Integration of Sustainable Design Principles into Load-Carriage Exoskeletons: A Systematic Review

This systematic review examines the integration of sustainable design principles (SDPs) into load-carriage exoskeleton development. Although these technologies are increasingly investigated for reducing biomechanical and physiological demands during load-carriage, their sustainability extends beyond functional performance to material selection, energy use, durability, affordability, safety and contextual suitability. A systematic search of Scopus, ScienceDirect, Web of Science, Google Scholar, and supplementary sources was conducted for literature published between 2013 to 2025 in accordance with PRISMA 2020 guidelines. Fifty sources met the inclusion criteria and were synthesized using a structured framework covering eight SDP dimensions. Safety and comfort was the most consistently reported sustainability dimension, with evidence in 47 sources (94%), followed by energy efficiency in 27 sources (54%). Materials efficiency and sustainability was clearly addressed in 20 sources (40%), while modularity and adaptation was predominantly reported partially in 39 sources (78%). Overall, 34 sources (68%) demonstrated moderate SDP conformity, eight (16%) moderately-high, seven (14%) as moderately-low and one (2%) low conformity; no source achieved high conformity. The mean SDP conformity score was 2.51/5.00. The findings suggest that sustainability considerations are generally incorporated as individual technical features rather than an integrated design strategy. Greater attention is required to durability, life-cycle performance, affordability, socio-cultural suitability, and long-term field validation. An integrated sustainability-oriented approach is therefore needed to guide the development of effective, maintainable, affordable, adaptable, and context-appropriate load-carriage exoskeletons.