Feasibility of a Biomechanically-Assistive Garment to Reduce Low Back Loading During Leaning and Lifting

Occupational exoskeletons: A roadmap toward large-scale adoption. Methodology and challenges of bringing exoskeletons to workplaces

The large-scale adoption of occupational exoskeletons (OEs) will only happen if clear evidence of effectiveness of the devices is available. Performing product-specific field validation studies would allow the stakeholders and decision-makers (e.g., employers, ergonomists, health, and safety departments) to assess OEs' effectiveness in their specific work contexts and with experienced workers, who could further provide useful insights on practical issues related to exoskeleton daily use. This paper reviews present-day scientific methods for assessing the effectiveness of OEs in laboratory and field studies, and presents the vision of the authors on a roadmap that could lead to large-scale adoption of this technology. The analysis of the state-of-the-art shows methodological differences between laboratory and field studies. While the former are more extensively reported in scientific papers, they exhibit limited generalizability of the findings to real-world scenarios. On the contrary, field studies are limited in sample sizes and frequently focused only on subjective metrics. We propose a roadmap to promote large-scale knowledge-based adoption of OEs. It details that the analysis of the costs and benefits of this technology should be communicated to all stakeholders to facilitate informed decision making, so that each stakeholder can develop their specific role regarding this innovation. Large-scale field studies can help identify and monitor the possible side-effects related to exoskeleton use in real work situations, as well as provide a comprehensive scientific knowledge base to support the revision of ergonomics risk-assessment methods, safety standards and regulations, and the definition of guidelines and practices for the selection and use of OEs.

Effectiveness of Soft versus Rigid Back-Support Exoskeletons during a Lifting Task

This study investigated the influence of passive back-support exoskeletons (EXO_BK) design, trunk sagittal inclination (TSI), and gender on the effectiveness of an exoskeleton to limit erector spinae muscle (ES) activation during a sagittal lifting/lowering task. Twenty-nine volunteers performed an experimental dynamic task with two exoskeletons (two different designs: soft (SUIT) and rigid (SKEL)), and without equipment (FREE). The ES activity was analyzed for eight parts of TSI, each corresponding to 25% of the range of motion (lifting: P1 to P4; lowering: P5 to P8). The impact of EXO_BK on ES activity depended on the interaction between exoskeleton design and TSI. With SKEL, ES muscle activity significantly increased for P8 (+36.8%) and tended to decrease for P3 (−7.2%, p = 0.06), compared to FREE. SUIT resulted in lower ES muscle activity for P2 (−9.6%), P3 (−8.7%, p = 0.06), and P7 (−11.1%), in comparison with FREE. Gender did not influence the effect of either back-support exoskeletons on ES muscle activity. These results point to the need for particular attention with regard to (1) exoskeleton design (rigid versus soft) and to (2) the range of trunk motion, when selecting an EXO_BK. In practice, the choice of a passive back-support exoskeleton, between rigid and soft design, requires an evaluation of human-exoskeleton interaction in real task conditions. The characterization of trunk kinematics and ranges of motion appears essential to identify the benefits and the negative effects to take into account with each exoskeleton design.

Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach

Lower back pain is a leading cause of work absence and activity limitations globally, with a 60% to 85% lifetime chance of occurrence. This article highlights the role that lifestyle medicine plays in managing lower back pain as a cost-effective intervention strategy. It is suggested that lifestyle medicine strategies, such as incorporating whole foods and a plant-based diet, sustainable physical activity and mind-body exercises, restorative sleep, stress resiliency, awareness and mitigation of substance abuse and addiction, and establishing meaningful social networks and self-care strategies, be a part of managing chronic lower back pain.

Effects of back-support exoskeleton use on trunk neuromuscular control during repetitive lifting: A dynamical systems analysis

Back-support exoskeletons (BSEs) are a promising ergonomic intervention to mitigate the risk of occupational low back pain. Although growing evidence points to the beneficial effects of BSEs, specifically in reducing low-back physical demands, there is limited understanding of potential unintended consequences of BSE use on neuromuscular control of the trunk during manual material handling (MMH). We quantified the effects of two passive BSEs (BackX™ AC and Laevo™ V2.5) on trunk dynamic stability and movement coordination during a repetitive lifting task. Eighteen participants (gender-balanced) completed four minutes of repetitive lifting in nine different conditions, involving symmetric and asymmetric postures when using the BSEs (along with no BSE as a control condition). Maximum Lyapunov exponents (short-term: λ_max-s; long-term: λ_max-l) and Floquet multipliers (FM_max) were respectively calculated to quantify the local dynamic and orbital stability of thorax and pelvis trajectories. Thorax-pelvis segmental coordination was also quantified using the continuous relative phase. Wearing the Laevo™ significantly increased λ_max-s for the pelvis (by ~ 8%) and FM_max for the thorax and pelvis (by ~ 5-10%). Use of either BSE decreased the in-phase coordination pattern for the thorax-pelvis coupling (by ~ 15%). These results suggest that BSE use can compromise neuromuscular control of the trunk, and caution should thus be used in selecting a suitable BSE for use in a given MMH task. Future work is needed, however, to assess the generalizability of different BSE design approaches in terms of unintended short-term and long-term effects on trunk neuromuscular control.

Design and preliminary evaluation of a flexible exoskeleton to assist with lifting

We present a passive (unpowered) exoskeleton that assists the back during lifting. Our exoskeleton uses carbon fiber beams as the sole means to store energy and return it to the wearer. To motivate the design, we present general requirements for the design of a lifting exoskeleton, including calculating the required torque to support the torso for people of different weights and heights. We compare a number of methods of energy storage for exoskeletons in terms of mass, volume, hysteresis, and cycle life. We then discuss the design of our exoskeleton, and show how the torso assembly leads to balanced forces. We characterize the energy storage in the exoskeleton and the torque it provides during testing with human subjects. Ten participants performed freestyle, stoop, and squat lifts. Custom image processing software was used to extract the curvature of the carbon fiber beams in the exoskeleton to determine the stored energy. During freestyle lifting, it stores an average of 59.3 J and provides a peak torque of 71.7 Nm.

Applicability of an Active Back-Support Exoskeleton to Carrying Activities

Occupational back-support exoskeletons are becoming a more and more common solution to mitigate work-related lower-back pain associated with lifting activities. In addition to lifting, there are many other tasks performed by workers, such as carrying, pushing, and pulling, that might benefit from the use of an exoskeleton. In this work, the impact that carrying has on lower-back loading compared to lifting and the need to select different assistive strategies based on the performed task are presented. This latter need is studied by using a control strategy that commands for constant torques. The results of the experimental campaign conducted on 9 subjects suggest that such a control strategy is beneficial for the back muscles (up to 12% reduction in overall lumbar activity), but constrains the legs (around 10% reduction in hip and knee ranges of motion). Task recognition and the design of specific controllers can be exploited by active and, partially, passive exoskeletons to enhance their versatility, i.e., the ability to adapt to different requirements.

The Effects of Upper-Body Exoskeletons on Human Metabolic Cost and Thermal Response during Work Tasks-A Systematic Review

BACKGROUND

New wearable assistive devices (exoskeletons) have been developed for assisting people during work activity or rehabilitation. Although exoskeletons have been introduced into different occupational fields in an attempt to reduce the risk of work-related musculoskeletal disorders, the effectiveness of their use in workplaces still needs to be investigated. This systematic review focused on the effects of upper-body exoskeletons (UBEs) on human metabolic cost and thermophysiological response during upper-body work tasks.

METHODS

articles published until 22 September 2020 were selected from Scopus, Web of Science, and PubMed for eligibility and the potential risk of bias was assessed.

RESULTS

Nine articles resulted in being eligible for the metabolic aspects, and none for the thermal analysis. All the studies were based on comparisons between conditions with and without exoskeletons and considered a total of 94 participants (mainly males) performing tasks involving the trunk or overhead work, 7 back-support exoskeletons, and 1 upper-limb support exoskeleton. Eight studies found a significant reduction in the mean values of the metabolic or cardiorespiratory parameters considered and one found no differences.

CONCLUSIONS

The reduction found represents a preliminary finding that needs to be confirmed in a wider range of conditions, especially in workplaces, where work tasks show different characteristics and durations compared to those simulated in the laboratory. Future developments should investigate the dependence of metabolic cost on specific UBE design approaches during tasks involving the trunk and the possible statistical correlation between the metabolic cost and the surface ElectroMyoGraphy (sEMG) parameters. Finally, it could be interesting to investigate the effect of exoskeletons on the human thermophysiological response.

Biomechanical assessment of two back-support exoskeletons in symmetric and asymmetric repetitive lifting with moderate postural demands

Two passive back-support exoskeleton (BSE) designs were assessed in terms of muscular activity, energy expenditure, joint kinematics, and subjective responses. Eighteen participants (gender-balanced) completed repetitive lifting tasks in nine different conditions, involving symmetric and asymmetric postures and using two BSEs (along with no BSE as a control condition). Wearing both BSEs significantly reduced peak levels of trunk extensor muscle activity (by ~9-20%) and reduced energy expenditure (by ~8-14%). Such reductions, though, were more pronounced in the symmetric conditions and differed between the two BSEs tested. Participants reported lower perceived exertion using either BSE yet raised concerns regarding localized discomfort. Minimal changes in lifting behaviors were evident when using either BSE, and use of both BSEs led to generally positive usability ratings. While these results are promising regarding the occupational use of BSEs, future work is recommended to consider inter-individual differences to accommodate diverse user needs and preferences.

Low-profile elastic exosuit reduces back muscle fatigue

We investigated the extent to which an un-motorized, low-profile, elastic exosuit reduced the rate of fatigue for six lumbar extensor muscles during leaning. Six healthy subjects participated in an A-B-A (withdrawal design) study protocol, which involved leaning at 45º for up to 90 s without exosuit assistance (A1), then with assistance (B), then again without assistance (A2). The exosuit provided approximately 12–16 Nm of lumbar extension torque. We measured lumbar muscle activity (via surface electromyography) and assessed fatigue rate via median frequency slope. We found that five of the six subjects showed consistent reductions in fatigue rate (ranging from 26% to 87%) for a subset of lumbar muscles (ranging from one to all six lumbar muscles measured). These findings objectively demonstrate the ability of a low-profile elastic exosuit to reduce back muscle fatigue during leaning, which may improve endurance for various occupations.

A review of soft wearable robots that provide active assistance: Trends, common actuation methods, fabrication, and applications

This review meta-analysis combines and compares the findings of previously published works in the field of soft wearable robots (SWRs) that provide active methods of actuation for assistive and augmentative purposes. A thorough investigation of major contributions in the field of an SWR is made to analyze trends in the field focused on fluidic and cable-driven systems, prevalent and successful approaches, and identify the future direction of SWRs and active actuation strategies. Types of soft actuators used in wearables are outlined, as well as general practices for fabrication methods of soft actuators and considerations for human-robot interface designs of garment-like exosuits. An overview of well-known and emerging upper body (UB)- and lower body (LB)-assistive technologies is categorized by the specific joints and degree of freedom (DoF) assisted and which actuator methodology is provided. Different use cases for SWRs are addressed, as well as implementation strategies and design applications.

Load Position and Weight Classification during Carrying Gait Using Wearable Inertial and Electromyographic Sensors

Lifting and carrying heavy objects is a major aspect of physically intensive jobs. Wearable sensors have previously been used to classify different ways of picking up an object, but have seen only limited use for automatic classification of load position and weight while a person is walking and carrying an object. In this proof-of-concept study, we thus used wearable inertial and electromyographic sensors for offline classification of different load positions (frontal vs. unilateral vs. bilateral side loads) and weights during gait. Ten participants performed 19 different carrying trials each while wearing the sensors, and data from these trials were used to train and evaluate classification algorithms based on supervised machine learning. The algorithms differentiated between frontal and other loads (side/none) with an accuracy of 100%, between frontal vs. unilateral side load vs. bilateral side load with an accuracy of 96.1%, and between different load asymmetry levels with accuracies of 75-79%. While the study is limited by a lack of electromyographic sensors on the arms and a limited number of load positions/weights, it shows that wearable sensors can differentiate between different load positions and weights during gait with high accuracy. In the future, such approaches could be used to control assistive devices or for long-term worker monitoring in physically demanding occupations.

A Biomechanical Waist Comfort Model for Manual Material Lifting

Low back pain (LBP) is a common disorder that affects the working population worldwide. LBP causes more disability than any other conditions all around the world. Most existing studies focus on the occupational physical factors in association with LBP, while few focus on individual factors, especially the lack of quantitative calculation of waist comfort in biomechanics. Based on the physical statistics of Chinese men, this research used human posture analysis (HPA) to establish the waist strength formula and analyzed the waist strength during a manual material handling. It also explored the influence of weight and height of lifting objects on the L5-S1 spinal load. On this basis, a waist comfort model was proposed in combination with the recommended weight limit (RWL) recommended by NIOSH, and the parameter selection and waist comfort value were verified by Jack simulation software. The results show that pulling force of the Erector Spinae of the waist is closely related to the weight and lifting height of the object. Parameter verification and Jack software simulation results show that the force of L5-S1 is less than 3400 N, which proves that the waist force under this posture is acceptable. The developed waist comfort model can be applied to evaluate work risk, to adjust working intensity and powered exoskeleton design, aiming to decrease the prevalence of LBP.

A Fully Soft and Passive Assistive Device to Lower the Metabolic Cost of Sit-to-Stand

Various assistive devices like exoskeletons have been developed to aid the growing number of disabled people. Recent studies have started to explore using soft rather than rigid components to create lightweight and unobtrusive systems that can be more easily adopted by the general population. However, there is a tradeoff between compliance and power in these systems. We investigated the physiological benefits of using an inconspicuous, soft and passive assistive device which would avoid bulkiness, heaviness and user discomfort. We chose to assist the sit-to-stand (STS) maneuver because it is a common activity of daily living (ADL). STS is also recognized as one of the most challenging ADLs due to the high knee torque required, and the primary limiting factor is known to be knee extensor strength. Thus, the objective of this research was to develop and evaluate an unobtrusive knee assist wear called X-tights that could aid knee extension during STS using only soft and passive components. This was accomplished by routing elastic bands across the lower extremity. Thirty-one healthy participants performed STS tests with and without the X-tights, while metabolic cost and muscle activity were recorded. Metabolic power significantly decreased, by 3.2 ± 1.5% (P = 0.04), when utilizing the X-tights during the STS, while there was no statistically significant differences in muscle activity. The present work introduces a new soft and passive assist wear that can be worn inconspicuously under normal clothing, and we demonstrate promising results for the future development and integration of soft assistive technology for daily life.

A Pilot Study of Varying Thoracic and Abdominal Compression in a Reconfigurable Trunk Exoskeleton During Different Activities

OBJECTIVE

Trunk exoskeletons are a new technology with great promise for human rehabilitation, assistance and augmentation. However, it is unclear how different exoskeleton features affect the wearer's body during different activities. This study thus examined how varying a trunk exoskeleton's thoracic and abdominal compression affects trunk kinematics and muscle demand during several activities.

METHODS

We developed a trunk exoskeleton that allows thoracic and abdominal compression to be changed quickly and independently. To evaluate the effect of varying compression, 12 participants took part in a two-session study. In the first session, they performed three activities (walking, sit-to-stand, lifting a box). In the second session, they experienced unexpected perturbations while sitting. This was done both without the exoskeleton and in four exoskeleton configurations with different thoracic and abdominal compression levels. Trunk flexion angle, low back extension moment and the electromyogram of the erector spinae and rectus abdominis were measured in both sessions.

RESULTS

Different exoskeleton compression levels resulted in significantly different peak trunk flexion angles and peak electromyograms of the erector spinae. However, the effects of compression differed significantly between activities.

CONCLUSION

Our results indicate that a trunk exoskeleton's thoracic and abdominal compression affect the wearer's kinematics and muscle demand; furthermore, a single compression configuration is not appropriate for all activities.

SIGNIFICANCE

The study suggests that future trunk exoskeletons should either be able to vary their compression levels to suit different activities or should have the compression designed for a specific activity in order to be beneficial to the wearer.

Effects of Two Passive Back-Support Exoskeletons on Muscle Activity, Energy Expenditure, and Subjective Assessments During Repetitive Lifting

OBJECTIVE

The aim of this study was to explore the efficacy of two different passive back-support exoskeleton (BSE) designs during repetitive lifting in different postures.

BACKGROUND

Although BSEs have been proposed as a potential intervention for reducing physical demands, limited information is available about the impacts of different exoskeleton designs in diverse work scenarios.

METHOD

Eighteen participants (gender-balanced) performed lab-based simulations of repetitive lifting tasks. These tasks were performed in 12 different conditions, involving two BSEs and a control condition, two levels of lifting symmetry (symmetric and asymmetric), and two postures (standing and kneeling). Outcome measures described muscle activity and energy expenditure, along with perceived discomfort, balance, and usability.

RESULTS

Using both BSEs significantly reduced peak activity of the trunk extensor muscles (by ~10%-28%) and energy expenditure (by ~4%-13%) in all conditions tested. Such reductions, though, were task dependent and differed between the two BSEs. In most of the tested conditions, using BSEs positively affected subjective responses regarding perceived exertion and usability.

CONCLUSION

Our results suggest that the beneficial effects of a BSE are task specific and depend on the specific BSE design approach. More work is needed, though, to better characterize this task specificity and to determine the generalizability of BSE effects on objective and subjective outcomes for a wider range of conditions and users.

APPLICATION

Our results provide new evidence to guide the selection and application of passive BSE designs in diverse lifting tasks.

Biomechanical Evaluation of Passive Back-Support Exoskeletons in a Precision Manual Assembly Task: "Expected" Effects on Trunk Muscle Activity, Perceived Exertion, and Task Performance

OBJECTIVE

To assess the efficacy of two different passive back-support exoskeleton (BSE) designs, in terms of trunk muscle activity, perceived low-back exertion, and task performance.

BACKGROUND

BSEs have the potential to be an effective intervention for reducing low-back physical demands, yet little is known about the impacts of different designs in work scenarios requiring varying degrees of symmetric and asymmetric trunk bending during manual assembly tasks.

METHOD

Eighteen participants (gender balanced) completed lab-based simulations of a precision manual assembly task using a "grooved pegboard." This was done in 26 different conditions (20 unsupported; 6 supported, via a chair), which differed in vertical height, horizontal distance, and orientation.

RESULTS

Using both BSEs reduced metrics of trunk muscle activity in many task conditions (≤47% reductions when using BackX™ and ≤24% reductions when using Laevo™). Such reductions, though, were more pronounced in the conditions closer to the mid-sagittal plane and differed between the two BSEs tested. Minimal effects on task completion times or ratings of perceived exertion were found for both BSEs.

CONCLUSION

Our findings suggest that using passive BSEs can be beneficial for quasi-static manual assembly tasks, yet their beneficial effects can be task specific and specific to BSE design approaches. Further work is needed, though, to better characterize this task specificity and to assess the generalizability of different BSE design approaches in terms of physical demands, perceived exertion, and task performance.

APPLICATION

These results can help guide the choice and application of passive BSE designs for diverse work scenarios involving nonneutral trunk postures.

Characterizing the comfort limits of forces applied to the shoulders, thigh and shank to inform exosuit design

Recent literature emphasizes the importance of comfort in the design of exosuits and other assistive devices that physically augment humans; however, there is little quantitative data to aid designers in determining what level of force makes users uncomfortable. To help close this knowledge gap, we characterized human comfort limits when applying forces to the shoulders, thigh and shank. Our objectives were: (i) characterize the comfort limits for multiple healthy participants, (ii) characterize comfort limits across days, and (iii) determine if comfort limits change when forces are applied at higher vs. lower rates. We performed an experiment (N = 10) to quantify maximum tolerable force pulling down on the shoulders, and axially along the thigh and shank; we termed this force the comfort limit. We applied a series of forces of increasing magnitude, using a robotic actuator, to soft sleeves around their thigh and shank, and to a harness on their shoulders. Participants were instructed to press an off-switch, immediately removing the force, when they felt uncomfortable such that they did not want to feel a higher level of force. On average, participants exhibited comfort limits of ~0.9–1.3 times body weight on each segment: 621±245 N (shoulders), 867±296 N (thigh), 702±220 N (shank), which were above force levels applied by exosuits in prior literature. However, individual participant comfort limits varied greatly (~250–1200 N). Average comfort limits increased over multiple days (p<3e-5), as users habituated, from ~550–700 N on the first day to ~650–950 N on the fourth. Specifically, comfort limits increased 20%, 35% and 22% for the shoulders, thigh and shank, respectively. Finally, participants generally tolerated higher force when it was applied more rapidly. These results provide initial benchmarks for exosuit designers and end-users, and pave the way for exploring comfort limits over larger time scales, within larger samples and in different populations.

Toward real-world evaluations of trunk exoskeletons using inertial measurement units

Trunk exoskeletons are an emerging technology that could reduce spinal loading, guide trunk motion, and augment lifting ability. However, while they have achieved promising results in brief laboratory studies, they have not yet been tested in longer-term real-world studies - partially due to reliance on stationary sensors such as cameras. To enable future real-world evaluations of trunk exoskeletons, this paper describes two preliminary studies on using inertial measurement units (IMUs) to collect kinematic data from an exoskeleton wearer. In the first study, a participant performed three activities (walking, sit-to-stand, box lifting) while trunk flexion angle was measured with both IMUs and reference cameras. The mean absolute difference in flexion angle between the two methods was 1.4° during walking, 3.6° during sit-to-stand and 5.2° during box lifting, showing that IMUs can measure trunk flexion with a reasonable accuracy. In the second study, six participants performed five activities (standing, sitting straight, slouching, 'good' lifting, 'bad' lifting), and a naïve Bayes classifier was used to automatically classify the activity from IMU data. The classification accuracy was 92.2%, indicating the feasibility of automated activity classification using IMUs. The IMUs will next be used to obtain longer-term recordings of different activities performed both with and without a trunk exoskeleton to determine how the exoskeleton affects a person's posture and behavior.

Ergonomic Mechanical Design and Assessment of a Waist Assist Exoskeleton for Reducing Lumbar Loads During Lifting Task

The purpose of this study was to develop a wearable waist exoskeleton to provide back support for industrial workers during repetitive lifting tasks and to assess reductions in back muscular activity. The ergonomic mechanical structure is convenient to employ in different applications. The exoskeleton attaches to the wearer’s body with 4 straps, takes only 30 s to put the exoskeleton on without additional help, weighs just 5 kg and is easy to carry. The mechanical clutch can assist the wearer as needed. Inertia Measurement Unit (IMU) was used to detect wearers’ motion intention. Ten subjects participated in the trial. Lower back muscle integrated electromyography (IEMG) of the left and right lumbar erector spinae (LES), thoracic erector spinae (TES), latissimus dorsi (LD) were compared in symmetrical lifting for six different objects (0, 5, 10, 15, 20, 25 kg) under two conditions of with and without the exoskeleton. The exoskeleton significantly reduced the back muscular activity during repetitive lifting tasks. The average integrated electromyography reductions were 34.0%, 33.9% and 24.1% for LES, TES and LD respectively. The exoskeleton can reduce burden and the incidence of strain on lumbar muscles during long-term lifting work.

Design of a Low Profile, Unpowered Ankle Exoskeleton That Fits Under Clothes: Overcoming Practical Barriers to Widespread Societal Adoption

Here, we present the design of a novel unpowered ankle exoskeleton that is low profile, lightweight, quiet, and low cost to manufacture, intrinsically adapts to different walking speeds, and does not restrict non-sagittal joint motion; while still providing assistive ankle torque that can reduce demands on the biological calf musculature. This paper is an extension of the previously-successful ankle exoskeleton concept by Collins, Wiggin, and Sawicki. We created a device that blends the torque assistance of the prior exoskeleton with the form-factor benefits of clothing. Our design integrates a low profile under-the-foot clutch and a soft conformal shank interface, coupled by an ankle assistance spring that operates in parallel with the user's calf muscles. We fabricated and characterized technical performance of a prototype through benchtop testing and then validated device functionality in two gait analysis case studies. To our knowledge, this is the first ankle plantarflexion assistance exoskeleton that could be feasibly worn under typical daily clothing, without restricting ankle motion, and without components protruding substantially from the shoe, leg, waist, or back. Our new design highlights the potential for performance-enhancing exoskeletons that are inexpensive, unobtrusive, and can be used on a wide scale to benefit a broad range of individuals throughout society, such as the elderly, individuals with impaired plantarflexor muscle strength, or recreational users. In summary, this paper demonstrates how an unpowered ankle exoskeleton could be redesigned to more seamlessly integrate into daily life, while still providing performance benefits for common locomotion tasks.

Towards The Internet-of-Smart-Clothing: A Review on IoT Wearables and Garments for Creating Intelligent Connected E-Textiles

Technology has become ubiquitous, it is all around us and is becoming part of us. Together with the rise of the Internet-of-Things (IoT) paradigm and enabling technologies (e.g., Augmented Reality (AR), Cyber-Physical Systems, Artificial Intelligence (AI), blockchain or edge computing), smart wearables and IoT-based garments can potentially have a lot of influence by harmonizing functionality and the delight created by fashion. Thus, smart clothes look for a balance among fashion, engineering, interaction, user experience, cybersecurity, design and science to reinvent technologies that can anticipate needs and desires. Nowadays, the rapid convergence of textile and electronics is enabling the seamless and massive integration of sensors into textiles and the development of conductive yarn. The potential of smart fabrics, which can communicate with smartphones to process biometric information such as heart rate, temperature, breathing, stress, movement, acceleration, or even hormone levels, promises a new era for retail. This article reviews the main requirements for developing smart IoT-enabled garments and shows smart clothing potential impact on business models in the medium-term. Specifically, a global IoT architecture is proposed, the main types and components of smart IoT wearables and garments are presented, their main requirements are analyzed and some of the most recent smart clothing applications are studied. In this way, this article reviews the past and present of smart garments in order to provide guidelines for the future developers of a network where garments will be connected like other IoT objects: the Internet-of-Smart-Clothing.