Modular hip exoskeleton improves walking function and reduces sedentary time in community-dwelling older adults

Abstract

Background Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function. Methods Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community. Results Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly. Conclusions This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device. Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127).

A State-of-the-Art of Exoskeletons in Line with the WHO’s Vision on Healthy Aging: From Rehabilitation of Intrinsic Capacities to Augmentation of Functional Abilities

“…A total of 22.2% of the included studies had a poor quality [32][33][34][35][36][37][38][39], 55.5% had a fair quality [24,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and 22.2% had a good quality [59][60][61][62][63][64][65][66] [Appendix B].…”

“…The included studies consisted of retrospective, prospective interventional, or observational research conducted in single or multi-center settings [Supplementary Materials (Tables S1-S3)]. A total of 17 studies investigated functional abilities [33,34,36,42,46,47,49,51,53,54,56,57,[59][60][61]63,65] [Table S1 in Supplementary Material], 23 investigated IC [32][33][34][35][36][37]42,45,47,49,50,52,53,[55][56][57][58][59][60][61][62][63]65] [Table S2 in Supplementary Material], and 26 investigated performance indicators [24,33,[35][36][37][38]…”

“…These studies covered a range of conditions, with ten investigating LLE use in patients with stroke [24,45,46,51,54,56,59,[63][64][65], four focusing on patients with Parkinson's Disease (PD) [38,58,60,61], two examining patient cohorts with various other neurological conditions [50,52], three centered on patients with osteoarthritis [42,53,57], and one each for hip fracture [34], sarcopenia [49], and depression [55]. Additionally, there were 14 studies involving healthy older adults [32,33,[35][36][37][39][40][41]43,44,47,48,62,66] [Supplementary Materials (Tables S1-S3)].…”

“…Seventeen studies assessed functional ability after the use of LLEs [33,34,36,42,46,47,49,51,53,54,56,57,[59][60][61]63,65] and their results are detailed in Table S1 in the Supplementary Materials.…”

“…Mobility measures were considered in 16 studies [33,34,36,42,46,47,49,51,53,54,56,57,[60][61][62]65], of which two focused on patients with PD [60,61], three on patients with osteoarthritis [42,53,57], one on patients with sarcopenia [49], one on patients with hip fracture [34], five on patients with stroke [46,51,54,56,65], and four on healthy older adults [33,36,47,62] [Table S1 in Supplementary Materials].…”