King Charles has spoken of his "great sadness" at missing the traditional Maundy Thursday service.
The King is not attending public events while he has treatment for cancer but recorded a message that was played at the service at Worcester Cathedral.
Queen Camilla was instead at the service, where she handed out Maundy money.
In his message, the King reaffirmed his coronation pledge "not to be served, but to serve" with "my whole heart".
He praised those who "extend the hand of friendship, especially in a time of need".
He added: "It is for me a great sadness that I cannot be with you today."
The number of recipients of Maundy Money matches the age of the monarch - so 75 men and women will receive this symbolic gift.
The King’s message, recorded in mid-March, included a Bible reading and a call that as a nation: "We need and benefit greatly from those who extend the hand of friendship to us, especially in a time of need."
Although not directly commenting on his own health - or the cancer diagnosis of the Princess of Wales - he spoke of the importance of those who care for others.
The 150 recipients of Maundy Money today "are wonderful examples of such kindness; of going way beyond the call of duty and of giving so much of their lives to the service of others in their communities," he said.
- King to attend Easter church service
- King proud of Kate’s courage after cancer news
- Kate rumours linked to Russian disinformation
The Maundy service, in which the monarch gives out gifts, is one of the oldest royal ceremonies, dating back at least as far as the 13th Century and the reign of King John, a monarch who is buried in this medieval cathedral.
Until James II in the 17th Century, the monarch also used to wash the feet of the poor, in an echo of Jesus washing the feet of the apostles at the Last Supper.
PA Media
The Queen handed out the traditional Maundy money
Now the ceremony involves giving purses of coins to older people, 75 men and 75 women, who have been involved in helping the church and the local community.
This year’s recipients received £5 coins with the image of a Tudor dragon, a 50p marking the The Royal National Lifeboat Institution’s 200th anniversary and specially minted silver Maundy coins.
The King’s message praised those getting the Maundy money as "wonderful examples of such kindness".
This was another engagement in which Queen Camilla has appeared on behalf of the King, while he continues with the cancer treatment that began last month.
PA Media
The King has continued to carry out meetings, including on Wednesday, when he held an audience with Mohamed Nasheed, secretary-general of the Climate Vulnerable Forum
He has not attended big public events with large crowds, but he will be at the Easter church service on Sunday morning at St George’s Chapel in Windsor.
It will be a smaller event this Easter, with the Prince and Princess of Wales and their children not attending, as Catherine continues her recovery.
The King had sent a video message to the annual Commonwealth service earlier this month, but it is understood that Worcester Cathedral did not have the video facilities, so an audio message was played instead.
