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Purpose: Forward Walking (FW) and Backward Walking (BW) on different gradients of the treadmill is a common exercise for lower extremity rehabilitation. However, limited studies are found about the three-dimensional analysis of lower extremity and status of the knee joint during FW and BW on different gradients. Therefore, this study aimed to investigate the lower extremity joints kinematics during FW and BW on incline and decline surfaces. Methods: The current research has a quasi-experimental design. Sixteen healthy males with the mean (SD) age of 22.4(2.5) years, volunteered to participate in this study. The subjects’ FW and BW with their preferred speed on a treadmill at four gradients (-7.5%, 0%, +5% and +10%), were analyzed by using motion capture system. All data were analyzed using paired sample t test (P

A simple ankle–foot exoskeleton that assists plantarflexion during push-off can reduce the metabolic power during walking. This suggests that walking performance during a maximal incremental exercise could be improved with an exoskeleton if the exoskeleton is still efficient during maximal exercise intensities. Therefore, we quantified the walking performance during a maximal incremental exercise test with a powered and unpowered exoskeleton: uphill walking with progressively higher weights. Nine female subjects performed two incremental exercise tests with an exoskeleton: 1 day with (powered condition) and another day without (unpowered condition) plantarflexion assistance. Subjects walked on an inclined treadmill (15 %) at 5 km h−1 and 5 % of body weight was added every 3 min until exhaustion. At volitional termination no significant differences were found between the powered and unpowered condition for blood lactate concentration (respectively, 7.93 ± 2.49; 8.14 ± 2.24 mmol L−1), heart rate (respectively, 190.00 ± 6.50; 191.78 ± 6.50 bpm), Borg score (respectively, 18.57 ± 0.79; 18.93 ± 0.73) and $$\dot{V}{\rm O}_{2}$$ peak (respectively, 40.55 ± 2.78; 40.55 ± 3.05 ml min−1 kg−1). Thus, subjects were able to reach the same (near) maximal effort in both conditions. However, subjects continued the exercise test longer in the powered condition and carried 7.07 ± 3.34 kg more weight because of the assistance of the exoskeleton. Our results show that plantarflexion assistance during push-off can increase walking performance during a maximal exercise test as subjects were able to carry more weight. This emphasizes the importance of acting on the ankle joint in assistive devices and the potential of simple ankle–foot exoskeletons for reducing metabolic power and increasing weight carrying capability, even during maximal intensities.