Mediterranean Diet and Physical Exercise for Cardiometabolic Health: A Narrative Review

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.