A Guideline-Grounded Multi-Agent Framework for Personalized Exercise Prescription from Clinical and Wearable Data

Abstract

Translating population-level exercise guidance into individualized prescriptions requires integrating clinical and wearable data, including diagnoses, medications, functional limitations, and baseline activity, with condition-specific recommendations, a process difficult to scale beyond specialist rehabilitation settings. We developed FITTER, a multi-agent framework that integrates these data with condition-specific guidance to generate personalized FITT-VP prescriptions and applies deterministic safety audit and repair to correct rule-checkable violations. We evaluated FITTER using data from 400 All of Us participants (300 cancer, 100 stroke) against five LLM comparators through computational evaluation, ablation, and structured clinician review. FITTER achieved 98.5% safety-constraint compliance versus 75.8-85.8% for comparators and showed greater quantitative dosing precision and guideline alignment. Cancer-cohort ablation identified safety audit and repair as the largest contributor to safety-constraint compliance. Clinicians reviewed 80 prescriptions across safety, personalization, instruction concreteness, anticipated effectiveness, and clinical acceptability. FITTER provides a clinician-facing approach integrating clinical and wearable data, guidance, and explicit safety constraints.