JMIR Publications

ABSTRACT

Background:

Physical inactivity among young adults has become a growing public health concern, increasing the risk of chronic diseases and diminishing quality of life. Wearable hip-assist exoskeletons have emerged as promising interventions that can augment the exercise load during ordinary walking; however, their effects on exercise motivation and perceived benefits remain largely unexplored.

Objective:

To compare the effects of exoskeleton-assisted walking and conventional walking on exercise continuation intentions and perceived exercise benefits. We also explored whether baseline physical activity levels moderated these effects.

Methods:

Using a randomized crossover design, 60 young adults (age: 23.45 ± 2.17 years; 26 men, 34 women) performed two walking sessions on the same approximately 1.9-km campus course under two conditions: (1) wearing a wearable hip exoskeleton (Bot Fit Pro, Samsung Electronics) in interval mode and (2) conventional walking without the device. The order of the conditions was randomized, with a minimum 24-h washout period. Immediately after each session, participants completed questionnaires assessing exercise continuation intention (7 items, Cronbach’s α = 0.929) and perceived exercise benefits (10 items, Cronbach’s α = 0.914) on a 5-point Likert scale. The exercise duration and perceived course difficulty were also recorded. Data were analyzed using the Wilcoxon signed-rank test for within-subject comparisons, the Mann–Whitney U test for between-group comparisons, and effect sizes (r = |z| / √N). Bonferroni correction was applied to the two primary outcomes (adjusted α = 0.025).

Results:

Compared with conventional walking, exoskeleton-assisted walking produced significantly higher scores for exercise continuation intention (z = −2.397, P = 0.017, r = 0.309) and perceived exercise benefits (z = −4.768, P < 0.001, r = 0.615), with no significant differences in exercise duration (P = 0.468), perceived course difficulty (P = 0.063), or order effects (all P > 0.05). Exploratory subgroup analysis revealed that the high-frequency exercise group (≥ 3 times/week, n = 39) showed significant improvements in both outcomes, whereas the low-frequency group (≤ 2 times/week, n = 21) showed no significant differences. The high-frequency group demonstrated a significantly greater improvement in perceived exercise benefits than the low-frequency group (U = 571.0, P = 0.012).

Conclusions:

Walking with a wearable hip exoskeleton significantly enhanced exercise continuation intention and perceived exercise benefits without increasing the exercise duration or perceived burden. Individuals with a higher baseline physical activity level showed greater sensitivity to the benefits of the exoskeleton, suggesting that wearable exoskeleton technology may serve as an effective motivational tool for promoting walking exercises across varying levels of physical activity. Clinical Trial: Clinical Research Information Service (CRIS) KCT0011848; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=33084&search_page=M&search_lang=&class_yn=