Jump to content

Diet And Physical Activity In Older Women

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Vidya Acharya, Kirenga Bamurange Liliane, Tolulope Adeniji, Janine van Dyk and Alexandra Stead  

Introduction

A balanced whole food diet

Physical activity and nutrition are vital for maintaining health and reducing the risk of non-communicable diseases. Women have distinct nutritional needs based on physiological and hormonal changes at several stages across the lifespan, including menstruation, pregnancy, breastfeeding, and menopause.[1] Sports and exercise medicine research has historically under-represented women, and older women in particular. Greater research attention focused on older women is needed to support longer life with better quality of life.[1]

Older age is associated with many physiological changes that increase the risk of undernutrition, including reduced bone and muscle mass (sarcopenia refers to the age-related progressive loss of skeletal muscle mass and strength), increased frailty, reduced cognitive function, and greater dependence on others for care.[1] The relationship between diet and the ageing process remains incompletely understood; however, evidence points to the probable effects of a range of dietary factors that can offset molecular damage, including inflammation (the chronic low-grade inflammatory state associated with ageing), oxidative stress (cellular damage caused by reactive oxygen species), and endothelial dysfunction, all of which contribute to the functional decline associated with ageing.[1]

Key Nutritional Considerations

Adequate intake of key nutrients can help improve overall health and quality of life in the older women.

Nutrient Timing

The timing of nutrient consumption appears to influence metabolism in women. A large proportion of nutrient timing recommendations have been derived from research conducted predominantly in male populations, which limits their direct applicability to women.[2] The timing of nutrient consumption during exercise directly affects performance, fatigue recovery, fat oxidation (the breakdown of fatty acids for energy), and energy expenditure.[1]

Women display distinct metabolic characteristics compared with men, including lower protein and carbohydrate oxidation and greater lipid oxidation during exercise, differences which are partly attributable to variations in muscle morphology, adiposity, and hormonal profiles.[2] The relationship between fed versus fasted exercise and fat oxidation is complex and influenced by individual metabolic factors; research suggests that the total pattern of daily energy balance and substrate utilisation, rather than any single meal timing strategy, is the primary determinant of body composition outcomes in women.[3]

Evidence suggests that consuming a bolus of protein before exercise, rather than carbohydrate, significantly increases energy expenditure and enhances fat oxidation following aerobic exercise, high-intensity interval training, and resistance training, and that pre-exercise protein intake may be more effective than post-exercise nutrition for achieving improvements in strength and lean body mass in women.[2] A randomised clinical trial of older women at risk of sarcopenia further demonstrated that micronutrient adequacy, specifically sufficient vitamin D and vitamin B12, was a key determinant of the magnitude of strength gains achieved through resistance and multicomponent training programmes, independent of macronutrient intake.[4]

Bone Health and Fracture Risk

Dietary intake plays a role in reducing the risk of fractures in older women. A large prospective cohort study of more than 26,000 women in the United Kingdom, followed for a median of 22.3 years, found that each additional cup of tea or coffee consumed per day was associated with a 4% lower risk of hip fracture, and each 25 g/day increment in dietary protein intake was associated with a 14% lower risk of hip fracture, with both associations most evident in women with a low body mass index (BMI).[5] The protective effects of tea and coffee on fracture risk are thought to relate to their high content of polyphenols and phytoestrogens, which may enhance osteoblast activity and suppress osteoclastic activity by reducing oxidative stress.[5] It should be noted that evidence regarding the overall relationship between habitual coffee and tea intake and bone mineral density (BMD) is mixed across populations. Some studies indicate high dietary intake of caffeinated beverages is linked to decreased bone mineral density and increased risk of hip fracture, while some meta-analyses reporting no significant association.[6]

Higher dietary protein intake is associated with greater BMD at the hip, whole body, and lumbar spine in older adults, and with a lower risk of vertebral and hip fracture, provided calcium intake is adequate.[7] A systematic review of randomised controlled trials of nutritional interventions in older women with sarcopenia found that protein intake of 1.0 to 1.2 g/kg body weight per day was more effective than the standard recommended dietary allowance of 0.8 g/kg/day for preserving lean muscle mass, functional performance, and overall strength.[8]

Vitamin D plays a central role in bone and muscle health in older women. Vitamin D deficiency, which is prevalent among peri- and postmenopausal women, impairs calcium absorption, elevates parathyroid hormone secretion, increases osteoclast activity, and reduces bone mass, collectively increasing fracture risk.[9] Low serum 25-hydroxyvitamin D levels are also consistently associated with decreased muscle strength, reduced physical performance, and increased prevalence of sarcopenia in older women, with benefits from supplementation most evident in individuals with confirmed deficiency and when combined with resistance training and adequate protein intake.[10] Magnesium is also essential for bone development and mineralisation; insufficient dietary magnesium intake is associated with reduced BMD and impairs the metabolism of both parathyroid hormone and vitamin D.[11] A clinical trial found that magnesium supplementation significantly increased vitamin D levels compared with placebo in a cohort of postmenopausal women, the majority of whom had vitamin D deficiency at baseline.[12]

Diet Quality

Assessing the overall quality of the diet, rather than individual nutrients in isolation, represents a more valid approach to nutritional epidemiology in older adults.[1] Current tools used to assess diet quality, such as the Dietary Approaches to Stop Hypertension (DASH) score and dietary pattern indices, evaluate dietary moderation, variety, and balance, and are sensitive to the overnutrition patterns more commonly seen in ageing populations.[1]

The Mediterranean diet, characterised by high consumption of fruits, vegetables, whole grains, legumes, fish, and olive oil, is among the most extensively studied dietary patterns in older adults globally. A 2024 systematic review and meta-analysis of 28 studies comprising 679,259 participants found that high adherence to the Mediterranean diet was associated with a 23% reduction in all-cause mortality risk and significant reductions in cardiovascular events in adults aged over 60 years.[13] A further systematic review of 28 studies published in 2025 found that adherence to the Mediterranean diet was associated with significant improvements in health-related quality of life, particularly in the physical health domains, in both healthy populations and those living with chronic conditions.[14]

Adherence to healthy dietary patterns is shaped by social, economic, and environmental factors across all world regions. The quality of a person's diet is often substantially determined by structural determinants, including income, educational attainment, food access, and cultural context, rather than individual choice alone.[1][15][16][17] Physiotherapists and rehabilitation professionals should be aware of these contextual factors when discussing nutrition with older patients.

Eating Disorders

Body weight dissatisfaction is associated with unhealthy dietary behaviours in older age, as in all age groups for women.[18] Eating disorder symptoms and preoccupation with body image have been identified in increasing numbers of women aged over 50 years; however, healthcare providers have not routinely screened for these conditions in this age group, often pursuing alternative medical diagnoses instead.[19]

The perimenopause represents a specific period of heightened vulnerability for the development or recurrence of disordered eating, as hormonal changes increase emotional vulnerability and interact with sociocultural pressures around body weight and ageing.[19] Unsupervised restrictive diets in this population carry a significant risk of micronutrient deficiency, inadequate protein intake, and the entrenchment of disordered eating behaviours.[18]

Clinicians working with older women should address dietary behaviours with tact and sensitivity to avoid reinforcing body weight dissatisfaction or triggering restrictive eating. Encouraging improvements in diet quality as a strategy for health and functional capacity, rather than weight loss, may be a more appropriate framing in this context.[19] Where disordered eating is suspected, timely referral to a specialist multidisciplinary team, including dietetics and mental health support, is indicated.[19]

Cancer

The cancer burden globally among women is high in both high-income countries (HICs) and lower-middle-income countries (LMICs), and it is expected to increase as populations age and as risk factors linked to urbanisation become more prevalent.[20] Physical activity at moderate to vigorous intensity is associated with a reduced risk of several cancers, including colon cancer, breast cancer, endometrial cancer, ovarian cancer, and cervical cancer.[21][22] Biological mechanisms through which physical activity reduces cancer risk include modulation of endogenous sex steroids, improvement in insulin sensitivity, reduction of chronic inflammation, and epigenetic alterations that regulate tumour suppressor gene expression.[21] A healthy dietary pattern is likewise associated with lower cancer risk and cancer mortality in women. In a large prospective cohort of 65,838 postmenopausal women, those with the highest adherence to cancer prevention dietary guidelines had a 17% lower risk of any cancer and a 22% lower risk of cancer mortality compared with those with the lowest adherence.[23] The Mediterranean dietary pattern in particular is associated with a reduced risk of several cancers, with proposed mechanisms including anti-inflammatory effects, modulation of oestrogen metabolism via dietary fibre, and antioxidant activity of polyphenols.[24] Where physical activity and dietary modification are combined as an intervention in people living with cancer, moderate-quality evidence supports reductions in body mass index, insulin, C-reactive protein, and depression, alongside improvements in quality of life.[25]

Relevance to Physiotherapy

Physiotherapists are well placed to incorporate nutritional awareness into clinical practice, given the established links between diet, physical activity, body composition, and functional outcomes in older women. The following clinical considerations are particularly relevant.

Older women presenting with musculoskeletal conditions, frailty, or reduced functional capacity should be screened for nutritional risk. A systematic review and meta-analysis found that the pooled prevalence of malnutrition and risk of malnutrition in geriatric rehabilitation settings was 13% and 47% respectively, and that poorer nutritional status was associated with lower functional independence and worse physical performance outcomes at both admission and discharge.[26] Malnutrition in older adults has further been shown to increase the risk of falls and osteoporotic fractures, contributing to a cycle of functional decline, loss of independence, and increased institutionalisation.[27]

Adequate protein intake and vitamin D status are foundational to preserving muscle mass and bone health in older women, both of which are central to physiotherapy goals in this population. A systematic review of randomised controlled trials of nutritional interventions specific to muscle-related components of sarcopenia in older women found that protein, vitamin D, and combined vitamin D and magnesium supplementation produced beneficial effects on muscle protein synthesis, muscle strength, and physical function.[28] Micronutrient sufficiency, particularly vitamin D and vitamin B12, has also been identified as a significant modifier of the strength gains achievable through resistance training in older women, suggesting that nutritional adequacy should be assessed alongside exercise prescription.[4]

Pre-exercise nutrition, particularly protein consumption prior to resistance training, may enhance strength gains and lean body mass in older women and should be considered in exercise prescription discussions.[2]

Disordered eating behaviours should be identified sensitively in clinical encounters. Physiotherapists should be aware that these are not exclusive to younger women and should facilitate timely referral to appropriate services when indicated.[19]

An interprofessional approach involving physiotherapy, dietetics, medicine, and exercise science is recommended to optimise the nutritional and physical activity management of older women with complex presentations. A cross-sectional international survey of physiotherapists and dietitians found that both professions consider malnutrition and sarcopenia shared problem domains and are broadly supportive of interprofessional treatment, yet in practice both professions largely treat these conditions independently, with resource constraints and unclear role boundaries identified as the primary barriers to collaboration.[29] Addressing these barriers through structured interprofessional education and clear role delineation is recommended to improve nutritional care outcomes in older adults.[30]

For further reading, see:

Resources

The following video provides an overview of exercise and nutrition for middle-aged and older adults. Dr. Stella Volpe discusses the importance of physical activity and dietary habits for healthy ageing and emphasises that it is never too late to make positive lifestyle changes.

EmbedVideo is missing a required parameter.

[31]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Mattioli AV, Selleri V, Zanini G, Nasi M, Pinti M, Stefanelli C, Fedele F, Gallina S. Physical activity and diet in older women: a narrative review. Journal of Clinical Medicine. 2022 Dec 22;12(1):81.
  2. ↑ 2.0 2.1 2.2 2.3 Cholewa J, Hudson A, Cicholski T, Cervenka A, Barreno K, Broom K, Broom M, Craig SAS. The effects of nutrient timing on training adaptations in resistance-trained females. Journal of Science and Medicine in Sport. 2019 Apr;22(4):472-477.
  3. ↑ Iwayama K, Seol J, Tokuyama K. Exercise timing matters for glycogen metabolism and accumulated fat oxidation over 24 h. Nutrients. 2023 Feb 23;15(5):1109.
  4. ↑ 4.0 4.1 Castellano-Plagaro A, Molina-García P, Cavero-Redondo I, Reina-Gutiérrez S, Díez-Fernández A, Saz-Lara A. Nutritional intake as a determinant of high-speed resistance and multicomponent training efficacy on strength in older women at risk of sarcopenia: a randomized clinical trial. Clinical Nutrition. 2025 Mar;47:76-85.
  5. ↑ 5.0 5.1 Greenwood DC, Hardie LJ, Frost GS, Alwan NA, Bradbury KE, Carter M, Elliott P, Evans CEL, Ford HE, Hancock N, et al. Foods, nutrients and hip fracture risk: a prospective study of middle-aged women. Clinical Nutrition. 2022 Nov;41(11):2483-2491.
  6. ↑ Chen CC, Shen YM, Li SB, Huang SW, Kuo YJ, Chen YP. Association of coffee and tea intake with bone mineral density and hip fracture: a meta-analysis. Medicina (Kaunas). 2023 Jun 20;59(6):1177.
  7. ↑ Shams-White MM, Quasem I, Moffet E, Del Valle HB, Weaver CM. Effect of dietary protein intake on bone mineral density and fracture incidence in older adults in the Health, Aging, and Body Composition Study. Journal of Gerontology: Biological Sciences. 2021;76(12):2213-2220.
  8. ↑ Ishaq I, Noreen S, Maduabuchi Aja P, Atoki AV. Role of protein intake in maintaining muscle mass composition among elderly females suffering from sarcopenia. Frontiers in Nutrition. 2025 Apr 23;12:1547325.
  9. ↑ Rodrigues MV, Hidalgo DA, Teles MJ, Bieging GH, Mendes GCM. Supplementation of vitamin D isolated or calcium-associated with bone remodelling and fracture risk in postmenopausal women without osteoporosis: a systematic review of randomised clinical trials. Maturitas. 2023 Sep;175:107809.
  10. ↑ Sánchez-Trigo H, Ramírez-Vélez R, Alonso-Martínez A, García-Alonso Y, Courel-Ibáñez J. Vitamin D and sarcopenia: implications for muscle health. Nutrients. 2025;17(12):2060.
  11. ↑ Zhang Y, Dong T, Hu W, Wang X, Xu B, Lin Z, Sun Y. The role of magnesium in the pathogenesis of osteoporosis. Frontiers in Endocrinology. 2024 May 24;15:1406248.
  12. ↑ Vázquez-Lorente H, Molina-López J, Herrera-Quintana L, Gamarra-Morales Y, López-González B, Planells E. Response of vitamin D after magnesium intervention in a postmenopausal population from the Province of Granada, Spain. Journal of Trace Elements in Medicine and Biology. 2021 May;65:126730.
  13. ↑ Furbatto M, Lelli D, Antonelli Incalzi R, Pedone C. Mediterranean diet in older adults: cardiovascular outcomes and mortality from observational and interventional studies - a systematic review and meta-analysis. Nutrients. 2024 Nov 19;16(22):3947.
  14. ↑ Guglielmetti M, Ferraris C, Tagliabue A, Frigerio F, Tavazzi E, Schiano di Cola F, Perna S, Rondanelli M. Mediterranean diet and quality of life in adults: a systematic review. Nutrients. 2025 Feb 5;17(3):577.
  15. ↑ Darmon N, Drewnowski A. Does social class predict diet quality?. The American journal of clinical nutrition. 2008 May 1;87(5):1107-17.
  16. ↑ Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutrition reviews. 2015 Oct 1;73(10):643-60.
  17. ↑ Jiao L. Social determinants of health, diet, and health outcome. Nutrients. 2024 Oct 26;16(21):3642.
  18. ↑ 18.0 18.1 Chatelan A, Carrard I. Diet quality in middle-aged and older women with and without body weight dissatisfaction: results from a population-based national nutrition survey in Switzerland. Journal of Nutritional Science. 2021;10:e38.
  19. ↑ 19.0 19.1 19.2 19.3 19.4 Samuels KL, Maine MM, Tantillo M. Disordered eating, eating disorders, and body image in midlife and older women. Current Psychiatry Reports. 2019 Jul 1;21(8):70.
  20. ↑ Torre LA, Islami F, Siegel RL, Ward EM, Jemal A. Global cancer in women: burden and trends. Cancer Epidemiology, Biomarkers and Prevention. 2017 Apr 1;26(4):444-57.
  21. ↑ 21.0 21.1 Friedenreich CM, Ryder-Burbidge C, McNeil J. Physical activity, obesity and sedentary behaviour in cancer aetiology: epidemiologic evidence and biologic mechanisms. Molecular Oncology. 2021 Mar;15(3):790-800.
  22. ↑ Cao M, Huang Y, Zhou Y, Wang H, Zhang J. Association between physical activity and gynecological cancers: a meta-analysis of prospective cohort studies. BMC Women's Health. 2025 Jul 3;25(1):300.
  23. ↑ Inoue-Choi M, Robien K, Lazovich D. Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the Women's Health Initiative. Cancer Epidemiology, Biomarkers and Prevention. 2013 Sep;22(9):1545-56.
  24. ↑ Jia W, Liu Y, Fan Y, Wang Q, Jiang L. Association of healthy diet and physical activity with breast cancer: lifestyle interventions and oncology education. Frontiers in Oncology. 2022 Mar 29;12:820935.
  25. ↑ Siouras V, Moustakidis S, Giannoukas AD, Sakellariou A, Stefanidis I, Hadjigeorgiou G, Vlychou M, Karetsi E, Papathanasiou IV, Boutlas S, et al. Combined effects of physical activity and diet on cancer patients: a systematic review and meta-analysis. Nutrients. 2024 Jun 2;16(11):1749.
  26. ↑ Beelen J, Vanhauwaert E, Janssen G, Jager-Wittenaar H. Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis. European Geriatric Medicine. 2020 Jun;11(3):195-207.
  27. ↑ Dymek M, Domalewska B, Malinowska-Lipień I, Brzostek T. Malnutrition in older adults: effect on falls and fractures - a narrative review. Nutrients. 2022 Jul 29;14(15):3123.
  28. ↑ Thornton M, Sim M, Kennedy MA, Blekkenhorst LC, Daly RM, Duckham RL. Nutrition interventions on muscle-related components of sarcopenia in females: a systematic review of randomised controlled trials. Calcified Tissue International. 2024 Jan;114(1):38-52.
  29. ↑ Reinders JJ, Hobbelen JSM, Tieland M, Weijs PJM, Jager-Wittenaar H. Interprofessional treatment of malnutrition and sarcopenia by dietitians and physiotherapists: exploring attitudes, interprofessional identity, facilitators, barriers, and occurrence. Journal of Multidisciplinary Healthcare. 2022 May 31;15:1177-1188.
  30. ↑ Bell JJ, Geirsdottir OG, Hertz K, Santy-Tomlinson J, Skúladóttir SS, Eleuteri S, Johansen A. Nutritional care of the older patient with fragility fracture: opportunities for systematised, interdisciplinary approaches across acute care, rehabilitation and secondary prevention settings. In: Falaschi P, Marsh D, editors. Orthogeriatrics: the management of older patients with fragility fractures. 2nd ed. Springer; 2021. Chapter 18.
  31. ↑ TEDx Talks. Exercise and nutrition for middle-age and older individuals | Dr. Stella Volpe | TEDxSJU [Internet]. YouTube; 2018 [cited 2024 Jan 26]. Available from: https://www.youtube.com/watch?v=I0BJU0iGTH0
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Diet_And_Physical_Activity_In_Older_Women&oldid=377065"