Effectiveness, applicability and challenges of active exoskeletons in manual materials handling tasks in industry: a systematic review

Active exoskeletons are designed to provide physical assistance and reduce the risk of musculoskeletal disorders (MSDs). This study reviews the effectiveness, applicability and challenges of using these devices in manual materials handling (MMH) tasks in industrial settings. A systematic search (Web of Science, Scopus, PubMed) up to June 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PICO (population, intervention, comparison, outcomes) guidelines, identified 37 studies. Objective and subjective measures were analyzed, with bias assessed via the Cochrane tool. Based on the available evidence, active exoskeletons appear to reduce muscle activity and spinal loading in controlled laboratory settings, and users generally reported improved comfort. However, trade-offs in support versus mobility, limited versatility and usability challenges hinder broader adoption. Future research should focus on more versatile designs, long-term field studies and diverse participant populations to better assess the practicality and acceptability of these devices in industrial environments.