Chronic inflammation is known to be a predominant factor in the development of many age-related conditions including cardiovascular disease, type II diabetes and neurodegenerative diseases. Previous studies have demonstrated that during the ageing process there is an increase in inflammatory biomarkers, which may be partially brought about by detrimental changes to the gut microbiota. The Mediterranean diet (MedDiet) and physical activity are protective against inflammation and chronic disease, and emerging evidence has shown that these effects may be partially mediated through favourable changes to the gut microbiota. In this review we have evaluated the published literature on the effect of a MedDiet and physical activity on the gut microbiota. We also discuss the relationship between the gut microbiota and inflammation with a focus on healthy ageing. While inconsistent study designs make forming definitive conclusions challenging, the current evidence suggests that both a MedDiet and physical activity are capable of modifying the gut microbiota in a way that is beneficial to host health. For example, the increases in the relative abundance of short chain fatty acid producing bacteria that are considered to possess anti-inflammatory properties. Modification of the gut microbiota through a MedDiet and physical activity presents as a potential method to attenuate age-related increases in inflammation, additional studies utilising older individuals are needed to fill the knowledge gaps existing in current literature.