Lower Limb Exoskeletons for Rehabilitation of Intrinsic Capacities and Augmentation of Functional Ability: State-of-the-Art Aligned with WHO's Healthy Aging Vision.

This systematic review aims to assess the impact of LLEs on intrinsic capacities and functional abilities in older adults.This systematic review aims to assess the impact of LLEs on intrinsic capacities and functional abilities in older adults.

A comprehensive search across multiple databases (including PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, CINAHL, PEDro, and IEEE Xplore Digital Library). Studies involving lower-limb exoskeletons (LLEs) in participants aged ≥50 years, with a mean age of ≥65 years, with a focus on intrinsic capacity and functional ability outcomes were included. Data extraction and classification adhered to WHO’s framework on healthy aging. 

We included 36 relevant studies involving older adults with health conditions such as sarcopenia, stroke, Parkinson’s Disease, and osteoarthritis. The studies included various LLE technologies such as Ekso®, HAL®, Stride Management Assist®, and Honda Walking Assist®, among others. Interventions spanned from one to forty sessions, focusing on evaluating improvements in intrinsic capacities and functional abilities. LLE training resulted in significant positive outcomes across different health conditions. Key performance indicators, such as the 10-Meter Walk Test, Five Times Sit-to-Stand test, and Timed Up and Go test, showed marked improvements. Other enhancements included gait quality, joint mobility, muscle strength, and balance. These gains were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking.

The review demonstrates that LLE interventions consistently enhance intrinsic capacities and functional abilities across a wide range of health conditions in older adults. These findings underscore the potential of LLEs to promote healthy aging and improve the well-being of this population.

The integration of lower limb exoskeletons (LLEs) into physiotherapy practice could significantly enhance mobility, independence, and quality of life for older adults by both rehabilitating and augmenting functional abilities in conditions like sarcopenia and stroke. To fully realize their potential, healthcare systems should invest in LLE technology, training, and policy support, ensuring equitable access and further research into long-term outcomes of rehabilitation and physical augmentation.