Effects of Traditional Mediterranean Physical Activity on Physical and Mental Health: A Systematic Review.

Abstract

The Traditional Mediterranean Physical Activity (TMPA) pattern, characterized by daily, incidental, and socially embedded movement, represents a core yet understudied component of the Mediterranean lifestyle. Unlike structured exercise, TMPA encompasses activities such as walking for transportation, agricultural work, gardening, household chores, and participation in cultural events. With global declines in functional daily movement and an increase in sedentary behavior, understanding the health impact of TMPA is increasingly relevant. A systematic literature search was conducted across major databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Scopus, and ProQuest) from inception to present. Of 6037 records identified, 27 studies met all inclusion criteria involving adult populations from Mediterranean countries and reporting physical activity-related health outcomes. Both quantitative and qualitative research, as well as systematic and narrative reviews, were included. A narrative synthesis of the 38 studies was undertaken due to heterogeneity in study design, outcomes, and TMPA definitions. Evidence consistently demonstrated that TMPA contributes to broad physical health benefits, including reduced cardiovascular and all-cause mortality, improved metabolic profiles, healthier body composition, enhanced musculoskeletal strength, and greater functional capacity in older adults. Its integration with other lifestyle pillars, such as diet, rest, and social engagement, appears to amplify these effects. TMPA was also associated with improved mental health outcomes, including reduced depressive symptoms, lower stress, enhanced emotional resilience, and greater life satisfaction. Studies emphasized that the social, outdoor, and culturally meaningful context of TMPA distinguishes its health effects from conventional exercise. However, substantial methodological variability, reliance on self-reported measures, and limited longitudinal research constrain the strength of causal inferences. Conclusions: TMPA emerges as a culturally embedded and sustainable form of daily movement with significant physical and mental health benefits. Its holistic, lifelong nature positions it as a valuable model for public health strategies aimed at counteracting sedentary lifestyles. Future research should prioritize standardized definitions, objective measurement tools, and longitudinal or interventional designs to clarify causal pathways. Incorporating TMPA principles into modern environments may offer innovative, culturally grounded approaches to promoting population health.