Abstract

Background: Biological aging varies substantially among individuals of the same chronological age, yet biological aging biomarkers require biospecimen collection and laboratory processing, limiting scalability for repeated monitoring. Objective: This study evaluated whether consumer smartwatch-derived digital biomarkers are associated with the pace of biological aging, quantified using DunedinPACE, a biomarker that measures biological aging rates. Methods: Baseline data were analyzed from the Healthy Minds for Life study within the Precision Aging Network. Among 1305 enrolled participants, 621 community-dwelling adults aged 50–79 years had both DunedinPACE and smartwatch data available. Smartwatch-derived biomarkers were grouped into mobility, cardiorespiratory physiology, sleep, and physiological stress domains. Associations with DunedinPACE were examined using Spearman correlations and adjusted linear regression models. Results: Significant associations were observed across all four domains. Daily step count showed the strongest mobility-domain association with DunedinPACE (r = −0.25, p < 0.01). Mean sleep peripheral oxygen saturation showed the strongest sleep-domain association (r = −0.22, p < 0.01). Resting heart rate showed the strongest physiological stress-domain association (r = 0.24, p < 0.01). Adjusted regression models supported these findings, with lower daily mobility, poorer sleep oxygenation and efficiency, greater wake after sleep onset, and higher resting heart rate showing the most consistent associations with higher DunedinPACE values. Conclusions: Smartwatch-derived biomarkers captured a multidomain profile of accelerated biological aging characterized by lower mobility, poorer sleep health, and elevated physiological stress. Consumer wearables can provide low-burden, real-world indicators of biological vulnerability, although longitudinal studies are needed before clinical use.

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