AHFE Open AccessPhysical Ergonomics and Human Factors
Editors: Hüsre Gizem Akalp, Waldemar Karwowski
Topics: Physical Ergonomics and Human Factors
ISBN: 978-1-964867-99-1
DOI: 10.54941/ahfe1007242
Table of Contents
Musculoskeletal pain in teleworkers in Brazil: prevalence and workplace environment risk factors
Inadequate workstation design, prolonged sitting, and environmental discomfort are emerging as critical contributors to pain and reduced work performance in home-based settings. Objective: To identify the prevalence of musculoskeletal pain among Brazilian teleworkers and identify workstation and environmental factors associated with an increased risk of the presence of pain in the last 12 months (chronic pain). Methods: A cross-sectional survey was conducted between June and September 2025, involving 184 teleworkers from various professional sectors. Data were collected through an online questionnaire addressing sociodemographic and work characteristics, including ergonomic conditions, and the Nordic Musculoskeletal Questionnaire (NMQ). Statistical analyses included Pearson’s Chi-square test, logistic regression, and Random Forest modeling to rank predictor importance. Odds ratios (ORs) were calculated to evaluate pain persistence (7-day and 30-day recall versus 12-month chronic pain). Results: the sample comprised 184 teleworkers, of whom 59.8% were women and 38.6% were men. Most respondents were between 30 and 50 years of age (47.8 %), reflecting the demographic composition of the contemporary Brazilian telework force, and nearly 60% held postgraduate degrees, indicating a highly educated professional group. The lower back (40.8%), neck (36.4%), and upper back (30.4%) emerged as the most frequently affected body regions. The principal workplace predictors included mouse and chair use, suboptimal temperature control, and prolonged sitting time. The OR analysis revealed strong chronicity, particularly for shoulder pain (OR = 49.7– 159; p < 0.001). Conclusion: Teleworking is associated with a high prevalence of musculoskeletal pain. These findings underscore the need for targeted ergonomic policies.
Maria Do Carmo Baracho Alencar, Irenilza Alencar Naas, Nilson Rogerio Da Silva, Florentino Serranheira
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Investigating the Regulation of the Circulatory System during Acute Hypobaric Hypoxia Exposure
To support sustainable lunar exploration, future lunar habitats are proposed to utilize hypobaric hypoxic (HH) internal atmospheres, such as 8.2 psia with 34% O₂ or 7.6 psia with 32% O₂, to optimize crew health and extravehicular activity (EVA) efficiency. However, both chronic adaptation and potential acute exposure due to system leaks pose significant physiological risks, particularly concerning cardiovascular compensation and tissue oxygen utilization, which are not yet fully understood.This study investigated the physiological responses to acute HH exposure by monitoring real-time cardiovascular parameters and skeletal muscle oxygenation in healthy participants. Experiments were conducted under three conditions: normobaric normoxia (simulated 40 m altitude) and acute HH at simulated altitudes of 3500 m and 4500 m.HH exposure induced significant decreases in arterial oxygen saturation, triggering compensatory increases in heart rate, respiratory rate, and tidal volume. Cardiovascular dynamics and skeletal muscle oxygen extraction and consumption exhibited distinct altitude-dependent patterns. These findings clarify the immediate physiological trade-offs between oxygen delivery and utilization under acute hypoxia.This study elucidates the key mechanisms of human cardiovascular and muscular metabolic adaptation to acute HH. The results provide critical physiological data for assessing crew health risks during lunar habitat operations and EVAs, informing the development of environmental control systems, safety protocols, and predictive health models for future deep space missions.
Deteng Huang, Chao Sun, Changhua Gao, Tian Liu, Jiaqi Zhou, Siyuan Guo, DING Li, Qin Yang
Open Access
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Conference Proceedings
Automated Ergonomic Problem and Solution Identification from Videos with a Knowledge-Retrieving Large Multimodal Model
Workers across diverse industries experience a high prevalence of work-related musculoskeletal disorders (WMSDs), the leading cause of non-fatal injuries. To mitigate WMSDs, it is crucial for ergonomic experts to identify ergonomic problems and solutions. However, implementing such manual identification across diverse workplaces is challenging because it is time-consuming and resource-intensive, highlighting the need for accessible tools for on-site personnel. Recent advances in large multimodal models (LMMs) have demonstrated their potential to identify ergonomic problems and solutions, given their strong scene understanding capabilities. However, LMMs often generate plausible but incorrect information, known as hallucination, particularly when handling long-context video inputs. This limitation is critical because workers without ergonomic expertise cannot verify the correctness of identified problems and solutions, leading to ineffective or even harmful interventions. To address this, we aim to automatically identify ergonomic problems and solutions from videos, supported by guideline-based evidence, by applying an ergonomic knowledge-retrieving LMM. We developed an ergonomic knowledge retrieval pipeline that enables the LMM to retrieve ergonomic knowledge from a knowledge graph and ground its predictions accordingly. To evaluate the correctness of identification and the relevance of the retrieved knowledge, we used accuracy and context precision as evaluation metrics. Evaluation on 25 real-world workplace videos yielded an accuracy and context precision of 0.80, outperforming a state-of-the-art LMM. Our results highlight the importance of integrating ergonomic knowledge into LMMs in identifying ergonomic problems and solutions. Our knowledge-retrieving LMM automates ergonomic problem and solution identification grounded in verified knowledge, helping reduce WMSDs through easier, broader adoption.
Gunwoo Yong, Sanghyun Lee
Open Access
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Conference Proceedings
Occupational Exoskeletons: Overview of Mental Workload Effects and Assessment Methodologies
This article builds on findings obtained from a study focusing on the use of exoskeletons in real-world automotive manufacturing environments. The results of electromyographic measurements in this study demonstrated a 24.8% reduction in deltoid muscle workload. In contrast, subjective assessments of perceived discomfort measurement sessions showed an average increase of 68.7%. These findings indicate that although exoskeletons can provide substantial reductions in physical workload, their use may simultaneously be associated with an increase in other forms of load that are not captured solely by biomechanical indicators.Attempts to compare these results with existing literature revealed absence of a standardized methodology for assessing mental workload in the context of exoskeleton use. The objective of this article is therefore to present a systematic review of studies addressing mental workload in relation to exoskeleton use, published between 2000 and 2025. A systematic literature search in the Web of Science database identified a total of 40 studies, of which only 13 specifically focused on occupational exoskeletons.The analysis shows that the assessment of mental workload in these studies is inconsistent and methodologically heterogeneous. These methodological differences lead to contradictory conclusions across individual studies. The reliability of the available evidence is further limited by small and gender-imbalanced samples, with a predominance of male participants.The findings of this review highlight the need to develop comprehensive and standardized methodologies for mental workload assessment, enabling a balanced evaluation of both physical benefits and cognitive demands and supporting the safe, effective, and human-centered implementation of exoskeletons in occupational settings.
Denisa Charvátová, Juraj Sinay
Open Access
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Conference Proceedings
Risk assessment through heart rate of a team of airport workers loading Unit Load Devices
Literature shows that musculoskeletal disorders (MSDs) are common among airport baggage handlers, but Unit load Device (ULD) loading/unloading has not been examined before. In this paper we recorded heart rates of six workers handling 12 ULDs each up to 1,000 kg. The workplace precludes the use of ISO 11228-2 standard because the tasks of loading/unloading are performed by a team of workers with no wheeled equipment on a slope surface. Besides, no single method in literature contemplates the assessment of braking tasks in the unloading stage. Both loading and unloading tasks showed low physical effort despite the heavy handled loads. Improvements could include ergonomic handles and better Aircraft Cargo Loader operation to minimize manual handling. Though limited by sample size and reliance on heart rate, the results suggest that heart rate could be a valuable parameter for assessing workers’ effort in non-standardized work environments where other risk assessments tools are non appliable. These findings can help enhance workplace safety and reduce MSD risks in air cargo operations. The adoption of these measures may also decrease aircraft loading times. The improvements could result in greater slot availability at the airport and subsequently enhance overall airport profitability.
Alessio Silvetti, Paola Giuntoli, Giorgia Chini, Alessandro Montefusco, Adriano Papale, Ari Fiorelli, Daniele Scialanga, Marta Petyx, Alberto Ranavolo, Tiwana Varrecchia, Deborah D'angelo, Orietta Angelosanto
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Differences in Mandolin Tremolo Motion between Beginners and Experts: Implications for Skill Acquisition
Mandolin tremolo is a fundamental technique requiring rapid, high-frequency motion of the elbow and wrist. Understanding the kinematic strategies adopted across different skill levels is crucial for optimizing skill acquisition protocols and potentially mitigating performance-related injuries. This study investigates the differences in forearm and wrist motion between novice and skilled mandolin players to provide data-driven guidance. Ten participants, categorized based on self-reported experience levels (ranging from under 1 year to 6 years), were recruited. Miniature IMU sensors were attached to the hand and forearm. Participants performed tremolo on the open A string at their preferred pace. We analyzed the angular velocity data, computing the vertical velocity of the pick by modeling the hand-forearm kinematic chain. The primary finding was that the symmetry and consistency of the upstroke/downstroke pick velocity exhibited the strongest correlation with skill level. Beginners demonstrated significant velocity decay during the resistive upstroke phase. Intermediate players compensated for this by rigidly coupling the hand and forearm to leverage forearm inertia. Crucially, expert players demonstrated a distinct shift, actively incorporating radial-ulnar wrist deviation to maintain high pick speed and smooth momentum transfer. These findings provide kinematic benchmarks and suggest a progression from gross-motor compensation to fine-motor control optimization for effective skill training.
Michihiko Fukunaga
Open Access
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An Illumination Study on Floating Storage and Offloading Vessel
There are a few floating storage offshore (FSO) facilities operating in Malaysian waters. Thisstudy was executed in one of the facilities 170 km from the East Coast of PeninsularMalaysia. The objective of this study is to investigate the lighting at the workplace at the FSOand to compare it with the recommended requirements of the Department of Safety andHealth (DOSH) Malaysia. Based on the calculated room index for each compartment, a totalof fifty-four (54) points were identified for illuminance measurement. Four representative points were selected for specific tasks/activities measurements. A total of forty-eight (48) accessibleindoor locations were measured to investigate the adequacy of the lighting (illuminance)inside the accommodation section and a few of the workshops. More than 50% of themeasured locations (i.e., twenty-eight (28) out of forty-eight (48)) were found to be recordedwith illumination below the recommended levels. The general lighting at three critical areaswas found to be low, from 17 to 109 lux. However, all three places use localized light thathas more than enough lux. At the same time, it was found that all desktop activities at thestudied locations did not manage to achieve the minimum recommended illumination levels.As for activities inside the workshops, specific tasks are supplemented with task lights. Due to this, the specific activities were found to meet the minimum illumination recommendationbased on the activities performed, even though the general lighting of each workshop wasfound to be below the recommended illumination levels.
Dian Darina Indah Daruis, Fatin Humaira' Mohd Naim
Open Access
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The impact of physical and mental stress on the cognitive abilities of employees in Industry 5.0 manufacturing environments: A systematic literature review
Transition to Industry 5.0 reshapes manufacturing work environments by placing human capabilities, wellbeing and sustainability in the centre of technological development. Job tasks tendency to switch from manual handling to cognitive nature as well as workforce ageing, it is critical to understand, the impact of physical and mental stress on cognitive abilities of employees. A systemic literature analysis performed within this study concentrates on relations between employee workload and cognitive performance in Industry 5.0 manufacturing settings, with the aim of identifying research gaps and establishing a theoretical basis for further empirical research. Review of 19 peer-reviewed articles, selected form databases including Scopus, MDPI and ResearchGate, covering the period 2015 – 2026. The findings indicate that physical and mental stress has significant impact on cognitive performance. Conversely, structured rest breaks, ergonomic improvements, physical activity and stress management practices demonstrate measurable positive effects on cognitive function. The results confirm the importance of human-centred workload management within manufacturing environment and highlight the requirement for integrated approach to address human as well as technological factors in the sustainable manufacturing environment.
Zanda Borovska, Henrijs Kalkis
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A Methodological Framework for Upper-Limb Comfort Reachability Modeling Using Biomechanical Simulation and Point-Cloud Representation
Modeling upper-limb comfort reachability is a fundamental task for ergonomic analysis and human–machine interface layout in transportation systems. Existing approaches often rely on simplified geometric assumptions or static anthropometric rules, limiting their ability to represent the continuous three-dimensional structure of comfort reach space and its variability across individuals. This study proposes a data-driven framework that integrates biomechanical simulation, point-cloud representation, and anthropometric parameterization to construct individualized upper-limb comfort reachability envelopes. An upper-limb musculoskeletal model is established in an open-source simulation platform to represent multi-degree-of-freedom motions of the shoulder, elbow, and wrist. Comfort criteria are defined by constraining joint excursions within specified proportions of physiological ranges. Joint configurations within admissible comfort ranges are sampled, and forward kinematics is applied to compute endpoint positions, generating a three-dimensional point-cloud representation of the comfort reach envelope. The proposed framework enables continuous, scalable, and individualized modeling of comfort reachability, supporting ergonomic assessment and human–machine interface design in transportation systems.
Jundong Pei, Yuanming Lv, Can Yang, Pengyu Chen, Huimin Hu, Junmin Du
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Designing for adoption: a culturally grounded, 3D-prototyped ergonomic hand tool for Andean potato harvesting
Small-scale potato harvesting in the Peruvian Andes relies on traditional hand tools that were not designed with ergonomic or user-centered principles. Farmers therefore face high physical demands, awkward postures, and increased risk of work-related musculoskeletal disorders. This study presents preliminary findings from the Discover and Define phases of a mixed-method project, guided by the 'Double diamond' design model, to develop an ergonomic harvesting tool. Physical evaluations and interviews with 12 rural farmers explored perceptions, needs, and cultural requirements for adoption. Anthropometric, hierarchical task analysis (HTA), and a Rapid Entire Body assessment (REBA) characterized tasks and postural risk. Surface electromyography (sEMG) measured muscle activation during traditional tool use, and a standardized comfort scale captured perceived discomfort. Farmers (49 years; IQR:45.5-54.0; 50% women) emphasized local repairability, similarity to familiar tools (e.g., picks and allachu), and easy of transport by hand and pack animals for adoption.HTA identified soil digging as the highest-risk subtask. REBA classified 83.3% of participants as high postural risk. sEMG showed elevated activation of the extensor carpi radialis (143.6 ± 56.8 µV) and biceps brachii (118.6 ± 53.3 µV). Mean overall comfort rating was 38.7 ± 7.2. These insights informed concept generation and rapid iteration from cardboard prototypes to a 3D-printed mock-up. The current design includes a telescopic handle adjustable from 84–90.5 cm and an ergonomic grip diameter of 39–41 mm, accommodating 80% of the sample, while preserving functional familiarity through a dual head with a 21.5 cm tip and blade. Prototype evaluation in field-like trials is underway.
Liliana Cruz-Ausejo, Consuelo Cano Gallardo, Juan Jose Valverde Ayte, Jose del Carmen Abad Castillo, Jerome Galea, Amit Bhattacharya
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An AI-Powered Model for Automatic Real-Time Assessment of Seated Work Postures Using Rapid Upper Limb Assessment (RULA)
Improper seated work postures are common in the workplace and can lead to various musculoskeletal problems, ranging from joint pain to permanent disability. Continuous assessment of seated work postures is necessary to help prevent these risks. However, existing studies have often relied on rule-based methods, which are highly vulnerable to measurement noise from motion capture devices. To overcome this limitation, this study proposes a learning-based approach for posture assessment. Ten participants were recruited to mimic the seven most common awkward and potentially risky seated work postures, while joint angles of their upper body were recorded and computed using both an RGB video-based approach and a Vicon motion capture system-based approach. The RGB measurements were used as features, while the Vicon measurements were used to derive accurate reference labels by comparison against Rapid Upper Limb Assessment (RULA) criteria. A multi-output Random Forest classifier was trained to predict joint-level posture assessment scores, and the model performance was evaluated using a leave-one-subject-out cross-validation scheme. The results provide initial evidence that the model achieved high performance in neck score assessment, while the trunk, shoulder, and elbow scores were more sensitive to posture types and inter-subject differences in posture execution. A larger dataset with more posture types or more subjects would improve the robustness and generalizability of the model.
Xiaoyi Wang, Calvin Or
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Integrating Physical and Psychosocial Risk Assessment Across Age and Gender: Preliminary Findings from the European WAge Project
The ageing of the workforce, together with the combined influence of ergonomic and psychosocial factors, poses a growing challenge for occupational health and sustainable work. This study, conducted within the European project WAge (wagehealth.eu), aims to develop an integrated analytical model that links physical and psychosocial risk assessment while explicitly considering age and gender. The ultimate goal is to inform evidence-based policies and interventions to improve working conditions and worker well-being. A cross-sectional field study was carried out between Q4 2024 and Q1 2025 in Spain, Portugal, and Poland, including a sample of >500 workers from industrial and service sectors. For each job position, data collection combined: (1) sociodemographic and job information; (2) objective physical workload assessment through video recording and observational ergonomic evaluation (REBA); and (3) self-reported measures covering perceived physical workload (based on ISO 12295), musculoskeletal health (Nordic Musculoskeletal Questionnaire), and psychosocial conditions (HEROCheck). Data are being analysed using descriptive statistics and multivariable regression models, adjusted for age, gender and job type, to explore associations between physical demands, psychosocial exposures, and health/work ability outcomes. Preliminary results of the Spanish sample (N=113) indicate meaningful relationships between physical and psychosocial factors. A detailed characterization of these interactions will support the development of a practical, adaptable screening methodology for diverse job profiles.
Alberto Ferreras Remesal, Mercedes Sanchís Almenara, Alicia Piedrabuena Cuesta, Sonia Serna Arnau, Richard Merhi Auar, Marisa Salanova Soria, Sonia García García, Patricia Such Faro
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Design of a rapid assessment tool to identify ergonomic risk factors due to manual material handling tasks in mexican workers
The project focuses on the design of a rapid assessment tool to identify exposure to ergonomic risk factors associated with manual material handling (MMH) tasks, such as lifting, lowering, pushing, pulling, carrying, and holding loads. The tool was developed using five evaluation criteria, each divided into 10 items rated on a scale from 0 (not met) to 4 (optimal compliance). The final version of the instrument consists of a checklist with 50 items, considering the evaluation criteria mentioned above. This format was conceived to make an easy-to-applied assessment in real working conditions, particularly by health and safety managers or other stakeholders who understand workplace procedures but are not necessarily experts in human factors and ergonomics. This rapid assessment tool allows for a structured and practical overview of compliance with ergonomic requirements and standards. In addition, this instrument may facilitate the implementation of ergonomic regulations in workplaces by making their interpretation and application more accessible. Ultimately, the evaluator can independently follow up on each item or address the entire criterion if necessary.
Sergio Alberto Valenzuela Gomez, Sergio Neri-Ledezma, Diana-Enid Alatorre-López
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Ergonomic risk assessment of agricultural tractors: a systematic review of literature
Agriculture plays a vital role in a country’s economy and development by providing food, employment, and economic contributions. Mechanization of processes such as land preparation, threshing, grinding, and milling improves productivity and product quality, prompting many developing countries to import standardized agricultural machinery. However, many technologies overlook occupational health and ergonomic principles, leading to operator–machine mismatches, limited adjustability, and repetitive tasks that increase safety risks. This highlights the need to adapt imported mechanized technologies to local conditions while minimizing risks to workers. Among agricultural machinery, tractors are essential but are also a leading source of fatal and non-fatal injuries in the sector. Integrating ergonomic considerations into tractor design is therefore critical to enhance both safety and performance. This study systematically reviews existing literature on the risk assessment of agricultural mechanization and emerging technologies, with a focus on tractors. Relevant literature was collected from the SCOPUS database using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. VOSviewer software was used to analyze keyword trends and their co-occurrences. The initial search was limited to publications from 2015 to the present, yielding 2,614 documents. Further screening based on publication year, subject area, document type, journal ranking, language, and conceptual relevance reduced the dataset to 165 documents for final review. The review examined operator health and safety risks associated with tractor operations, including operation types, risk factors, and ergonomic assessment methods. Findings emphasize the need for a comprehensive understanding of tractor ergonomics, particularly during real-world implement use, and of the interactions among vibration, posture, muscle workload, and comfort. The results also highlight the importance of ergonomic evaluations that integrate observational, instrumental, and self-report methods.
John Kenneth Punongbayan, Benette Custodio
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Toward Harmonized Human–Machine Interaction: Assistive Communication for Elderly with Aphasia
This research aims to develop a practical and user-friendly communication device for elderly individuals with higher brain dysfunction, particularly those with aphasia caused by stroke. Current gaze-tracking devices are often ineffective due to unstable eye movements in older users. To address this, the project integrates prior achievements in rehabilitation robotics and elderly monitoring to create functions for facial expression detection, classification, and adaptive learning. Unlike existing emotion-recognition systems, this approach seeks to infer communicative intent from facial features and translate it into speech and synchronized avatar actions, enhanced by adjusted voice frequency, speed, and gestures for clarity. The innovation lies in tailoring the system to individual disabilities, enabling urgent responses (e.g., breathing difficulties), and refining accuracy through machine learning. With Japan’s aging workforce—26% of 35 million seniors employed—communication support is increasingly vital to prevent workplace accidents and service decline. This study positions machines not as replacements but as partners harmonizing with human cognition and emotion. By combining assistive robotics expertise with monitoring avatars, the project aims for low-cost, socially implementable solutions applicable at home, in communities, and workplaces, ultimately contributing to safer and more inclusive elderly communication.
Taisuke Sakaki
Open Access
Article
Conference Proceedings
Influence of chair height on posture while playing the cello: a biomechanical analysis using motion capture
Posture plays a significant role in the physical health of musicians in general, especially those who play string instruments, such as cellists, for whom the interaction between the trunk, upper limbs, and instrument support requires proper alignment. This study aims to investigate the influence of different chair heights on the posture of a cellist during the performance of a musical scale, using biomechanical analysis through motion capture. One participant who was a beginner on the instrument performed the task under four conditions: seated on the same chair adjusted to heights of 42 cm (23.1% of the participant’s height), 48 cm (26.4%), and 54 cm (29.7%), and in a near-standing position. Joint angles of the shoulder (the primary variable) were analyzed, as well as those of the pelvis and the elbow of the arm holding the bow (secondary variables). No changes in the height of the endpin were considered; that is, it was not adjusted and remained at the same setting for all participant positions. The results showed that chair height has a direct effect on shoulder flexion, with lower mean values observed at the 48 cm chair height and greater demands in the near-standing posture. Thus, within the scope and limitations of this study, it was concluded that chair height can, to some extent, alter the ideal posture of the cellist, impacting comfort, stability, and biomechanical efficiency. Furthermore, the importance of individualized furniture adjustments for musicians is emphasized.
Gregorio Lameira, Alexandre Anibal Campos Bonilla, Milton Cinelli
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Ergonomic Risk Assessment and Fatigue Of Solid Waste Collectors in Chombueng District, Ratchaburi Province, Thailand
This study investigates ergonomic risks and physical fatigue among 22 sanitation workers in Chom Bueng District, Ratchaburi Province. Using a descriptive cross-sectional design, data were collected via structured questionnaires, body discomfort maps, and the Rapid Entire Body Assessment (REBA). The results indicated that while workers possessed high levels of safety knowledge (mean = 8.31), a significant correlation existed between knowledge and safety practices ($p=0.009$). Ergonomic analysis revealed that 100% of waste collectors (attendants) were at a "Very High Risk" level (REBA Score ≥ 11), primarily due to repetitive lifting, twisting, and awkward postures. In contrast, drivers faced a "Moderate Risk" level. Significant fatigue was reported in the lower back (72.7%), shoulders (68.2%), and legs. The study suggests that administrative controls and ergonomic modifications are urgently required to mitigate long-term musculoskeletal disorders.
Sutasinee Phichaikan, Amonrada Rongthong
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Assessing the Subjective Effects of a Passive Low-Back Exosuit in Manual Urban Waste Collection: A Pilot Study
This pilot study evaluated the subjective effects of a commercial low-back support exosuit during standard work operations in manual urban waste collection, a sector characterized by high prevalence of work-related musculoskeletal disorders (WMSDs). Although occupational exoskeletons (OEXOs) and exosuits are considered a viable solution to mitigate the risk of developing WMSDs, their actual workplace adoption remains limited. Empirical field data regarding the real-world use of OEXOs, particularly exosuits, is still scarce, necessitating more field studies to investigate real-world complexities. Moreover, while manual waste collection stands out due to its physically demanding nature, with repetitive bending and lifting, awkward postures and high operational pacing, there is little knowledge about OEXOs use in this context. This study addressed both gaps by providing insights into subjective contextual exosuit experience and potential barriers to the integration of wearable assistive technologies into work procedures.Ten waste collectors from an Italian waste management company participated in the study, wearing the Herowear Apex 2, a passive soft low-back exosuit, for approximately two hours during standard work shifts. This device features a backpack-like module, thigh sleeves, a clutch mechanism and elastic bands that store energy during bending and return it during lifting. The device was selected for its quick-engagement clutch mechanism and low-profile architecture. Participants received exosuit training the day prior to the trial and were supervised by researchers throughout the study. A mixed-methods approach was adopted. Quantitative data were collected post-trial using the NASA-TLX scale, the Local Body Discomfort (LBD) scale and an ad hoc five-point Likert-like questionnaire. Qualitative data included post-trial semi-structured interviews. Given the pilot sample size (n=10), descriptive statistical analysis was performed on quantitative data, while thematic analysis was used for qualitative data.NASA-TLX results indicated that the overall perceived workload with and without exosuit was comparable, with slight improvements in physical demand and performance when wearing the device. The LBD scale showed the participants found the exosuit generally comfortable, with light discomfort reported across the body regions. The Likert questionnaire revealed high variability regarding perceived usefulness, while participants broadly agreed on ease of operating the device, social acceptability, preserved range of motion and increased sweating due to the device.Qualitative findings provided critical operational insights. Significant concerns were raised regarding increased thermal discomfort, with unanimous worry about summer usability when sweat could make the device difficult to tolerate. Although there was general agreement on the simplicity of the clutch mechanism, high operational pacing and traffic pressure discouraged continuous manual activation. Participants also noted that the device did not address discomfort in the shoulders and knees, highlighting the regional limitations of a low-back support system in this context. A key functional trade-off was identified: in the passive system, users must exert effort to load the elastic element during trunk flexion to receive assistive force during the subsequent lift, a dynamic that may reduce perceived benefits.These findings contribute field-level evidence on OEXO use and point to contextual factors that must be addressed for successful integration of exosuits in physically demanding occupational settings.
Andrea Catalano, Giuseppe Andreoni, and Nicola Francesco Lopomo
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