The increased participation in wheelchair sports in conjunction with environmental challenges posed by the most recent Paralympic venues has stimulated interest into the study of thermoregulation of wheelchair users. This area is particularly pertinent for the spinal cord injured as there is a loss of vasomotor and sudomotor effectors below the level of spinal lesion. Studies within this area have examined a range of environmental conditions, exercise modes and subject populations. During exercise in cool conditions (15-25 degrees C), trained paraplegic individuals (thoracic or lumbar spinal lesions) appear to be at no greater risk of thermal injury than trained able-bodied individuals, although greater heat storage for a given metabolic rate is evident. In warm conditions (25-40 degrees C), trained subjects again demonstrate similar core temperature responses to the able-bodied for a given relative exercise load but elicit increased heat storage within the lower body and reduced whole-body sweat rates, increasing the risk of heat injury. The few studies examining a wide range of lesion levels have noted that, for paraplegic individuals where heat production is matched by available sweating capacity, excessive heat strain may be offset. Studies relating to tetraplegic subjects (cervical spinal lesions) are fewer in number but have consistently shown this population to elicit much faster rates of core and skin temperature increase and thermal imbalance in both cool and warm conditions than paraplegic individuals. These responses are due to the complete absence or severely reduced sweating capacity in tetraplegic subjects. During continuous exercise protocols, the main thermal stressor for tetraplegic subjects appears to be environmental heat gain, whereas during an intermittent-type exercise protocol it appears to be metabolic heat production. Fluid losses during exercise and heat retention during passive recovery from exercise are related to lesion level. Future research is recommended to focus on the specific role of absolute and relative metabolic rates, sweating responses, training status and more sport- and vocation-specific exercise protocols.