Volume 29, Issue 163, September 2025

Crohn’s Disease - Role of Diet and Physical Activity in Inducing and Maintaining Remission

Jan Wojdal^1♦, Katarzyna Ciepłucha², Aleksandra Wądołowska³, Barbara Przybył⁴, Zuzanna Mogilany⁵, Blanka Serafin-Juszczak⁶, Karolina Kusek⁷, Maria Wydra⁸, Michał Wilk⁹, Daniel Narożniak¹⁰

¹Copernicus Memorial Hospital, Pabianicka 62, 93-513, Łódź, Poland
²Rydygier Specialist Hospital in Krakow, Osiedle Złotej Jesieni 1, 31- 820 Kraków, Poland
³University Clinical Hospital No. 1 of the Medical University of Lodz, Kopcińskiego 22, 90-153 Łódź, Poland
⁴University Clinical Hospital No. 2 of the Medical University of Lodz; Stefana Żeromskiego 113, 90-549 Łódź, Poland
⁵Hospital of the Ministry of Interior and Administration in Lodz, Północna 42, 91–425 Łódź: Lodz, Poland
⁶University Clinical Hospital No. 2 of the Medical University of Lodz: Łódź, ul. Stefana Żeromskiego 113, 90-549 Łódź, Poland
⁷Central Clinical Hospital of Medical University of Lodz; Pomorska 251, 92-213 Łódź, Poland
⁸Rydygier Specialist Hospital in Krakow; Osiedle Złotej Jesieni 1, 31- 820 Kraków, Poland
⁹Central Clinical Hospital, of Medical University of Lodz; Pomorska 251, Łódź, Poland
⁹St. Raphael’s Voivodeship Specialist Hospital in Czerwona Góra, Czerwona Góra 10, 26-060 Chęciny, Poland

^♦Corresponding author
Jan Wojdal, Copernicus Memorial Hospital, Pabianicka 62, 93-513, Łódź, Poland

ABSTRACT

Background: Diet and physical activity are modifiable factors recommended to assist pharmacotherapy in Crohn’s Disease (CD); however, their relative effectiveness and underlying mechanisms remain insufficiently understood. Methods: We systematically searched PubMed, Scopus, and Google Scholar (Jan 2005 – Mar 2025) for randomised controlled trials, cohort studies, and systematic reviews comparing exclusive enteral nutrition (EEN), partial enteral nutrition (PEN), the Crohn's Disease Exclusion Diet (CDED ± PEN), or goal-directed exercise interventions. Results: EEN induced remission in 60-85% of paediatric and 50-65% of adult patients and achieved the highest early mucosal healing rates. CDED + 50% PEN achieved comparable week-6 remission and superior 12-week steroid-free durability (76 % vs 45 % with EEN). PEN alone maintained remission but was inferior for primary induction (~40%). The RTC showed that walking, moderate continuous training, high-intensity interval training, and impactresistance programs were safe in quiescent CD, improved VO₂peak, muscle strength, and bone mineral density, and did not precipitate relapse. Higher habitual activity levels lowered the risk of six-month flare-ups. Conclusion: EEN and CDED+PEN are the most effective non-pharmacological induction regimens, while CDED offers better long-term adherence. Structured aerobic and resistance exercises are safe and offer functional advantages, but their effect on mucosal remission requires confirmation. To improve personalised maintenance algorithms, we need large randomised controlled trials (RCTs) that combine exercise with a standardised diet.

Keywords: Crohn’s Disease; Exclusive Enteral Nutrition; Partial Enteral Nutrition; Crohn’s Disease Exclusion Diet; Exercise Therapy

Medical Science, 2025, 29, e170ms3712

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DOI: https://doi.org/10.54905/disssi.v29i163.e170ms3712

Published: 18 September 2025