Physical exercise and healthy diet recommendations in older people

Mediterranean diet confers broad geriatric benefits

In older adults at high cardiovascular risk, Mediterranean diet with extra-virgin olive oil or nuts lowers major cardiovascular events by ~30% versus low-fat diet. Evidence also supports benefits in metabolic disease, sarcopenia/frailty, osteoarthritis, fractures (especially hip in women), depression, and dementia; alcohol is not essential.

Implement structured Mediterranean diet pathways

Use validated adherence tools, refer low-adherence older adults to trained dietitians, assess socioeconomic factors, deliver personalized meal planning and cooking support, and reassess adherence at 6 months. Guidelines provide strong, condition-specific recommendations (e.g., peripheral artery disease, atrial fibrillation, stroke, type 2 diabetes).

Promote feasible activity, reduce sedentary behavior

Few older adults meet WHO exercise targets; replacing sedentary time with walking is beneficial. Evidence indicates about 7,000 steps/day is a realistic target for mortality and disease risk reduction. Exercise is comparable to donepezil for cognition and benefits Alzheimer’s disease, MCI, and late-life mental health.

This continuing education session, titled “Physical exercise and healthy diet recommendations in older people,” is delivered by Prof. Nicola Veronese and organized by Klinik Barmelweid. He reviews robust evidence for the Mediterranean diet—conceptualized beyond the plate to include lifestyle factors—highlighting the PREDIMED trial, in which Mediterranean diet arms enriched with extra-virgin olive oil or nuts reduce major cardiovascular events by about 30% versus a low-fat control over five years. He summarizes associations between higher Mediterranean diet adherence and lower risks of invasive breast cancer, common metabolic conditions (type 2 diabetes, metabolic syndrome, obesity, NAFLD), as well as benefits for sarcopenia and frailty without the need for protein supplementation. Additional musculoskeletal and neuropsychiatric benefits include lower osteoarthritis prevalence/incidence, reduced fracture risk (especially hip fractures in women), and reduced dementia/Alzheimer’s disease risk, with plausible mechanisms such as anti-inflammatory effects, myostatin inhibition, gut microbiome modulation, and bioactive compounds (e.g., oleuropein, resveratrol). He presents new guidelines and clinical pathways recommending, for high cardiovascular risk individuals, a Mediterranean diet (preferably enriched with extra-virgin olive oil or nuts) over a low-fat diet, and notes ongoing debate about excluding alcohol/wine from Mediterranean diet definitions. On physical activity, he discusses WHO recommendations and stresses realistic targets for older adults, including reducing sedentary time and aiming for approximately 7,000 steps/day, noting that the 10,000-step threshold is arbitrary. He reviews evidence that exercise supports cognition and mental health—showing effects comparable to donepezil on cognitive outcomes, protection against Alzheimer’s disease, and benefits across anxiety, depression, schizophrenia, bipolar disorder, and delirium. He concludes by emphasizing the need to implement these evidence-based, non-pharmacological strategies—Mediterranean diet and regular physical activity—into routine geriatric care pathways.