Physical Activity in Patients with Celiac Disease: A Systematic Review.

Objectives: Celiac disease (CD) is an immune-mediated disorder triggered by gluten ingestion. Although a gluten-free diet (GFD) is the only effective treatment, patients may still experience inflammation, nutritional imbalances, and reduced quality of life. Physical activity (PA) has demonstrated anti-inflammatory benefits; however, its role in CD management remains unclear. This systematic review aimed to synthesize evidence on the associations of PA and the outcomes of exercise interventions in individuals with CD, focusing on metabolic, nutritional, clinical, and functional outcomes. Methods: Following PRISMA guidelines, we included peer-reviewed observational and experimental studies assessing PA in individuals with CD across all age groups, without language or date restrictions. Searches were conducted in PubMed, Scopus, Web of Science, EMBASE, and SPORTDiscus. The risk of bias was evaluated using JBI and Cochrane RoB 2 tools. Results: Fourteen studies (17 publications) were included, the vast majority of which were cross-sectional, along with one quasi-experimental study and two randomized controlled trial cohorts reported across five publications. Data from these predominantly observational studies suggested possible, yet inconsistent, links between higher PA levels and better profiles in body composition, inflammatory and oxidative markers, quality of life, and psychological outcomes. Positive associations were also observed in some studies regarding gastrointestinal symptoms and adherence to the GFD. However, findings on metabolic markers and bone mineral density were inconsistent and linked to dietary factors. Conclusions: While PA represents a potential adjunct in the comprehensive management of CD, particularly in relation to functional and inflammatory outcomes. However, the current evidence remains highly preliminary, limited, and inconsistent, which restricts the strength of any definitive conclusions. Therefore, high-quality, longitudinal studies and well-designed clinical trials are needed to confirm its long-term benefits, especially in the pediatric population, and to establish specific recommendations.