PurposeThis study aims to evaluate and synthesize literature on exoskeleton implementation in the construction industry to understand their current applications, evaluate existing research approaches and identify critical areas for future investigation. Through a comprehensive analysis of empirical studies, the research seeks to establish a clear roadmap for advancing exoskeleton adoption in construction work.Design/methodology/approachThis study conducts a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. By searching relevant databases and applying predefined inclusion criteria, the review focused on empirical studies that evaluate the effectiveness and acceptance of exoskeletons in construction. Both objective parameters (EMG data, Kinematic analysis, heart rate) and subjective parameters (user comfort, perceived exertion, usability surveys) were analyzed to assess how impactful are exoskeletons among construction workers.FindingsThe review identified 236 publications, of which 36 were included, revealing several critical insights: (1) A significant reliance on studies conducted in controlled environments, accounting for 77.78% of studies. (2) A limited representation of actual construction workers, mainly non-construction worker volunteers, which may affect the practical relevance of the findings. (3) A significant gap exists in standardized evaluation protocols, with researchers using varying assessment methods that hinder cross-study comparisons. (4) Predominantly short-term nature of existing studies. These findings highlight the need for more real-world testing, standardized evaluation frameworks and longitudinal studies.Originality/valueThis review contributes original insights into the deployment of exoskeletons in the construction sector, particularly highlighting the industry's gap in direct, in situ engagement with construction workers. It suggests that future research should prioritize long-term, onsite studies to achieve a more comprehensive understanding of exoskeletons’ impacts, thus supporting the development of targeted intervention strategies for reducing work-related musculoskeletal disorders (WMSDs) among construction workers.