Abstract
Musculoskeletal disorders remain the leading occupational disease in many regions of the world. Occupational exoskeletons are emerging as an alternative for managing biomechanical risk, yet their transition from the laboratory to the workplace remains difficult. This article offers an experience report on the evaluation and implementation of these devices, prepared by three ergonomics and human factors professionals and drawing on interventions involving more than 600 workers and over twenty different models, across six sectors of activity in Colombia, Germany and Spain. After an overview of the current state of the technology, ten practical challenges are identified: device weight, thermal discomfort, skin friction, donning and doffing complexity, hygiene, bulk, the adaptation curve, movement restriction, fit and sizing, and psychosocial factors. It is concluded that ergonomic support is a necessary condition for translating biomechanical potential into real and sustained benefits.
References
Liu M, Rong J, An X, Li Y, Min Y, Yuan G, et al. Global, regional, and national burden of musculoskeletal disorders, 1990-2021: an analysis of the Global Burden of Disease Study 2021 and forecast to 2035. Front Public Health. 2025;13:1562701. doi: 10.3389/fpubh.2025.1562701.
Greggi C, Visconti VV, Albanese M, Gasperini B, Chiavoghilefu A, Prezioso C, et al. Work-related musculoskeletal disorders: a systematic review and meta-analysis. J Clin Med. 2024;13(13):3964. doi: 10.3390/jcm13133964.
Nedelkoska L, Quintini G. Automation, skills use and training. Paris: OECD Publishing; 2018. (OECD Social, Employment and Migration Working Papers, n.º 202). [citado 21 Ago 2026]. Disponible en: https://www.oecd.org/content/dam/oecd/en/publications/reports/2018/03/automation-skills-use-and-training_b611ef08/2e2f4eea-en.pdf
De la Garza C, Fadier E. Le retour d’expérience en tant que cadre théorique pour l’analyse de l’activité et la conception sûre. Activités. 2007;4(1):188-97. https://doi.org/10.4000/activites.1485
Berger R. Now I see it, now I don’t: researcher’s position and reflexivity in qualitative research. Qual Res. 2015;15(2):219-34. doi: 10.1177/1468794112468475.
Exoskeleton Report. Exoskeleton catalog / industrial [Internet]. ExoskeletonReport.com; 2026 [citado 21 Ago 2026]. Disponible en: https://exoskeletonreport.com/product-category/exoskeleton-catalog/industrial/
Ferreira ML, de Luca K, Haile LM, Steinmetz JD, Culbreth GT, Cross M, et al. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-29. doi: 10.1016/S2665-9913(23)00098-X.
ASTM International. ASTM F3323-24. Standard terminology for exoskeletons and exosuits. West Conshohocken (PA): ASTM International; 2024. [citado 21 Ago 2026]. Disponible en: https://store.astm.org/f3323-24.html
Mohamed Refai MI, Moya-Esteban A, van Zijl L, van der Kooij H, Sartori M. Benchmarking commercially available soft and rigid passive back exoskeletons for an industrial workplace. Wearable Technol. 2024;5:e6. doi: 10.1017/wtc.2024.2.
Hochreiter D, Schmermbeck K, Vazquez-Pufleau M, Ferscha A. Intention prediction for active upper-limb exoskeletons in industrial applications: a systematic literature review. Sensors (Basel). 2025;25(17):5225. doi: 10.3390/s25175225.
Ashta G, Finco S, Battini D, Persona A. Passive exoskeletons to enhance workforce sustainability: literature review and future research agenda. Sustainability. 2023;15(9):7339. doi: 10.3390/su15097339.
Bär M, Steinhilber B, Rieger MA, Luger T. The influence of using exoskeletons during occupational tasks on acute physical stress and strain compared to no exoskeleton: a systematic review and meta-analysis. Appl Ergon. 2021;94:103385. doi: 10.1016/j.apergo.2021.103385.
Maurice P, Čamernik J, Gorjan D, Schirrmeister B, Bornmann J, Tagliapietra L, et al. Objective and subjective effects of a passive exoskeleton on overhead work. IEEE Trans Neural Syst Rehabil Eng. 2019;28(1):152-64. doi: 10.1109/TNSRE.2019.2945368.
Kranenborg SE, Greve C, Reneman MF, Roossien CC. Side-effects and adverse events of a shoulder- and back-support exoskeleton in workers: a systematic review. Appl Ergon. 2023;111:104042. doi: 10.1016/j.apergo.2023.104042
Park JH, Kim S, Nussbaum MA, Srinivasan D. Effects of back-support exoskeleton use on gait performance and stability during level walking. Gait Posture. 2022;92:181-90. doi: 10.1016/j.gaitpost.2021.11.028.
Cohic A, Segers T, Thamsuwan O. Impact of an occupational back-support exoskeleton on muscle synergies during a pick-up movement. Eur J Appl Physiol. 2026;126(3):1515-30. doi: 10.1007/s00421-025-05954-4.
Luger T, Bär M, Seibt R, Rimmele P, Rieger MA, Steinhilber B. A passive back exoskeleton supporting symmetric and asymmetric lifting in stoop and squat posture reduces trunk and hip extensor muscle activity and adjusts body posture: a laboratory study. Appl Ergon. 2021;97:103530. doi: 10.1016/j.apergo.2021.103530.
Xiang X, Tanaka M, Umeno S, Kikuchi Y, Kobayashi Y. Dynamic assessment for low back-support exoskeletons during manual handling tasks. Front Bioeng Biotechnol. 2023;11:1289686. doi: 10.3389/fbioe.2023.1289686.
Chaffin DB, Andersson GBJ, Martin BJ. Occupational biomechanics. 4.ª ed. Hoboken (NJ): John Wiley & Sons; 2006.
International Ergonomics Association. What is ergonomics (HFE)? Ginebra: IEA; 2000 [citado 10 Jun 2020]. Disponible en: https://iea.cc/what-is-ergonomics/
National Institute for Occupational Safety and Health. Hierarchy of controls. Cincinnati (OH): NIOSH; 2024 [citado 21 Ago 2026]. Disponible en: https://www.cdc.gov/niosh/topics/hierarchy/default.html
Ralfs L, Hoffmann N, Glitsch U, Heinrich K, Johns J, Weidner R. Insights into evaluating and using industrial exoskeletons: summary report, guideline, and lessons learned from the interdisciplinary project “Exo@Work”. Int J Ind Ergon. 2023;97:103494. doi: 10.1016/j.ergon.2023.103494.
van Laar DM, Bieleman HJ, Rijnders CSI, Saakes DP, Reneman MF, Roossien CC. Occupational exoskeletons as a technological solution for musculoskeletal disorders: a systematic review of barriers and facilitators for sustainable workplace integration. J Occup Rehabil. 2026. doi: 10.1007/s10926-026-10397-5. Epub ahead of print.
Bhat S, Gavin J, Warner M, Myall M. Mapping the evidence on occupational exoskeleton use for the workforce in healthcare, social care, and industry: a systematic scoping review. Wearable Technol. 2025;6:e53. doi: 10.1017/wtc.2025.10033.
Cardoso A, Ribeiro A, Carneiro P, Colim A. Evaluating Exoskeletons for WMSD Prevention: A Systematic Review of Applications and Ergonomic Approach in Occupational Settings. Int J Environ Res Public Health. 2024 Dec 19;21(12):1695. doi: 10.3390/ijerph21121695.
Liu Y, Zhang Z, Xue Y, Wang M, Fan H, Li R, et al. Thermophysiological and subjective thermal responses to soft and rigid spinal exoskeletons in young male workers: an experimental study. Appl Sci. 2026;16(2):820. doi: 10.3390/app16020820.
Joshi A, Bartels L, Viswanathan SH, Martinez DM, Sadeghi K, Jaiswal AK, et al. Evaluation of thermal properties and thermoregulatory impacts of lower back exosuit using thermal manikin. Int J Ind Ergon. 2023;98:103517. doi: 10.1016/j.ergon.2023.103517.
Flor-Unda O, Arcos-Reina R, Nunez-Nagy S, Alarcos B. Adverse effects due to the use of upper limbs exoskeletons in the work environment: a scoping review. Biomimetics (Basel). 2025;10(5):340. doi: 10.3390/biomimetics10050340.
Linnenberg C, Weidner R. Industrial exoskeletons for overhead work: circumferential pressures on the upper arm caused by the physical human-machine-interface. Appl Ergon. 2022;101:103706. doi: 10.1016/j.apergo.2022.103706.
Dufraisse M, Atain Kouadio JJ, Hayot C, Desbrosses K, Clerc-Urmès I, Morel O, et al. Embodiment of occupational exoskeletons as developing a sense of ownership and readiness-to-hand: laboratory and field explorations. Hum Factors. 2026;68(2):239-259. doi: 10.1177/00187208251368269.
Subasinghe D, Aviles J, Shayan AM, Srinivasan D. Short-term adaptations to lifting and gait kinematics when using a passive back-support exoskeleton. Ann Biomed Eng. 2025;53(9):2264-81. doi: 10.1007/s10439-025-03770-7.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2026 Yaniel Torres, Israel Benavides, Gustavo Rosal
