Family-involvement in mHealth-based Physical Activity Interventions for Improving Physical Performance among Community-dwelling Older Adults: A Systematic Review (Preprint)

BACKGROUND Aging is commonly associated with declines in physical performance, while physical activity interventions have been shown to benefit older adults. Traditional face‑to‑face interventions often limit participation due to mobility, scheduling, and accessibility challenges. mHealth offers a promising alternative; however, older adults may still face difficulties related to digital literacy, motivation, and perceived ease of use. Involving family members in mHealth‑based physical activity interventions may help enhance engagement and ultimately improve physical performance among community‑dwelling older adults. OBJECTIVE This study aimed to examine both the effects of mHealth-based PA interventions involving family members on the physical performance of community-dwelling older adults and the role of family members in these interventions. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Synthesis Without Meta-analysis (SWiM) guidelines. A comprehensive search was conducted across Web of Science, CINAHL, Scopus, PsycINFO, PubMed, and Embase from database inception to 30 June 2025. The inclusion criteria focused on involving family support for mHealth-based physical activity interventions targeting community-dwelling older adults aged 60 years or above. Studies involving caregivers without a clearly defined family role were excluded. A narrative synthesis was used to analyze data relevant to the review aims. RESULTS Seven studies (n = 285) met the inclusion criteria. None of the identified studies explicitly required a family member to participate in the interventions, and only two studies specifically recruited family members. Adherence was assessed using various strategies, with reported rates ranging from 15% to 100%. Most interventions used mHealth technologies for communication and delivery of educational materials. Across studies, family members most commonly served as supervisors, technology-use supporters, and safety monitors. Physical performance outcomes were measured through both physical function and physical activity. Six studies assessed physical function using indicators such as mobility, strength, endurance, and balance; however, the effectiveness of interventions in improving physical function remained inconclusive. Two studies evaluated physical activity levels and reported positive effects. CONCLUSIONS This review provides insights into the roles of family members in mHealth‑based PA interventions for community‑dwelling older adults. Involving family members may enhance physical performance, particularly in physical activity. Closer relationships between family members and older participants were associated with higher adherence. However, the combined effect of family support and mHealth technology on improving overall physical performance remains unclear. CLINICALTRIAL The protocol for this review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42024575953).