Gender-specific effects of passive wearable exoskeletons (pwExo) on gait stability and fall risk in simulated construction tasks

Exoskeletons (Exos) offer significant benefits, but they may also introduce balance-related challenges, which could vary across genders or be exacerbated by gender-specific factors. This study investigates their biomechanical impact on gait stability and fall risk, considering gender-specific differences and task-specific outcomes. Key metrics, including Peak Pressure (PP), Mean Pressure (MP), Pressure-Time Integral (PTI), and Full Width at Half Maximum (FWHM), were analyzed across dynamic and static tasks. Results revealed that pwExos significantly influenced plantar pressure distribution, particularly in dynamic tasks such as lifting and carrying. Female participants experienced substantial reductions in peak heel pressure (up to 17.7%, p = 0.021), metatarsal pressures (14.2%, p = 0.034), and arch PTI (up to 52.8%), suggesting enhanced load redistribution and stability, whereas males exhibited increased forefoot loading, including a 15.5% increase in metatarsal PP and a 90.8% rise in toe PTI, indicating potential compensatory adaptations. Mean Pressure in females decreased by 73.5% at the heel during placing tasks, while males showed increased anterior pressure in static tasks. The pwExos were most effective during high-load tasks such as lifting and walking with sandbags (10lb), where pressure redistribution was greatest. While static tasks showed limited benefits, improvements in the arch and metatarsal regions suggest partial stabilization. These findings emphasize the potential of pwExos to enhance stability and reduce biomechanical fatigue, highlighting the need for task-specific and gender-sensitive designs. Future research should assess long-term effects, real-world applicability, and the role of individual factors such as Body Mass Index to optimize Exo integration in construction safety and health management. • pwExo reduced heel pressure by up to 17.7% and arch pressure by 22.7% in females. • Male participants showed a 15.5% increase in metatarsal PP and up to 90.8% PTI increase. • Female participants experienced a 73.5% reduction in heel MP during static tasks. • pwExo provided limited biomechanical benefit during static placement activities. • Findings support task- and gender-specific Exo design for gait stability improvement.