Low back pain (LBP) remains the most prevalent and costly work-related disability worldwide and is directly associated with "physical" risk factors prevalent in manual material handling (MMH) tasks. Back-support exoskeletons (BSEs) are a promising ergonomic intervention to mitigate LBP risk, by reducing muscular exertion and spine loading. The purpose of this work was to help better understand both the "intended" and "unintended" consequences of BSE use on physical risk factors for LBP, as an essential prerequisite for the safe and effective implementation of this technology in actual workplaces. The first study assessed the effects of using two BSEs on objective and subjective responses during repetitive lifting involving symmetric and asymmetric postures. Wearing both BSEs significantly reduced peak levels of trunk extensor muscle activity and reduced energy expenditure. Such reductions, though, were more pronounced in the symmetric conditions and differed between the two BSEs tested. The second study quantified the assistive torque profiles of two passive BSEs using a computerized dynamometer, with both human subjects and a mannequin. Clear differences in torque magnitudes were evident between the BSEs, though both generated more assistive torques during flexion than extension. The third study estimated the effects of BSE use on lumbosacral compressive and shear forces during repetitive lifting using an optimization-based model. Using both BSEs reduced peak compression and anteroposterior shear forces, but these effects differed between tasks and BSE designs. Reductions in composite measures of trunk muscle activity did not correspond consistently with changes in spine forces when using a BSE. The fourth study quantified the effects of two passive BSEs on trunk stability and movement coordination during repetitive lifting. Some adverse effects on stability were evident for pelvis and thorax movements and coupling of these body segments, suggesting that caution is needed in selecting a BSE for a given MMH task. Overall, we found that the efficacy of BSEs is design- and task-specific. Important safety features of the exoskeletons were also identified, providing insights on their performance boundaries. Overall, the BSEs tested were more effective and safer in tasks closer to the mid-sagittal plane and with moderate degrees of trunk flexion. / Doctor of Philosophy / Low back pain (LBP) remains the most prevalent and costly work-related disability worldwide, and the risk of LBP is related to "physical" risk factors common in manual material handling (MMH) tasks. Back-support exoskeletons (BSEs) are a new ergonomic intervention that may reduce the risk of occupational LBP, by reducing muscular efforts and loads on the spine. For the safe use of BSEs, though, it is critical to better understand both the "intended" and "unintended" consequences of this emerging technology. In this dissertation, such consequences of BSE use were evaluated in the context of repetitive lifting tasks. The first study assessed the efficacy of two BSEs in terms of physical demands during repetitive lifting tasks involving a range of torso bending and twisting. Wearing both BSEs reduced the physical demands on back muscles and decreased energy consumption. Larger reductions, though, were observed in forward bending and such reductions differed between the two BSEs tested. The second study measured the amount of support provided by two BSEs using a new measurement method, which was examined for both human subjects and a mannequin. Clear differences in the BSE support were evident between the BSEs, and both devices generated more support during torso forward bending than returning upright. The third study estimated the effects of BSE use on low back loadings during repetitive lifting using a computational model. Using both BSEs reduced loads on the low back region, though such reductions were task-specific and depended on the BSE design. The fourth study quantified the effects of the BSE use on torso stability and movement patterns during repetitive lifting. Some adverse effects on stability were evident for lower and upper torso, suggesting that caution is needed in selecting a BSE for a given MMH task. Findings from this work show the potential benefits of BSEs for use in MMH tasks, yet such benefits can depend on the BSE design and the MMH task they are used for. Further, BSE use can lead to adverse effects, especially with tasks involving extreme working postures.