Effects of wearable hip exoskeleton-assisted postprandial walking on glycemic responses in patients with type 2 diabetes: a randomized crossover study

Postprandial walking attenuates glucose excursions in type 2 diabetes mellitus (T2DM), but it is not known whether specific wearable hip-exoskeleton modes add benefit beyond non-assisted walking. In a randomized, partially counterbalanced crossover proof-of-concept study, 14 adults with T2DM completed three 30-minute overground walking conditions: non-assisted walking (Non-BF), Bot-Fit Aqua mode (BF-Aqua), and Bot-Fit Boost mode (BF-Boost). Walking speed was individualized to 40% heart rate reserve and held constant across conditions. Capillary glucose was measured at baseline and every 10 min over 120 min; heart rate, blood lactate, and perceived exertion were assessed during walking. Compared with Non-BF, both robotic modes reduced total and incremental glucose exposure, mean blood glucose, peak glucose, and glucose spike (all P < .05); the incremental area under the glucose curve fell from 6461 ± 2477 mg·min/dL to 4877 ± 1946 under BF-Aqua and 5072 ± 2339 under BF-Boost ( P < .001). BF-Aqua further reduced early glucose exposure and variability but elicited a higher mean heart rate (118.9 ± 20.2 versus 105.7 ± 16.3 beats/min; P < .01) and higher peak blood lactate. BF-Boost produced the lowest perceived exertion (4.0 ± 1.3 versus 5.2 ± 2.3 for Non-BF; P < .05) at a heart rate comparable to Non-BF (101.3 ± 13.9 beats/min). In adults with T2DM, robotic assistance or resistance during postprandial walking may enhance its acute glycemic benefit while permitting mode-specific modulation of physiological demand. Larger, longer-term trials are needed. ClinicalTrials.gov, NCT07692802. Retrospectively registered on July 9, 2026. https://clinicaltrials.gov/study/NCT07692802 .