The rapidly ageing population has been identified as a major global challenge; within Wales there is a growing imbalance in the age-profiles of rural communities in particular. The demands of providing appropriate healthcare for a changing population are exacerbated by lifestyle changes associated with ageing, specifically low levels of physical activity, reduced exposure to the sun and compromised ability to synthesise vitamin D. This report focuses on two important health outcomes affected by these changes that are of increasing concern within Wales: diabetes (DM2: diabetes mellitus type 2) and falls incidence. The article critically reviews the evidence base pertaining to the relationships between physical activity, vitamin D, and both the pathogenesis of DM2 and falls incidence. Current interventions are discussed and a series of recommendations for service delivery within Wales’ rural communities are presented. We argue that there is a clear role for targeting these modifiable lifestyle factors in reducing the prevalence and severity of falls and diabetes, two growing areas of social and economic concern within Wales.