":[{"value":"18 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"SDD reports consultancy activity with Hoffmann-La Roche Ltd. outside of this study. Other authors declare no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"602"}}