Exercise is a potent regulator of immune and inflammatory function, yet its impact in para-athletes remains insufficiently characterized due to the physiological diversity imposed by varying impairments. This narrative review synthesizes current evidence on exercise-induced inflammation and immunity across para-sport populations, examining both adaptive and maladaptive processes in relation to training, recovery, and performance. Para-athletes with spinal cord injury, limb deficiency, or cerebral palsy display distinct immunological signatures, influenced by autonomic disruption, altered muscle mass distribution, and neuromotor control deficits. While moderate exercise elicits beneficial cytokine responses and enhances immune surveillance, excessive or unaccustomed training can precipitate chronic low-grade inflammation, delayed recovery, and heightened infection susceptibility. Factors such as exercise modality, intensity, and environmental context (e.g., competition stress, travel, thermal load) further modulate these responses. Evidence supports targeted nutritional and rehabilitative interventions including omega-3 fatty acids, vitamin D optimization, antioxidant timing, and neuromuscular electrical stimulation as potential modulators of inflammatory balance. However, methodological limitations, small sample sizes, and inconsistent reporting hinder generalization. A paradigm shift toward impairment-specific, longitudinal, and mechanistic investigations is essential to advance clinical and applied knowledge in this field.