Tolerability and the Accelerome: Open-Source Wrist Accelerometry Relates to Symptom Burden in Androgen Ablated Older...

Older men on androgen suppression for prostate cancer experience substantial symptom burden that is often missed between clinic visits. In prior work from our group, frequency-domain features ranked highly for predicting geriatric impairment, motivating a focus on interpretable spectral measures from open-source wrist accelerometry. Our overall objective was to identify accelerometry features from a pre-specified library that track weekly symptom burden in older men on ADT, and to characterize the temporal scale of the top candidates; spectral features were of particular interest.

A retrospective secondary analysis of an open-source pilot was performed. Ten men ≥65 years with metastatic prostate cancer completed weekly symptom burden and self-rated health over ∼100 days. Symptom-triggered (and random) 48-h, 10-Hz wrist-accelerometry sessions were aggregated to 60-s counts-per-minute (CPM) and vector-magnitude change. From these, 98 pre-specified statistical and spectral features were extracted. Associations with a weekly Symptom Burden + Self-Rated Health Index composite (SBSI) were assessed using linear mixed-effects models (days + random intercept), Spearman correlations across five 30-day bins, penalized mixed-effects regression least absolute shrinkage and selection operator (λ = 0.5, 1), and a 500-tree random forest.

Nine participants provided 44 monitoring windows (14-48 h). In mixed-effects models, two CPM features were nominally associated with SBSI but did not survive false-discovery-rate adjustment. Across 30-day bins, a minute-scale restlessness pattern (CPM_top_15_freq3) rose with higher SBSI (ρ = +0.95; p = 0.012), while an overall rhythm balance measure (CPM_median_freq) tended to shift lower (ρ = -0.88; p = 0.049). Penalized models (λ = 1) retained both features, and random-forest importance ranked them highest. Within-participant plots showed restlessness increased during higher symptom weeks, while slower rhythm balance showed individual variability.

Two interpretable CPM spectral features - restlessness (CPM_top_15_freq3) and global rhythm balance (CPM_median_freq) - were consistently associated with weekly symptom burden in this cohort. Findings are preliminary and warrant prospective validation for remote symptom monitoring.