Smart wearables equipped with integrated flexible actuators possess the ability to autonomously respond and adapt to changes in the environment. Fibrous textiles have been recognised as promising platforms for integrating flexible actuators and wearables owing to their superior body compliance, lightweight nature, and programmable architectures. Various studies related to textile actuators in smart wearables have been recently reported. However, the review focusing on the advanced design of these textile actuator technologies for smart wearables is lacking. Herein, a timely and thorough review of the progress achieved in this field over the past five years is presented. This review focuses on the advanced design concepts for textile actuators in smart wearables, covering functional materials, innovative architecture configurations, external stimuli, and their applications in smart wearables. The primary aspects focus on actuating materials, formation techniques of textile architecture, actuating behaviour and performance metrics of textile actuators, various applications in smart wearables, and the design challenges for next-generation smart wearables. Ultimately, conclusive perspectives are highlighted.