CClinicalTrials.gg
CompletedNCT04033146Updated Jun 21, 2024Results posted

Optimizing Ankle Exoskeleton Assistance for Walking Across the Life Span

An interventional study of Ankle Exoskeleton Assistance in Aging, sponsored by Georgia Institute of Technology. Completed at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2024-06-21.

Sponsored by Georgia Institute of Technology · Not applicable, Interventional, and Basic science

Phase
Not applicable
Study type
Interventional
Enrollment
16
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study summary

The investigators seek to determine whether ankle exoskeletons can reduce metabolic energy expenditure during walking for users across the age-spectrum.

Read the detailed description

Older adults walk with greater metabolic rates than young adults. Growing evidence suggests that the greater older adult metabolic rates are related to the structural properties of their lower leg tissues. The tendons of the leg of older adults are more compliant than that of young adults. Accordingly, older adult leg tendons stretch more under a given load, such as during walking, causing their muscles to operate at shorter, less optimal lengths, and higher activity levels than the muscles of young adults - a less economical way to produces force.

Thus, the investigators seek to examine whether wearing wearable robotic boots (i.e., ankle exoskeletons) could enable muscles to produce force more economically. By adding an exoskeleton in-parallel to the ankle, the investigators hypothesize that older adults will walk with lower whole-body metabolic rate than without the exoskeleton assistance.

In this study, the investigators will have both young and older adult participants walk on a treadmill with a commercially available ankle exoskeleton set in multiple assistance modes. During these trials, the investigators will measure the metabolic cost of walking in young and older adults and also take many physiological and biomechanical measurements to help assess how exoskeletons work to reduce walking effort.

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Conditions studied

  • Aging

Keywords

  • Walking
  • Aging
  • Exoskeleton Device
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In context

Lead sponsor

Georgia Institute of Technology is the lead sponsor of 24 studies on the registry; 5 are open to participants now.

Of its 9 completed or terminated interventional studies of FDA-regulated products, 7 (78%) have results posted.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • Subjects must be able to walk for 60 minutes in a 90-minute time frame.
  • Subjects are apparently free of cardiovascular, metabolic, and renal disease, which includes no signs or symptoms suggestive of cardiovascular, metabolic or renal disease.
  • Subjects have no current musculoskeletal injury.
  • Subjects need to be either 18-45 or 65+ years old.

These criteria meet the American College of Sports Medicine's 2015 guidelines for participant health screening prior to joining a moderate or moderate-to-vigorous exercise protocol. (Riebe et al., 2015).

Exclusion criteria

Exclusion Criteria:

  • Have dementia or an inability to give informed consent
  • Have a musculoskeletal injury or feel pain while walking
  • Have a history of dizziness and/or balance problems
  • Have cardiovascular, heart, metabolic, or renal disease, or respiratory problems
  • Smoke cigarettes
  • Asthma
  • Feel pain or discomfort in the chest, neck, jaw, arms during rest or exercise
  • Have orthopnea or paroxysmal nocturnal dyspnea
  • Have ankle edema
  • Have palpitations or tachycardia
  • Have a heart murmur
  • Have had a heart attack
  • Have diabetes
  • Have a pace maker
  • Have unusual shortness of breath with usual activities
  • Are \<18 or 46-64 years of age
  • Do not speak or understand English
05

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
16 participants (actual)

Study arms

  • Experimental
    Young Adult Exoskeleton Users

    Study participants who are 18-45 year old.

    Device: Ankle Exoskeleton Assistance

  • Experimental
    Older Adult Exoskeleton Users

    Study participants who are greater than 65 years of age.

    Device: Ankle Exoskeleton Assistance

Interventions

  • DeviceAnkle Exoskeleton Assistance

    The investigators will use ankle-exoskeletons to modulate the amount of mechanical power generated by the user's ankle joint. That is, participants will walk in a robotic device that either (a) adds a spring or (b) a motor in parallel with their calf muscles to help them generate a stronger propulsive push-off that could reduce the effort of walking.

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What researchers measure

Primary outcomes

  1. Net Metabolic Rate (Watts/kg)

    The rate of metabolic energy that participants expend during a short walking bout in each of the experimental conditions.

    Time frame: 3rd session, up to 2 weeks

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Results

Posted Jun 21, 2024

Participant flow

Participants were enrolled and participated in the study from 2/4/2020 to 5/23/2023.

Participant flow — Overall Study
MilestoneYoung Adult Exoskeleton UsersOlder Adult Exoskeleton Users
Started106
Completed106
Not completed00

Outcome measures

PrimaryNet Metabolic Rate (Watts/kg)

The rate of metabolic energy that participants expend during a short walking bout in each of the experimental conditions.

Time frame:
3rd session, up to 2 weeks
Reported as:
Mean · watts/kg
Net Metabolic Rate (Watts/kg)
watts/kgYoung Adult Exoskeleton UsersOlder Adult Exoskeleton Users
No Exoskeleton3.30 ± 0.663.47 ± 0.31
No Torque3.86 ± 0.624.18 ± 0.62
Spring-like Torque3.72 ± 0.784.34 ± 0.57
Motor-like Low Torque3.51 ± 0.833.68 ± 0.65
Motor-like Medium Torque3.13 ± 0.703.46 ± 0.56
Motor-like High Torque3.24 ± 0.653.20 ± 0.52
Statistical analysis
  • Young Adult Exoskeleton Users vs Older Adult Exoskeleton Users · ANOVA · p = <0.001 (Threshold was 0.05)

Adverse events

Collected over 4 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Young Adult Exoskeleton Users0/10 (0%)0/10 (0%)0/10 (0%)
Older Adult Exoskeleton Users0/6 (0%)0/6 (0%)0/6 (0%)

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Young Adult Exoskeleton UsersOlder Adult Exoskeleton UsersTotal
<=18 years000
Between 18 and 65 years10010
>=65 years066
Sex: Female, Male
Sex: Female, Male(Participants)Young Adult Exoskeleton UsersOlder Adult Exoskeleton UsersTotal
Female358
Male718
Race and Ethnicity Not Collected
Race and Ethnicity Not Collected(Participants)Young Adult Exoskeleton UsersOlder Adult Exoskeleton UsersTotal
Count of participants——0
08

Study locations

1 site
  • Physiology of Wearable Robotics Laboratory (Georgia Tech)
    Atlanta, Georgia 30332, United States
09

References and documents

Publications

  • Asbeck AT, De Rossi SM, Holt KG, and Walsh CJ. A biologically inspired soft exosuit for walking assistance. The international journal of robotics research 34: 744-762, 2015.
  • Biewener AA, Farley CT, Roberts TJ, Temaner M. Muscle mechanical advantage of human walking and running: implications for energy cost. J Appl Physiol (1985). 2004 Dec;97(6):2266-74. doi: 10.1152/japplphysiol.00003.2004. Epub 2004 Jul 16. PubMed 15258124 ↗
  • Browne MG, Franz JR. The independent effects of speed and propulsive force on joint power generation in walking. J Biomech. 2017 Apr 11;55:48-55. doi: 10.1016/j.jbiomech.2017.02.011. Epub 2017 Feb 21. PubMed 28262285 ↗
  • Cavagna GA, Kaneko M. Mechanical work and efficiency in level walking and running. J Physiol. 1977 Jun;268(2):467--81. doi: 10.1113/jphysiol.1977.sp011866. PubMed 874922 ↗
  • CAVAGNA GA, SAIBENE FP, MARGARIA R. MECHANICAL WORK IN RUNNING. J Appl Physiol. 1964 Mar;19:249-56. doi: 10.1152/jappl.1964.19.2.249. No abstract available. PubMed 14155290 ↗
  • Collins SH, Wiggin MB, Sawicki GS. Reducing the energy cost of human walking using an unpowered exoskeleton. Nature. 2015 Jun 11;522(7555):212-5. doi: 10.1038/nature14288. Epub 2015 Apr 1. PubMed 25830889 ↗
  • Csapo R, Malis V, Hodgson J, Sinha S. Age-related greater Achilles tendon compliance is not associated with larger plantar flexor muscle fascicle strains in senior women. J Appl Physiol (1985). 2014 Apr 15;116(8):961-9. doi: 10.1152/japplphysiol.01337.2013. Epub 2014 Feb 6. PubMed 24505104 ↗
  • DeVita P, Helseth J, Hortobagyi T. Muscles do more positive than negative work in human locomotion. J Exp Biol. 2007 Oct;210(Pt 19):3361-73. doi: 10.1242/jeb.003970. PubMed 17872990 ↗
  • DeVita P, Hortobagyi T. Age causes a redistribution of joint torques and powers during gait. J Appl Physiol (1985). 2000 May;88(5):1804-11. doi: 10.1152/jappl.2000.88.5.1804. PubMed 10797145 ↗
  • Elliott G, Sawicki GS, Marecki A, Herr H. The biomechanics and energetics of human running using an elastic knee exoskeleton. IEEE Int Conf Rehabil Robot. 2013 Jun;2013:6650418. doi: 10.1109/ICORR.2013.6650418. PubMed 24187237 ↗
  • Farris DJ, Sawicki GS. The mechanics and energetics of human walking and running: a joint level perspective. J R Soc Interface. 2012 Jan 7;9(66):110-8. doi: 10.1098/rsif.2011.0182. Epub 2011 May 25. PubMed 21613286 ↗
  • Ferris DP, Sawicki GS, Domingo A. Powered lower limb orthoses for gait rehabilitation. Top Spinal Cord Inj Rehabil. 2005;11(2):34-49. doi: 10.1310/6gl4-um7x-519h-9jyd. PubMed 16568153 ↗
  • Franz JR, Slane LC, Rasske K, Thelen DG. Non-uniform in vivo deformations of the human Achilles tendon during walking. Gait Posture. 2015 Jan;41(1):192-7. doi: 10.1016/j.gaitpost.2014.10.001. Epub 2014 Oct 12. PubMed 25457482 ↗
  • Gottschall JS, Kram R. Energy cost and muscular activity required for propulsion during walking. J Appl Physiol (1985). 2003 May;94(5):1766-72. doi: 10.1152/japplphysiol.00670.2002. Epub 2002 Dec 27. PubMed 12506042 ↗
  • Griffin TM, Tolani NA, Kram R. Walking in simulated reduced gravity: mechanical energy fluctuations and exchange. J Appl Physiol (1985). 1999 Jan;86(1):383-90. doi: 10.1152/jappl.1999.86.1.383. PubMed 9887153 ↗
  • Holt NC, Roberts TJ, Askew GN. The energetic benefits of tendon springs in running: is the reduction of muscle work important? J Exp Biol. 2014 Dec 15;217(Pt 24):4365-71. doi: 10.1242/jeb.112813. Epub 2014 Nov 13. PubMed 25394624 ↗
  • Huang HJ, Kram R, Ahmed AA. Reduction of metabolic cost during motor learning of arm reaching dynamics. J Neurosci. 2012 Feb 8;32(6):2182-90. doi: 10.1523/JNEUROSCI.4003-11.2012. PubMed 22323730 ↗
  • Malcolm P, Derave W, Galle S, De Clercq D. A simple exoskeleton that assists plantarflexion can reduce the metabolic cost of human walking. PLoS One. 2013;8(2):e56137. doi: 10.1371/journal.pone.0056137. Epub 2013 Feb 13. PubMed 23418524 ↗
  • Martin PE, Rothstein DE, Larish DD. Effects of age and physical activity status on the speed-aerobic demand relationship of walking. J Appl Physiol (1985). 1992 Jul;73(1):200-6. doi: 10.1152/jappl.1992.73.1.200. PubMed 1506370 ↗
  • Mian OS, Thom JM, Ardigo LP, Minetti AE, Narici MV. Gastrocnemius muscle-tendon behaviour during walking in young and older adults. Acta Physiol (Oxf). 2007 Jan;189(1):57-65. doi: 10.1111/j.1748-1716.2006.01634.x. PubMed 17280557 ↗
  • Mooney LM, Rouse EJ, Herr HM. Autonomous exoskeleton reduces metabolic cost of human walking during load carriage. J Neuroeng Rehabil. 2014 May 9;11:80. doi: 10.1186/1743-0003-11-80. PubMed 24885527 ↗
  • Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C; American College of Sports Medicine; American Heart Association. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007 Aug 28;116(9):1094-105. doi: 10.1161/CIRCULATIONAHA.107.185650. Epub 2007 Aug 1. PubMed 17671236 ↗
  • Nuckols Rich DT, Sawicki Greg. Ultrasound measurements link soleus muscle dynamics and metabolic cost during human walking with elastic ankle exoskeletons. In Prep.
  • Onambele GL, Narici MV, Maganaris CN. Calf muscle-tendon properties and postural balance in old age. J Appl Physiol (1985). 2006 Jun;100(6):2048-56. doi: 10.1152/japplphysiol.01442.2005. Epub 2006 Feb 2. PubMed 16455811 ↗
  • Ortega JD, Beck ON, Roby JM, Turney AL, Kram R. Running for exercise mitigates age-related deterioration of walking economy. PLoS One. 2014 Nov 20;9(11):e113471. doi: 10.1371/journal.pone.0113471. eCollection 2014. PubMed 25411850 ↗
  • Ortega JD, Farley CT. Individual limb work does not explain the greater metabolic cost of walking in elderly adults. J Appl Physiol (1985). 2007 Jun;102(6):2266-73. doi: 10.1152/japplphysiol.00583.2006. Epub 2007 Mar 15. PubMed 17363623 ↗
  • Ortega JO, Lindstedt SL, Nelson FE, Jubrias SA, Kushmerick MJ, Conley KE. Muscle force, work and cost: a novel technique to revisit the Fenn effect. J Exp Biol. 2015 Jul;218(Pt 13):2075-82. doi: 10.1242/jeb.114512. Epub 2015 May 11. PubMed 25964423 ↗
  • Panizzolo FA, Green DJ, Lloyd DG, Maiorana AJ, Rubenson J. Soleus fascicle length changes are conserved between young and old adults at their preferred walking speed. Gait Posture. 2013 Sep;38(4):764-9. doi: 10.1016/j.gaitpost.2013.03.021. Epub 2013 May 1. PubMed 23642629 ↗
  • Rall JA. Sense and nonsense about the Fenn effect. Am J Physiol. 1982 Jan;242(1):H1-6. doi: 10.1152/ajpheart.1982.242.1.H1. PubMed 7058903 ↗
  • Rasske K, Thelen DG, Franz JR. Variation in the human Achilles tendon moment arm during walking. Comput Methods Biomech Biomed Engin. 2017 Feb;20(2):201-205. doi: 10.1080/10255842.2016.1213818. Epub 2016 Jul 27. PubMed 27460018 ↗
  • Rubenson J, Pires NJ, Loi HO, Pinniger GJ, Shannon DG. On the ascent: the soleus operating length is conserved to the ascending limb of the force-length curve across gait mechanics in humans. J Exp Biol. 2012 Oct 15;215(Pt 20):3539-51. doi: 10.1242/jeb.070466. Epub 2012 Jul 5. PubMed 22771749 ↗
  • Sawicki GS, Ferris DP. Mechanics and energetics of level walking with powered ankle exoskeletons. J Exp Biol. 2008 May;211(Pt 9):1402-13. doi: 10.1242/jeb.009241. PubMed 18424674 ↗
  • Stanaway FF, Gnjidic D, Blyth FM, Le Couteur DG, Naganathan V, Waite L, Seibel MJ, Handelsman DJ, Sambrook PN, Cumming RG. How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. BMJ. 2011 Dec 15;343:d7679. doi: 10.1136/bmj.d7679. PubMed 22174324 ↗
  • Stenroth L, Peltonen J, Cronin NJ, Sipila S, Finni T. Age-related differences in Achilles tendon properties and triceps surae muscle architecture in vivo. J Appl Physiol (1985). 2012 Nov;113(10):1537-44. doi: 10.1152/japplphysiol.00782.2012. Epub 2012 Oct 4. PubMed 23042907 ↗
  • Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J. Gait speed and survival in older adults. JAMA. 2011 Jan 5;305(1):50-8. doi: 10.1001/jama.2010.1923. PubMed 21205966 ↗
  • Takahashi KZ, Gross MT, van Werkhoven H, Piazza SJ, Sawicki GS. Adding Stiffness to the Foot Modulates Soleus Force-Velocity Behaviour during Human Walking. Sci Rep. 2016 Jul 15;6:29870. doi: 10.1038/srep29870. PubMed 27417976 ↗
  • Takahashi KZ, Lewek MD, Sawicki GS. A neuromechanics-based powered ankle exoskeleton to assist walking post-stroke: a feasibility study. J Neuroeng Rehabil. 2015 Feb 25;12:23. doi: 10.1186/s12984-015-0015-7. PubMed 25889283 ↗

Study documents

  • Study protocol · Apr 25, 2024
  • Statistical analysis plan · Apr 25, 2024
  • Informed consent form · Mar 17, 2023

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 21, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT04033146
Lead sponsor
Georgia Institute of Technology
Collaborators
National Institute on Aging (NIA)
Responsible party
Sponsor
First posted
Jul 25, 2019
Start date
Feb 4, 2020
Primary completion
May 23, 2023
Completion
May 23, 2023
Results posted
Jun 21, 2024
Last update
Jun 21, 2024

Study contacts

Gregory S Sawicki, Ph.D.
principal investigator · Georgia Institute of Technology

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Jun 2024. You cannot join it, but the record below documents what was studied.

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