Adaptive hip exoskeleton control using heart rate feedback reduces oxygen cost during ecological locomotion.

Despite their potential, exoskeletons have not reached widespread adoption in daily life, partly due to the challenge of seamlessly adapting assistance across various tasks and environments. Task-specific designs, reliance on complex sensing and extensive data-driven training often limit the practicality of the existing control strategies. To address this challenge, we introduce an adaptive control strategy for hip exoskeletons, emphasizing minimal sensing and ease of implementation. Using only insole pressure and heart rate (HR) sensing, the controller modulates assistance across various locomotor tasks. We evaluated this strategy with twelve able-bodied participants in a real-world scenario including level walking, stairs, and inclines. The controller successfully adapted assistance timing and amplitude to different activities. This resulted in effort intensity reductions (measured by oxygen uptake) of up to 12.6% compared to walking with no exoskeleton, and up to 25.5% compared to walking with the exoskeleton in zero-torque mode. Cardiodynamic response of HR, although delayed, proved sufficient for adaptation in tasks lasting longer than around 45 s, and delay-induced limitations primarily affected brief bouts of abrupt change in intensity. However, we found discernible patterns in HR shortly after the onset of such changes that can be exploited to improve responsiveness. Our findings underscore the potential of HR as a promising measure of user effort intensity, encouraging future research to explore its integration into advanced adaptive algorithms.