Human interaction matters: personal and relational determinants of adherence and sustained participation in tele-exercise programmes for older adults: an integrative review

Abstract

An integrative review of the literature was conducted, searching the PubMed, Scopus and Web of Science databases and including studies published between 2015 and 2025. Quantitative, qualitative and mixed-methods studies involving community-dwelling older adults and structured tele-exercise programmes were considered. Study selection followed PRISMA 2020 transparency principles where applicable, and findings were analysed using narrative and thematic synthesis. Five studies were included, predominantly pilot or feasibility designs, involving monitored asynchronous tele-exercise and self-managed asynchronous tele-exercise modalities. Findings indicated that adherence and sustained participation were more consistent in interventions with structured professional monitoring, albeit delayed, compared with self-managed programmes, in which greater variability and a decline in practice over time were observed. The continuation of exercise appears to depend on the interaction between personal determinants, such as motivation, perceived benefits, and self-regulation, and relational determinants, such as support, feedback, and perceived follow-up. Technological barriers and limited digital literacy emerged as cross-cutting factors affecting sustained participation. It is concluded that tele-exercise is a viable approach to promote physical activity among older adults; however, maintenance of participation is strongly influenced by the level of human interaction and professional support. These findings should be interpreted as indicative behavioural trends rather than definitive causal evidence, reinforcing the need for participant-centred tele-exercise models with appropriate follow-up strategies and standardised metrics to evaluate adherence and sustained participation.