ObjectivesThe aims of the study were to evaluate the external and internal work load of trained handcyclists during a mountain time trial, to compare the results with a world-class handcyclist, and to identify time trial performance determinants.DesignTen trained and one world-class handcyclists performed a graded exercise test to determine power output and heart rate at the (first and second) ventilatory thresholds and exhaustion. Power output and heart rate were continuously measured during the race.ResultsThe mean absolute power output during the race (119 ± 21 vs. 203 W,P< 0.001) was lower in the trained handcyclists compared with the world-class handcyclist. The absolute and relative heart rate during the race (86 ± 7% vs. 88%,P= 0.40) and relative power output during the race (66 ± 10% vs. 62%,P= 0.24) were similar. Trained handcyclists cycled significantly less time at a power output between first and second ventilatory thresholds (48% vs. 64%,P= 0.02) and more at a power output greater than second ventilatory threshold (34% vs. 11%,P= 0.005). Power output at the second ventilatory threshold showed the strongest correlation with finish time (r= −0.78) and peak power output with mean power output of the race (r= 0.90).ConclusionsThe laboratory outcome peak power output and power output at the second ventilatory threshold are important performance determinants for longer time trials in handcyclists, and it is, therefore, important to improve these outcomes with training. Because the trained handcyclists cycled most of the race in intensity zones 2 and 3, it is recommended to incorporate these zones also in the training.