{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T21:25:47Z","timestamp":1786397147994,"version":"build-2736575974"},"reference-count":96,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. The Mediterranean diet (MD) and regular physical activity are established components of cardiovascular prevention, but evidence regarding their combined cardiometabolic effects remains heterogeneous. Objective: This narrative review critically summarizes current evidence on the joint role of the MD and physical exercise in cardiometabolic health. Methods: A structured literature search was conducted in PubMed, Web of Science, and Scopus using terms related to the MD, CVD, cardiometabolic health, physical activity, and exercise. Experimental and observational human studies published between 2016 and 2026 were considered, together with relevant systematic reviews and meta-analyses. Particular attention was given to 10 key human studies, including randomized intervention studies and observational cohorts. Owing to substantial heterogeneity in populations, interventions, comparators, follow-up periods, and outcomes, the evidence was synthesized narratively. Results: The key studies generally reported favorable changes in body weight and composition, blood pressure, glucose regulation, and lipid profiles. One observational study also found a lower likelihood of cardiovascular medication initiation among participants with sustained adherence to both lifestyle components. However, most outcomes were surrogate cardiometabolic markers, and the independent effects of diet and exercise were often difficult to isolate. Conclusions: The MD and regular physical activity appear to be complementary components of cardiometabolic prevention. However, current evidence does not establish a consistent additive or synergistic effect. Further long-term, well-controlled studies are needed to clarify their independent and combined contributions across different populations.<\/jats:p>","DOI":"10.3390\/nu18152548","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:42:36Z","timestamp":1785850956000},"page":"2548","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mediterranean Diet and Physical Exercise for Cardiometabolic Health: A Narrative Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7202-5386","authenticated-orcid":false,"given":"Mohammad Aminullah Nurain","family":"Binti","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8632-2120","authenticated-orcid":false,"given":"M\u00f3nika","family":"Fekete","sequence":"additional","affiliation":[{"name":"Institute of Preventive Medicine and Public Health, Semmelweis University, 1089 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-1336","authenticated-orcid":false,"given":"J\u00e1nos Tam\u00e1s","family":"Varga","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/qjmed\/hcaf022","article-title":"Global Burden of Cardiovascular Diseases and its Risk Factors, 1990\u20132021: A Systematic Analysis for the Global Burden of Disease Study 2021","volume":"118","author":"Tan","year":"2025","journal-title":"QJM Int. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"231","DOI":"10.23736\/S2724-5683.21.05538-9","article-title":"Cardiovascular disease burden: Italian and global perspectives","volume":"69","author":"Saglietto","year":"2021","journal-title":"Minerva Cardiol. Angiol."},{"key":"ref_3","first-page":"e30119","article-title":"A Systematic Review of Major Cardiovascular Risk Factors: A Growing Global Health Concern","volume":"14","author":"Adhikary","year":"2022","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s11357-025-01690-x","article-title":"Dietary patterns and mortality risk in geriatric patients with atherosclerotic cardiovascular disease: An analysis of the National Health and Nutrition Examination Survey","volume":"48","author":"Wang","year":"2026","journal-title":"Geroscience"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s11357-022-00668-3","article-title":"Understanding heterogeneity of responses to, and optimizing clinical efficacy of, exercise training in older adults: NIH NIA Workshop summary","volume":"45","author":"Erickson","year":"2023","journal-title":"Geroscience"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1161\/CIRCRESAHA.118.313348","article-title":"The Mediterranean diet and cardiovascular health: A critical review","volume":"124","author":"Gea","year":"2019","journal-title":"Circ. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1161\/CIR.0000000000001146","article-title":"Popular dietary patterns: Alignment with American Heart Association 2021 dietary guidance: A scientific statement from the American Heart Association","volume":"147","author":"Gardner","year":"2023","journal-title":"Circulation"},{"key":"ref_8","first-page":"3801","article-title":"Survival and longevity of European rulers: Geographical influences and exploring potential factors, including the Mediterranean diet\u2014A historical analysis from 1354 to the twentieth century","volume":"46","author":"Szarvas","year":"2024","journal-title":"Geroscience"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Papadaki, A., Nolen-Doerr, E., and Mantzoros, C.S. (2020). The Effect of the Mediterranean Diet on Metabolic Health: A Systematic Review and Meta-Analysis of Controlled Trials in Adults. Nutrients, 12.","DOI":"10.3390\/nu12113342"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s11357-024-01467-8","article-title":"Centenarians-the way to healthy vascular ageing and longevity: A review from VascAgeNet","volume":"47","author":"Summer","year":"2025","journal-title":"Geroscience"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nystoriak, M.A., and Bhatnagar, A. (2018). Cardiovascular Effects and Benefits of Exercise. Front. Cardiovasc. Med., 5.","DOI":"10.3389\/fcvm.2018.00135"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Glenn, A.J., Viguiliouk, E., Seider, M., Boucher, B.A., Khan, T.A., Blanco Mejia, S., Jenkins, D.J.A., Kahleov\u00e1, H., Raheli\u0107, D., and Salas-Salvad\u00f3, J. (2019). Relation of Vegetarian Dietary Patterns With Major Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Front. Nutr., 6.","DOI":"10.3389\/fnut.2019.00080"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3211","DOI":"10.1007\/s11357-023-00873-8","article-title":"The multifaceted benefits of walking for healthy aging: From Blue Zones to molecular mechanisms","volume":"45","author":"Ungvari","year":"2023","journal-title":"Geroscience"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"543","DOI":"10.3390\/nu18030543","article-title":"Multimodal therapeutic strategies for the management of sarcopenia and frailty in chronic obstructive pulmonary disease: A narrative review","volume":"18","author":"Naas","year":"2026","journal-title":"Nutrients"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3461","DOI":"10.1007\/s11357-024-01320-y","article-title":"Resistance training improves cardiac function in older women: A randomized controlled trial","volume":"47","author":"Rodrigues","year":"2025","journal-title":"Geroscience"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2667","DOI":"10.1007\/s11357-021-00463-6","article-title":"Six weeks of high-intensity interval training enhances contractile activity induced vascular reactivity and skeletal muscle perfusion in older adults","volume":"43","author":"Herrod","year":"2021","journal-title":"Geroscience"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1007\/s11357-024-01296-9","article-title":"Adherence to the Mediterranean diet and its protective effects against colorectal cancer: A meta-analysis of 26 studies with 2,217,404 participants","volume":"47","author":"Ungvari","year":"2025","journal-title":"Geroscience"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Fazekas-Pongor, V., Major, D., Varga, J.T., Lehoczki, A., Varga, P., Jarecsny, T., Lip\u00e9cz, \u00c1., Cs\u00edp\u0151, T., Szappanos, \u00c1., and Matiscs\u00e1k, A. (2026). Physiological and Recovery Responses to Dietary Polyphenols in the Context of Exercise: Relevance for Muscle Aging and Sarcopenia. Nutrients, 18.","DOI":"10.3390\/nu18050788"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12937-023-00909-x","article-title":"Combined versus independent effects of exercise training and intermittent fasting on body composition and cardiometabolic health in adults: A systematic review and meta-analysis","volume":"23","author":"Khalafi","year":"2024","journal-title":"Nutr. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.3390\/antiox11091700","article-title":"Polyphenols\u2013gut\u2013heart: An impactful relationship to improve cardiovascular diseases","volume":"11","author":"Bianchi","year":"2022","journal-title":"Antioxidants"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Barbosa, A.R., Pais, S., Marreiros, A., and Correia, M. (2024). Impact of a Mediterranean-Inspired Diet on Cardiovascular Disease Risk Factors: A Randomized Clinical Trial. Nutrients, 16.","DOI":"10.3390\/nu16152443"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/met.2010.0031","article-title":"Mediterranean diet and weight loss: Meta-analysis of randomized controlled trials","volume":"9","author":"Esposito","year":"2011","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.3390\/nu10111577","article-title":"The combined effect of promoting the Mediterranean diet and physical activity on metabolic risk factors in adults: A systematic review and meta-analysis of randomised controlled trials","volume":"10","author":"Malakou","year":"2018","journal-title":"Nutrients"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3456","DOI":"10.3390\/nu12113456","article-title":"Mediterranean personalized diet combined with physical activity therapy for the prevention of cardiovascular diseases in Italian women","volume":"12","author":"Cinelli","year":"2020","journal-title":"Nutrients"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3390\/antiox10030397","article-title":"Mediterranean diet and physical activity decrease the initiation of cardiovascular drug use in high cardiovascular risk individuals: A cohort study","volume":"10","author":"Lassale","year":"2021","journal-title":"Antioxidants"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e2337994","DOI":"10.1001\/jamanetworkopen.2023.37994","article-title":"An energy-reduced Mediterranean diet, physical activity, and body composition: An interim subgroup analysis of the PREDIMED-Plus randomized clinical trial","volume":"6","author":"Konieczna","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"354","DOI":"10.3390\/nu17020354","article-title":"Exploring gender differences in the effects of diet and physical activity on metabolic parameters","volume":"17","author":"Gorini","year":"2025","journal-title":"Nutrients"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1024\/0300-9831\/a000462","article-title":"Effect of the Mediterranean diet in combination with exercise on metabolic syndrome parameters: 1-year randomized controlled trial","volume":"89","author":"Mucalo","year":"2019","journal-title":"Int. J. Vitam. Nutr. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"777","DOI":"10.2337\/dc18-0836","article-title":"Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial","volume":"42","author":"Basora","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1093\/ajcn\/nqaa064","article-title":"Effect of a lifestyle intervention program with energy-restricted Mediterranean diet and exercise on the serum polyamine metabolome in individuals at high cardiovascular disease risk: A randomized clinical trial","volume":"111","author":"Tinahones","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1093\/ajcn\/nqab150","article-title":"Effect on gut microbiota of a 1-y lifestyle intervention with Mediterranean diet compared with energy-reduced Mediterranean diet and physical activity promotion: PREDIMED-Plus Study","volume":"114","author":"Muralidharan","year":"2021","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Prieto-Gonz\u00e1lez, P., Yagin, F.H., Alghannam, A.F., and Canli, U. (2025). Effects of a Mediterranean diet and structured exercise intervention on selected anthropometric, cardiovascular, and metabolic variables in physically inactive adults: A randomized controlled trial. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1695412"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3929","DOI":"10.3390\/nu17243929","article-title":"Mediterranean diet, polyphenols, and neuroprotection: Mechanistic insights into resveratrol and oleuropein","volume":"17","author":"Fekete","year":"2025","journal-title":"Nutrients"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Tong, T.Y., Wareham, N.J., Khaw, K.-T., Imamura, F., and Forouhi, N.G. (2016). Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: The EPIC-Norfolk study. BMC Med., 14.","DOI":"10.1186\/s12916-016-0677-4"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3218","DOI":"10.1080\/10408398.2015.1107021","article-title":"A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: Are individual components equal?","volume":"57","author":"Grosso","year":"2017","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/ejcn.2017.58","article-title":"Mediterranean diet and multiple health outcomes: An umbrella review of meta-analyses of observational studies and randomised trials","volume":"72","author":"Dinu","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"889","DOI":"10.3945\/an.116.012138","article-title":"Mediterranean diet, cognitive function, and dementia: A systematic review of the evidence","volume":"7","author":"Petersson","year":"2016","journal-title":"Adv. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1146\/annurev-food-032217-020802","article-title":"Advances in understanding the molecular basis of the mediterranean diet effect","volume":"9","author":"Corella","year":"2018","journal-title":"Annu. Rev. Food Sci. Technol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Kryczyk-Poprawa, A., Rz\u0105sa-Duran, E., Varga, J.T., Lehoczki, A., Z\u00e1b\u00f3, V., Fazekas-Pongor, V., Major, D., Cs\u00edp\u0151, T., Szappanos, \u00c1., and Lip\u00e9cz, \u00c1. (2026). Gut Microbiota-Targeted Nutrition for Healthy Aging: Mechanistic Roles of Polyphenols and Dietary Fiber in Geroscience. Nutrients, 18.","DOI":"10.3390\/nu18152478"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3109\/07853898909149929","article-title":"Seven Countries Study. First 20-year mortality data in 12 cohorts of six countries","volume":"21","author":"Menotti","year":"1989","journal-title":"Ann. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.amjmed.2014.10.014","article-title":"The Mediterranean diet, its components, and cardiovascular disease","volume":"128","author":"Widmer","year":"2015","journal-title":"Am. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"7651","DOI":"10.3390\/nu7095356","article-title":"Effects of Olive Oil on Markers of Inflammation and Endothelial Function-A Systematic Review and Meta-Analysis","volume":"7","author":"Schwingshackl","year":"2015","journal-title":"Nutrients"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"556","DOI":"10.3945\/ajcn.115.109165","article-title":"Whole-grain and blood lipid changes in apparently healthy adults: A systematic review and meta-analysis of randomized controlled studies","volume":"102","author":"Ross","year":"2015","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.3945\/ajcn.115.110965","article-title":"Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: Systematic review, meta-analysis, and dose-response of 61 controlled intervention trials","volume":"102","author":"Falk","year":"2015","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1016\/S0140-6736(02)98858-6","article-title":"Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: A randomised controlled trial","volume":"359","author":"John","year":"2002","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"100997","DOI":"10.1016\/j.eclinm.2021.100997","article-title":"Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis","volume":"38","author":"Khan","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1161\/CIRCULATIONAHA.108.816736","article-title":"Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women","volume":"119","author":"Fung","year":"2009","journal-title":"Circulation"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1161\/CIRCULATIONAHA.115.017158","article-title":"Changes in diet quality scores and risk of cardiovascular disease among US men and women","volume":"132","author":"Bhupathiraju","year":"2015","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.numecd.2010.06.004","article-title":"Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: The EPIC-Spain cohort study","volume":"22","author":"Tormo","year":"2012","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.1056\/NEJMoa025039","article-title":"Adherence to a Mediterranean diet and survival in a Greek population","volume":"348","author":"Trichopoulou","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1136\/bmj.38415.644155.8F","article-title":"Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study","volume":"330","author":"Trichopoulou","year":"2005","journal-title":"BMJ"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1161\/01.CIR.99.6.779","article-title":"Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon Diet Heart Study","volume":"99","author":"Salen","year":"1999","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1038\/sj.ejcn.1601575","article-title":"Mediterranean diet and all-causes mortality after myocardial infarction: Results from the GISSI-Prevenzione trial","volume":"57","author":"Barzi","year":"2003","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1056\/NEJMoa1800389","article-title":"Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts","volume":"378","author":"Estruch","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1080\/10408398.2019.1565281","article-title":"Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials","volume":"60","author":"Viguiliouk","year":"2020","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_56","first-page":"CD009825","article-title":"Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease","volume":"3","author":"Rees","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.atherosclerosis.2011.04.026","article-title":"Effect of a traditional Mediterranean diet on apolipoproteins B, AI, and their ratio: A randomized, controlled trial","volume":"218","author":"Estruch","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1601015","DOI":"10.1002\/mnfr.201601015","article-title":"The Mediterranean Diet decreases LDL atherogenicity in high cardiovascular risk individuals: A randomized controlled trial","volume":"61","author":"Goday","year":"2017","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1161\/CIRCULATIONAHA.116.023712","article-title":"Mediterranean Diet Improves High-Density Lipoprotein Function in High-Cardiovascular-Risk Individuals: A Randomized Controlled Trial","volume":"135","author":"Elosua","year":"2017","journal-title":"Circulation"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1093\/ajcn\/77.5.1146","article-title":"Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: A meta-analysis of 60 controlled trials","volume":"77","author":"Mensink","year":"2003","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1161\/CIRCULATIONAHA.118.035225","article-title":"Meta-analysis of randomized controlled trials of red meat consumption in comparison with various comparison diets on cardiovascular risk factors","volume":"139","author":"Satija","year":"2019","journal-title":"Circulation"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jneb.2015.08.023","article-title":"The effect of the Mediterranean diet on hypertension: A systematic review and meta-analysis","volume":"48","author":"Nissensohn","year":"2016","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"76","DOI":"10.3945\/an.115.009753","article-title":"Dietary patterns and blood pressure in adults: A systematic review and meta-analysis of randomized controlled trials","volume":"7","author":"Ndanuko","year":"2016","journal-title":"Adv. Nutr."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.3945\/ajcn.116.146803","article-title":"A Mediterranean diet lowers blood pressure and improves endothelial function: Results from the MedLey randomized intervention trial","volume":"105","author":"Davis","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/S0140-6736(16)30383-X","article-title":"The economic burden of physical inactivity: A global analysis of major non-communicable diseases","volume":"388","author":"Ding","year":"2016","journal-title":"Lancet"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1249\/MSS.0000000000001939","article-title":"Physical activity, all-cause and cardiovascular mortality, and cardiovascular disease","volume":"51","author":"Kraus","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1161\/CIRCRESAHA.125.325526","article-title":"Epidemiology and cardiovascular benefits of physical activity and exercise","volume":"137","author":"Mi","year":"2025","journal-title":"Circ. Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1161\/CIRCULATIONAHA.121.058162","article-title":"Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults","volume":"146","author":"Lee","year":"2022","journal-title":"Circulation"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s11357-024-01489-2","article-title":"Sex-specific mechanisms in vascular aging: Exploring cellular and molecular pathways in the pathogenesis of age-related cardiovascular and cerebrovascular diseases","volume":"47","author":"Ungvari","year":"2025","journal-title":"Geroscience"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"100401","DOI":"10.1016\/j.jnha.2024.100401","article-title":"Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)","volume":"29","author":"Izquierdo","year":"2025","journal-title":"J. Nutr. Health Aging"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/eurjhf\/hfr017","article-title":"Exercise training in heart failure: From theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation","volume":"13","author":"Piepoli","year":"2011","journal-title":"Eur. J. Heart Fail."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Soynikov, Y., and Lukyantseva, H. (2025). Reactive and adaptive changes of the cardiovascular system in men in response to different types of physical exercise: Physiological and training context. Cherkasy Univ. Bull. Biol. Sci. Ser., 70\u201387.","DOI":"10.31651\/2076-5835-2018-1-2025-2-70-87"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1093\/cvr\/cvab246","article-title":"Functional and structural adaptations of the coronary macro-and microvasculature to regular aerobic exercise by activation of physiological, cellular, and molecular mechanisms: ESC Working Group on Coronary Pathophysiology and Microcirculation position paper","volume":"118","author":"Koller","year":"2022","journal-title":"Cardiovasc. Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1161\/01.CIR.101.3.336","article-title":"The athlete\u2019s heart. A meta-analysis of cardiac structure and function","volume":"101","author":"Pluim","year":"2000","journal-title":"Circulation"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1159\/000543314","article-title":"Effect of acute resistance exercise and resistance exercise training on central pulsatile hemodynamics and large artery stiffness: Part II","volume":"13","author":"Wakeham","year":"2025","journal-title":"Pulse"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1093\/eurjpc\/zwad023","article-title":"Effects of endurance exercise training on left ventricular structure in healthy adults: A systematic review and meta-analysis","volume":"30","author":"Morrison","year":"2023","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1093\/ehjci\/jeae155","article-title":"Diastolic function and dysfunction in athletes","volume":"25","author":"Dalen","year":"2024","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1038\/s41569-023-00847-5","article-title":"Obesity and the risk of cardiometabolic diseases","volume":"20","author":"Valenzuela","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_83","first-page":"89","article-title":"Effect of exercise training on the renin\u2013angiotensin\u2013aldosterone system: A meta\u2013analysis","volume":"38","author":"Man","year":"2024","journal-title":"J. Hum. Hypertens."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"3525","DOI":"10.1007\/s11357-024-01329-3","article-title":"Active longevity and aging: Dissecting the impacts of physical and sedentary behaviors on longevity and age acceleration","volume":"47","author":"Lu","year":"2025","journal-title":"Geroscience"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"5235","DOI":"10.1007\/s11357-025-01647-0","article-title":"Exercise and survival benefit in cancer patients: Evidence from a comprehensive meta-analysis","volume":"47","author":"Ungvari","year":"2025","journal-title":"Geroscience"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Ny\u00e1ry, D., Fekete, M., Lehoczki, A., Fazekas-Pongor, V., Lip\u00e9cz, \u00c1., Cs\u00edp\u0151, T., Major, D., P\u00e9terfi, A., Cs\u00edk, B., and Z\u00e1b\u00f3, V. (2026). Inflammaging and Sarcopenia as Interconnected Hallmarks of Aging: Integrative Roles of Bioactive Compounds and Lifestyle Interventions. Nutrients, 18.","DOI":"10.3390\/nu18121920"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.numecd.2014.03.003","article-title":"Mediterranean dietary pattern, inflammation and endothelial function: A systematic review and meta-analysis of intervention trials","volume":"24","author":"Schwingshackl","year":"2014","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Abrignani, V., Salvo, A., Pacinella, G., and Tuttolomondo, A. (2024). The Mediterranean diet, its microbiome connections, and cardiovascular health: A narrative review. Int. J. Mol. Sci., 25.","DOI":"10.20944\/preprints202403.0461.v1"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1093\/aje\/kwp282","article-title":"Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study","volume":"170","author":"Buckland","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"3565","DOI":"10.1007\/s11357-024-01491-8","article-title":"Impact of adherence to the Mediterranean diet on stroke risk","volume":"47","author":"Ungvari","year":"2025","journal-title":"Geroscience"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"3831972","DOI":"10.1155\/2017\/3831972","article-title":"Exercise Modifies the Gut Microbiota with Positive Health Effects","volume":"2017","author":"Monda","year":"2017","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Varga, P., Ungvari, A., Kallai, A., Ponyai, P.T., Csik, B., Feher, A., Fekete, M., Lipecz, A., Tarantini, S., and Yabluchanskiy, A. (2026). Mediterranean Diet Adherence and Microvascular Function Assessed by Laser Speckle Contrast Imaging: Pilot Findings from the Semmelweis Study. Adv. Transl. Res.","DOI":"10.1556\/1661.2026.00014"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Onu, A., Tutu, A., Trofin, D.-M., Onu, I., Galaction, A.-I., Onita, C.A., Iordan, D.-A., and Matei, D.-V. (2026). Diet, physical exercise, and gut microbiota modulation in metabolic syndrome: A narrative review. Life, 16.","DOI":"10.3390\/life16010098"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"e019033","DOI":"10.1136\/bmjopen-2017-019033","article-title":"Evaluation of Mediterranean diet adherence scores: A systematic review","volume":"8","year":"2018","journal-title":"BMJ Open"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.2522\/ptj.20150668","article-title":"Consensus on Exercise Reporting Template (CERT): Modified Delphi Study","volume":"96","author":"Slade","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1136\/bjsports-2016-096651","article-title":"Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement","volume":"50","author":"Slade","year":"2016","journal-title":"Br. J. Sports Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2548\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:14:31Z","timestamp":1785989671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":96,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18152548"],"URL":"https:\/\/doi.org\/10.3390\/nu18152548","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}