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review presenting insights on the physiological relevance between biological signals fluctuations and muscle health
status, the detection mechanisms and functional layouts of wearable sensors to capture these signals, as well as
their real-world applications in competitive sports and public fitness is timely needed. Herein, this article
systematically reviews the physiological mechanisms of muscle fatigue, injury and repair, with a focus on elaborating
the characteristic change patterns of related bioelectrical, biochemical and biomechanical markers in the process.
Sensing mechanisms and working layouts of wearable technology are comprehensively summarized. Importantly,
corresponding applications in real-world settings associated with improving professional athletic performance and
public fitness are proposed, including load monitoring, fatigue evaluation, personalized nutrition management, as
well as artificial intelligence (AI)-enabled multimodal fusion. Based on this, future perspectives are envisioned to
better aid sports activities and engineer the development of sports science and sports medicine.

INTRODUCTION
Skeletal muscle is the core executive tissue of human motor function, and its structural integrity and
functional stability directly determine athletic performance, training adaptability and injury susceptibility .
[1-3]
Exercise-induced muscle fatigue and injury is a common problem in the fields of sports science and sports
medicine . It not only leads to a decline in short-term motor function, but may cause long-term sequelae
[4]
such as chronic strain and fibrosis through a vicious cycle of “fatigue accumulation-repair delay-injury
recurrence”, undermining athletes’ competitive level and the health maintenance of the general population
during sports . The traditional muscle health management model relies on macroscopic training volume
[5]
statistics, subjective fatigue assessment and static imaging detection [6,7] . It has limitations in lagging
assessment and single indicators, and hence can hardly reflect individual physiological response differences
and meet the modern sports science demands in “precise training, early warning and personalized
rehabilitation” . In recent years, the rapid development of wearable sensing technology, along with accurate
[3]
biomechanical analysis, artificial intelligence algorithms and microfluidic technology, have brought exciting
opportunities to revolutionize muscle health management .
[8,9]

Wearable devices based on surface electromyography (sEMG) and electrocardiography (ECG) have achieved
real-time capture of neuromuscular activities and central regulatory states [10-12] . Body-worn biomechanical
monitoring (e.g., inertial measurement unit, pressure sensing insoles, wearable elastography) can quantify
the mechanical load, vertical stiffness during running and jumping, and soft tissue elastic changes in
exercise [13-16] . This helps to provide an objective basis for injury risk forecasting and healing process tracking.
The sweat-based, multi-index biochemical sensing patch has broken the barriers of traditional invasive,
intermittent blood sampling and detection, achieving non-invasive, continuous monitoring of physiological
metabolite (e.g., lactic acid, electrolytes, and urea), acute and chronic inflammation (e.g., interleukins), and
hydration status [17-19] . Innovative fusions of these technologies have stimulated the transformation of muscle
health management from “experience-based” to “data-driven”. It benefits forming a multi-dimensional,
closed-loop technical system for competitive sports and public fitness, covering exercise intensity
monitoring, body fatigue assessment, injury risk prediction, and training recovery intervention. In spite of
the promising opportunity, the majority of existing publications focus on listing popular biomarkers and
exemplifying corresponding sensor designs and general applications from the perspective of engineering, or
solely highlight the overlapping physiological mechanisms inducing muscle fatigue and injury in a
biomedical view [20-24] . Insights from the intersection of biomedicine, engineering and sports science that
elaborate the physiological relevance between biological signals fluctuations and muscle health status, the
detection mechanisms and functional layouts of wearable sensors to capture these signals, as well as their
real-world applications in competitive sports and public fitness are yet to be posed.