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HEALTH BENEFITS INDUCED BY ADHERENCE TO THE 
MEDITERRANEAN LIFESTYLE COMPONENTS DIET AND 

PHYSICAL ACTIVITY

Cécil J. W. MEULENBERG

Science and Research Centre Koper, Institute for Kinesiology Research, Slovenia

Corresponding author:
Cécil J. W. MEULENBERG

Science and Research Centre Koper, Institute for Kinesiology Research
Garibaldijeva 1, SI-6000 Koper, Slovenia

Phone: +386 31 424 233
E-mail: cecil.meulenberg@zrs-kp.si

ABSTRACT

The purpose of this overview is to present the evidence that adherence to Mediter-
ranean lifestyle components is beneficial for functional and cognitive health. Although 
Mediterranean diet is the principal component of this lifestyle, other components, like 
physical activity and socializing, form complex interactions and together they complete 
into the Mediterranean lifestyle. Individual components and their interactions have not 
been studied thoroughly, however, there is an increasing attention for these matters 
through scientific literature in original research, reviews and meta-analysis. This paper 
considers the recent knowledge and trends related to defining the indicators concern-
ing these lifestyle components, as well as summarizes the health benefits induced by 
adherence to them and explains why Mediterranean lifestyle components are important 
for health.

Keywords: lifestyle, Mediterranean diet, physical activity, health benefit, interac-
tions.

Review article                           doi: https://doi.org/10.35469/ak.2019.175
received: 2018-12-04                UDC: 613.2+613.7



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PREHRANA IN GIBALNA AKTIVNOST KOT ZDRAVJU KORISTNI 
SESTAVINI SREDOZEMSKEGA ŽIVLJENJSKEGA SLOGA

IZVLEČEK

Namen preglednega članka je predstaviti dosedanja dognanja o tem, kako lahko 
ima upoštevanje sredozemskega načina življenja dobrodejne učinke na funkcionalno in 
kognitivno zdravje posameznika. Medtem ko številni avtorji trdijo, da je sredozemska 
prehrana poglavitna sestavina zdravega načina življenja, le ta z drugimi dejavniki, kot 
so gibalna aktivnost in bogato socialno življenje, tvori zapletene interakcije in skupaj 
z njimi dopolnjuje sredozemski način življenja. Posamezne komponente in njihov med-
sebojni vpliv še niso popolnoma raziskane, vendar pa jim raziskovalci v izvirnih znan-
stvenih raziskavah, preglednih člankih in meta-analizah, posvečajo vedno več pozorno-
sti. Prispevek obravnava najnovejša dognanja in trende v zvezi z opredelitvijo kazalcev 
omenjenih komponent sredozemskega življenjskega sloga, poleg tega pa pojasnjuje 
tudi, zakaj so sredozemske sestavine življenjskega sloga tako pomembne za zdravje.

Ključne besede: življenjski slog, sredozemska prehrana, telesna dejavnost, zdravje, 
interakcije

INTRODUCTION

The attention to the possible benefit for health of the diet and the lifestyle typical 
of Mediterranean countries came from the “seven countries study”. Started in 1947 
by Ancel Keys and co-workers the study compared diet and lifestyles in the USA, 
Finland, Yugoslavia, Japan, the Netherlands, Italy and Greece, and led to the discov-
ery that Italy, Greece and Yugoslavia (particularly the coastal region of Croatia) had 
a much lower incidence of non-communicable degenerative diseases (Keys, Fidanza, 
Karvonen, Kimura & Taylor, 1972). Later on, Ancel Keys and his co-workers settled 
in Italy in the small village of Pioppi, south of Naples, and deeply analysed the life-
style and the food choice not only in Italy but also in Greece (particularly on the island 
of Crete), Spain, Portugal and Croatia. From their work, the foundation of the concept 
of Mediterranean diet and lifestyles were set (Keys et al., 1986). Unfortunately, in 
those countries, 60 years later, the traditional way of eating and the healthy lifestyles 
have been cancelled, to a great extent due to homogenization of dietary choices and 
living habits typical of the global economy (Bach-Faig et al., 2011; Martinez-Lacoba, 
Pardo-Garcia, Amo-Saus & Escribano-Sotos, 2018).



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CHARACTERISTICS OF MEDITERRANEAN DIET

Mediterranean diet within the scientific fields of dietetics, nutrition and food tech-
nology is predominantly handled as a traditional dietary pattern with a focus on its con-
stituents (e.g., Bach et al., 2006; Katz & Meller, 2014; Davis, Bryan, Hogson & Mur-
phy, 2015). It is plant-based with freshly-harvested vegetables, fruits, nuts and seeds, 
beans and legumes, many herbs and spices, and whole grains. With frequent consump-
tion of fish and other sea foods, selective dairy intake and quite limited consumption of 
meat, eggs and sweets, but emphasizing the use and consumption of healthful fats like 
extra virgin olive oils and fishy fats, and moderate amounts of (red) wine.

The Mediterranean diet is not an homogeneous model globally nor within the Medi-
terranean area, as it is highly dependent on the region, and influenced by socio-cultural, 
religious and economic factors (Bach et al., 2006). Despite these regional variations, 
the average nutrient content of the diet is relatively consistent among various studies 
(Davis et al., 2015). For eight studies the percentage of total daily energy (9.3 MJoule) 
was as follows: 37% as fat of which 5% polyunsaturated, 19% monounsaturated, and 
9% saturated (note the ratio of 2 for unsaturated to saturated); 15% protein; 43% car-
bohydrate; with for some constituents: fibre 33 g/day, vitamin C 225 mg/day and folate 
508 µg/day. Thus, the diet promotes high intake of fibre, results in a favourable ratio 
of omega-6 and omega-3 essential fatty acids (Trichopoulou et al., 2014; Davis et al., 
2015), and especially increases the non-enzymatic antioxidant capacity through the 
consumption of antioxidants and polyphenols from extra virgin olive oil (Zamora-Ros 
et al., 2013).

MEDITERRANEAN DIET-INDUCED HEALTH EFFECTS

The combination of foods and the content of nutrient constituents made the Medi-
terranean diet a subject of many scientific studies, that investigated the potential health 
effect during the intervention by Mediterranean eating (reviewed by Sofi, Macchi, Ab-
bate, Gensini & Casini, 2014; Martinez-Lacoba et al., 2018). An early systematic re-
view by Serra-Majem, Roman and Estruch (2006) investigated 35 experimental studies 
referring to the Mediterranean diet as an intervention and showed favourable effects on 
lipoprotein levels, endothelium-dependent vasodilatation, insulin resistance, metabolic 
syndrome, antioxidant capacity, myocardial and cardiovascular mortality, and cancer 
incidence. Moreover, Sofi et al. showed by analysing 18 cohort prospective studies 
that adherence to the Mediterranean diet for three to 18 years reduced the risk of over-
all mortality, with a clear reduction of the incidence for cardiovascular, cancer, and 
neurodegenerative diseases and stroke (Sofi, Cesari, Abbate, Gensini & Casini, 2008; 
Sofi, Abbate, Gensini & Casini, 2010). In recent years, these beneficial health effects 
have been confirmed, namely in the form of improved insulin sensitivity (Ryan et al., 
2013), reduced cancer risk (Giacosa et al., 2013), and particularly well-demonstrated 
the reduced risk of cardiovascular diseases (de Lorgeril & Salen, 2006; 2011; Ibarrola-



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Jurado et al., 2011; Nordmann et al., 2011; Bonaccio et al., 2018; Estruch et al., 2018). 
Lower prevalence of general obesity and metabolic syndrome has been shown (Ibar-
rola-Jurado et al., 2011), and also the improvement of quality of life and diminished 
pulmonary inflammation in asthmatic patients (Sexton et al., 2013; Papamichael, Itsio-
poulos, Susanto & Erbas, 2017; Papamichael et al., 2018). Finally, higher adherence 
to a Mediterranean diet was associated with a reduction in mortality (Trichopoulou, 
Bamia & Trichopoulos, 2009; Bonaccio et al., 2018). Thus, in conclusion, adherence 
to the Mediterranean diet, the plant-based diet as described above, seems to provide 
longevity with a reduced risk for chronic non-communicable diseases.

DIET AS PART OF MEDITERRANEAN LIFESTYLE

Long and healthy (functional and cognitive) ageing is of importance to humans as 
a species, and perhaps these health benefits attributed to the diet, in combination with 
where, and in which cultural environmental settings the diet is embedded, were the rea-
sons that in 2010 the Mediterranean diet got inscribed in the UNESCO representative 
list of intangible cultural heritage of humanity (UNESCO, 2010).

On UNESCO’s webpages, one can find the following description: ‘The Mediter-
ranean diet involves a set of skills, knowledge, and traditions concerning crops, har-
vesting, fishing, animal husbandry, conservation, processing, cooking, and particularly 
the sharing and consumption of food. Eating together is the foundation of the cultural 
identity and continuity of communities throughout the Mediterranean basin. It is a mo-
ment of social exchange and communication, an affirmation and renewal of family, 
group or community identity. The Mediterranean diet emphasizes values of hospital-
ity, neighbourliness, intercultural dialogue and creativity, and a way of life guided by 
respect for diversity.’

These writings clearly emphasize a particular social ensemble of traits that centres 
around food production, harvesting and consumption, guided by the Mediterranean 
climate and region. An update by the Mediterranean Diet Foundation Expert Group 
(Bach-Faig et al., 2011), additionally adds to emphasize sobriety and moderation, with 
inclusion of cultural and lifestyle components that are based on the Mediterranean diet 
pyramid, such as conviviality, culinary activities, adequate rest, and physical activity. 
Mediterranean diet, when used in dietetics or nutritional sciences, often refers to the 
plant-based and micronutrient-balanced diet, while often, in the wider scientific fields 
like the social sciences, or in specific fields like kinesiology, this UNESCO-recognized 
Mediterranean intangible heritage as such, should be, more appropriately, referred to as 
Mediterranean lifestyle.

UNESCO, the Scientific Committee of the International Foundation of Mediter-
ranean Diet and others acknowledge the specific lifestyle characteristics (Sotos-Prieto 
et al., 2015; Yannakoulia, Kontogianni, & Scarmeas, 2015; Dernini et al., 2017). They 
indicate that such lifestyle components are worth being identified (Bach et al., 2006), 
as they might be valuable to human health and heritage.



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BRAIN HEALTH INFLUENCED BY MEDITERRANEAN LIFESTYLE 
COMPONENTS

Brain function, overwhelmingly studied, is a good example to demonstrate its de-
pendence on lifestyle components. In relation to Mediterranean lifestyle components 
beneficial to cognitive health, next to adherence to the diet, Yannakoulia et al. (2015) 
particularly mention the participation in leisure activities, social interaction, physical 
activity and the quality of sleep. Each of these factors have been individually demon-
strated to effectively maintain better cognitive performance, promote healthy cogni-
tive ageing, reduce depressive symptoms, and delay neurodegeneration (e.g., Polidori, 
Nelles & Pientka, 2010; Schreiber et al., 2016; Clare et al., 2017; Kivipelto, Mangial-
asche & Ngandu, 2018; Zhao et al., 2018).

Sofi et al. came to the conclusion (Sofi et al., 2008; 2010) that the adherence to the 
Mediterranean diet reduced mild cognitive impairment and the risk to undergo Parkin-
son’s and Alzheimer’s diseases. More recent studies confirm that higher adherence to 
the Mediterranean diet is associated with improved cognition (Féart et al., 2009; Mar-
tínez-Lapiscina et al., 2013; Ye et al., 2013), assessed through, amongst others, Mini 
Mental State Examinations and the clock drawing tests. Adherence to the Mediterra-
nean diet thus establishes lower risk of cognitive impairment (Ye et al., 2013; Gardener 
et al., 2015), it reduces the risk of Alzheimer’s disease (Scarmeas et al., 2006), and 
induces better performance in the executive function domain (Gardener et al., 2015).

The positive impact of the Mediterranean diet on brain health is detectable also 
at morphological level. Among 672 cognitively normal participants from the U.S.A., 
with an average of 79.8 years of age, higher adherence to the Mediterranean diet 
was associated with larger frontal, parietal, occipital, and average cortical thickness 
(Staubo et al., 2017). In line with this, among 400 Scottish elderly persons, a low 
adherence to the Mediterranean diet predicted brain atrophy (Luciano et al., 2017). 
A study with 4447 participants in the Netherlands showed that a higher diet quality, 
especially the one that abode by the Mediterranean diet, was associated with larger 
overall and hippocampal brain tissue volumes (Croll et al., 2018). Similarly, among 
459 participants in the United Kingdom, a higher and prolonged adherence (over 11 
years) to guidelines for healthy diet was associated with larger hippocampal volume 
(Akbaraly et al., 2018). These studies clearly indicate that diet itself affects brain 
volume and structure.

Further, higher adherence to the Mediterranean diet has been shown to reduce the 
incidence of depression from a meta-analysis among 20 longitudinal and 21 cross-
sectional studies (Lassale et al., 2018), and in addition, a diet with a low potential to 
induce inflammation, was associated with lower depression incidence in four longitu-
dinal studies (Lassale et al., 2018). A recent randomized controlled trial showed that a 
12-week intervention with Mediterranean diet significantly reduced the symptoms of 
major depression (Jacka et al., 2017). Thus, as for functionality of the brain, a condition 
as behaviour in the form of depression, is clearly influenced by diet as well. Presum-
ably, it is influenced in both directions, depending on the quality of diet.



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Moreover, a healthy diet maintains a healthy balanced intestinal microbiota (Cryan 
& Dinan, 2012; Dash, Clarke, Berk & Jacka, 2015; Johnson & Foster, 2018), and re-
search indicates that this symbiosis establishes an intestines-brain axis, and is of major 
support to the health of the brain, by influencing the development of the brain, as well 
as behaviour and mood. Interestingly, in the intestines, the microbial fermentation of 
host-indigestible dietary fibres produces short-chain fatty acids that act as signals in the 
host (Kelly, Minuto, Cryan, Clarke & Dinan, 2017; Johnson & Foster, 2018). Supple-
mentation of such fatty acids to mice has been shown to alleviate selective and enduring 
alterations induced by repeated psychosocial stress (van de Wouw et al., 2018). Such 
fatty acids are not the only products from the presence of microbiota that can influence 
the host’s endocrine signalling. Not even closely do we have proper understanding of 
the microbiota-intestines-brain axis.

Continuing to reason along this axis, which means drawing associations between the 
consumption of specific foods and brain health might seem far-fetched. The examples 
of depression studies mentioned in the previous paragraph make it very plausible for 
food (the microbiota-intestine-brain axis) to affect our mood and behaviour. Besides, 
the following examples emphasize this importance. There is established evidence that 
altered microbiota populations exist in human patients with autism spectrum disorders, 
schizophrenia, depression and obesity, compared to unaffected patients and can contrib-
ute to (brain) inflammation as well (Cryan & Dinan, 2012; Dash et al., 2015; Kelly et 
al., 2017; Johnson & Foster, 2018). Another accent comes from a recent large cohort, in 
which removal of the vermiform appendix − that hosts microbiota, pathogens and im-
mune cells − decades before the onset of Parkinson’s disease, lowers the risk of obtain-
ing Parkinson’s disease (Killinger et al., 2018). Even more interesting is the fact that 
bacteria are presumed to live in our brains during our life (Roberts, Farmer & Walker, 
2018). Altogether, food consumption not only determines the quantity and quality of 
the micronutrients available to the host, but influences the contamination of the host 
with microorganisms and potential symbioses as well, consequently having effect on 
the host by the microorganism’s metabolism and the production of endocrine signals. 

Brain health is a complex matter and dependent on various lifestyle factors. The 
same can be claimed about human health in general. Finding the palette for optimal 
living requires identifying the details, relations and synergies of lifestyle components.

HOW TO MEASURE ADHERENCE TO THE MEDITERRANEAN 
LIFESTYLE

To measure adherence to the Mediterranean diet, questionnaires on food consump-
tion frequency have been used. In general, when conducting population-based pros-
pective investigations, the participants are invited to complete extensive, validated, 
food or physical-activity frequency questionnaires at baseline. During the follow-up, 
adherence is assessed by multiple-items scales that incorporate salient characteristics 
of both eating habits and/or physical activity patterns. Usually, the populations’ range 



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of the scores and the higher scores, describe the population’s greater adherence to the 
topic or lifestyles of interest.

More recently, in order to assess adherence to lifestyle-habits, Sotos-Prieto et al. 
(2015) designed the 28-indicator Mediterranean lifestyle (MEDLIFE) index that ad-
ditionally included physical activity patterns, adequate rest, social interactions and 
conviviality. Expanding on the MEDLIFE index, and beyond the obvious category (1) 
health and nutritional benefits, Dernini et al. (2017) characterized the multiple dimen-
sions and benefits of the Mediterranean lifestyle through a methodological framework 
(Med Diet 4.0). It identifies and recognizes country-specific and culturally appropriate 
variations, i.e., regional food diversity, making a future-derived scale internationally 
applicable. Additionally, the framework introduces several sustainability categories 
and proposes to assess specific indicators for benefits in additional areas: (2) richness 
in biodiversity and low environmental impact; (3) high social and cultural food val-
ues; and (4) positive local economic returns. The framework is described by the Sci-
entific Committee of the International Foundation of Mediterranean Diet (Dernini et 
al., 2017) and would be of special interest as it describes a wider lifestyle with various 
components, but up till now a practical index has not been tested.

The 24-hour dietary recall (Thompson & Byers, 1994), the questionnaires on food 
consumption frequency (Sampson, 1985), together with the recent scales and frame-
works like MEDLIFE (Sotos-Prieto et al., 2015) and the Med Diet 4.0 (Dernini et al., 
2017) are easily implemented. Especially the latter two would facilitate the comparison 
of studies that investigate adherence to the Mediterranean lifestyle and the contribut-
ing interrelated lifestyle components (Bach et al., 2006). Such comparison is important 
for understanding the quality of human life (both in health and of footprint), and the 
identification of common and/or cultural-specific lifestyle components, that could gain 
attention and thus might find a way of becoming tangible heritage.

MEDITERRANEAN LIFESTYLE INTERVENTIONS

The state of health across the lifespan − during childhood, adolescence and old age 
− is a product of the cumulative factors experienced (Calder et al., 2018). In general, 
a healthy diet with the specific distribution and prevalence of physical and sedentary 
activities influence physiological and metabolic functions that altogether determine 
disease, cognition and functionality (Calder et al., 2018; Martin et al., 2018). How-
ever, the interactions of such components are poorly studied. Therefore, the following 
sections of this paper will recapitulate the details of various systematic reviews that 
include meta-analysis of randomized controlled trials (or cohorts), where adherence to 
the components 1) physical activity and 2) Mediterranean diet, were addressed as an 
intervention, either separately or in combination.



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MEDITERRANEAN DIET AS AN INTERVENTION

In relation to health benefits induced by Mediterranean diet as an intervention, 
Kastorini et al. (2011) reviewed 35 clinical trials and Garcia et al. (2016) reviewed 
29 randomized controlled trials. Both reviews showed that waist circumference was 
significantly reduced, while also systolic and diastolic blood pressures, blood glucose 
and triglycerides levels were significantly reduced with adherence to the Mediterra-
nean diet. High-density lipoprotein cholesterol levels were increased as reported by 
Kastorini et al. (2011), although no change was observed by Garcia et al. (2016). Both 
reviews showed that adherence to the Mediterranean diet positively effects the bio-
markers linked to the metabolic syndrome, especially for interventions longer than 3 
months in duration. Interestingly, it was mentioned that adherence to the Mediterranean 
diet was significantly beneficial when the study was of high quality and the interven-
tion was longer in duration (Kastorini et al., 2011; Garcia et al., 2016), besides, it was 
conducted in Europe (Garcia et al., 2016).

Esposito, Kastorini, Panagiotakos and Giugliano (2011) reviewed 16 randomized 
controlled trials, 1 to 24 months in duration, were Mediterranean diet was used as an 
intervention compared to a control diet. The Mediterranean diet groups showed greater 
reductions in body weight and body mass index for trials longer than 6 months in dura-
tion, while the effect was larger in association with increased physical activity or energy 
restriction. Thus, typically none of the studies reported weight gain with adherence to a 
Mediterranean diet more than 6 months in length, which made the authors conclude that 
Mediterranean diet is useful as an intervention targeted to lose weight (Esposito et al., 
2011), despite the diet being high in fat of predominantly extra virgin olive oils origin.

PHYSICAL ACTIVITY AS AN INTERVENTION

Despite the fact that plenty of intervention studies based on physical activity are 
available in the scientific literature, the current discussion restricts itself to the most 
relevant systematic reviews and meta-analysis of randomized controlled trials.

Physical activity as an intervention during randomized controlled trials was re-
viewed by Kodama et al. (2007) who identified 25 intervention studies with an aver-
age length of about 7 months. Aerobic training resulted in increases of high-density 
lipoprotein cholesterol levels (Kodama et al., 2007), with no association between ex-
ercise frequency or intensity. Strasser, Siebert and Schobersberger (2010) identified 
13 randomized controlled trials, in which the effect of physical resistance training on 
average 3 times a week for 1.5 to 12 months, was compared between a control group 
and patients with abnormal glucose regulation. The physical activity reduced the fat 
mass and systolic blood pressure (Strasser et al., 2010), while no statistically significant 
effects on total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides 
and diastolic blood pressure were observed. Further, Cornelissen and Smart (2013) 
identified 93 trials and showed that physical activity as endurance, dynamic resistance, 



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and isometric resistance training lowered both systolic and diastolic blood pressures 
for interventions smaller than 6 months. Whereas interventions longer than 6 months 
induced smaller reductions in blood pressures, and the combination of these types of 
physical training lowered only diastolic blood pressure (Cornelissen & Smart, 2013). 
Lin et al. (2015) identified 29 randomized controlled trials with physical activity as 
an intervention with a medium duration of 3 months. It was shown that exercise sig-
nificantly improved cardiorespiratory fitness and lowered the levels of fasting insulin, 
triglycerides and leptin, while increasing the levels of both high-density lipoprotein 
cholesterol and apolipoprotein A1, and interleukin-18. The effects of physical activity 
were more pronounced in persons over 50 years of age, men, and persons suffering 
from type 2 diabetes, hypertension and metabolic syndrome.

Physical activity improves the blood pressure regardless of the type of exercise, 
and, just like diet, positively influences the indicators of metabolic syndrome.

CONCURRENT PHYSICAL ACTIVITY AND MEDITERRANEAN DIET 
AS AN INTERVENTION

Recently, the randomized controlled trials assessing overall health resulting from 
the combined intervention, physical activity and adherence to Mediterranean diet, were 
systematically reviewed (Malakou et al., 2018). This meta-analysis identified 11 ran-
domized controlled trials executed between 2003 and 2017, of which the intervention 
duration lasted from 2 months to 6 years. The combined intervention reduced body 
weight, body mass index, waist circumference, both systolic and diastolic blood pres-
sures, while as well reducing the levels of blood glucose, triglycerides and total cho-
lesterol, and increasing the high-density lipoprotein cholesterol levels. No evidence 
of an effect on insulin concentrations was found. Although the authors mention the 
high degree of heterogeneity between the results from the trials, and the need for well-
designed and thoroughly executed randomized controlled trials, the combination of 
Mediterranean diet and physical activity as an intervention clearly provides a reduction 
in weight (especially with interventions shorter than 12 months in duration), and a re-
duced metabolic syndrome risk.

Interestingly, Malakou et al. (2018) mention that none of the randomized controlled 
trials compare the combined effect against control groups receiving only physical ac-
tivity, Mediterranean diet or no treatment respectively. Only two studies compared the 
combined intervention results with usual control group (Droste et al., 2013; Dunn, Siu, 
Freund & Boutcher, 2014) and found a reduced metabolic syndrome risk for the com-
bined intervention. Still, it is not clear whether a synergistic effect of the concurrent 
interventions exists.

In addition, the results of recent studies seem to suggest that there are synergistic 
effects. In the U.S.A., out of 170.672 women and men aged 51 to 71 years at baseline 
in 1996/1997 and followed-up in 2009, adhering to high physical activity levels and 
Mediterranean diet, was associated with lower risk of mortality than groups only ad-



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hering to physical activity recommendations or only following the Mediterranean diet 
(Behrens et al., 2013). In a study in Spain, among 19.467 female and male university 
graduates aged 27 to 46 years of age at baseline in 1999 and followed-up in 2016, simi-
lar results were found (Alvarez-Alvarez et al., 2018a). More specifically, the combina-
tion of interventions showed a reduced risk for cardiovascular disease as compared to 
the physical activity or Mediterranean diet separately (Alvarez-Alvarez et al., 2018b).

In combination with these epidemiological studies, it is concluded that adherence to 
a Mediterranean lifestyle, and most likely the individual Mediterranean lifestyle com-
ponents, high physical activity and richly consuming the plant-based Mediterranean 
diet, will provide better health perspectives. This seems additionally true for living out 
of the geographical region from which the Mediterranean diet is originating.

CONCLUSIONS

Mediterranean lifestyle seems to be the palette we should strive to adhere to. It 
incorporates diet, physical activity and other lifestyle components, all worth promoting 
publicly for all ages. Health benefits, only induced by its components of diet and physi-
cal activity, seem numerous: increasing general and cognitive health with a reduced 
risk for non-communicable diseases, especially metabolic syndrome. However, further 
studies are needed that will investigate the synergy effects of combined components 
that determine the essential, effect-inducing, interactions between the Mediterranean 
lifestyle components. This can be done by thoroughly planned randomized controlled 
trials, using the established scales to assess the adherence, and the proper inclusion of 
multiple control groups.

For adults, the World Health Organisation recommends a minimum of 150 minutes 
of moderate-intense physical activity throughout the week. The International Society 
for Nutritional Psychiatry Research, recognizes diet and nutrition as central determi-
nants of both physical and mental health, referred to as nutritional or orthomolecular 
medicine (Zell & Grundmann, 2012; Sarris et al., 2015), with a recent success story 
that concerns the reversing of cognitive decline (Bredensen, 2017). The Mediterranean 
lifestyle embraces these recommendations. Besides, it promotes outdoor physical ac-
tivities, organic food consumption, and sustainable novel food production.

Thus, the adherence to the Mediterranean lifestyle can nowadays be geographically 
applicable anywhere, and it gives the opportunity for practitioners, care givers and the 
public to create and adopt to more personalized nutritional and functional therapy, re-
sulting in a better general health. 



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Acknowledgement

This manuscript was prepared as part of the research programme Kinesiology for 
Quality of Life (P5-0381) funded by the Slovenian Research Agency.

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