9 10 11 Running title: Autonomic function and the inflammatory response to a wheelchair half-12 marathon 13 The authors declare no conflicts of interest. 14 interleukin-6; heat shock protein 72; wheelchair racing; upper-body exercise; sympathetic 15 response; adrenaline 16 Word count: 4283 17 Abstract 32This study investigates the relationship between autonomic function and the inflammatory 33 response to a wheelchair half-marathon in people with a spinal cord injury (SCI). Seventeen 34 wheelchair athletes with a cervical SCI (CSCI, N=7) and without CSCI (NON-CSCI, N=10) 35 participated in a wheelchair half-marathon. Blood was taken prior, post and 1 h post-race to 36 determine the concentrations of adrenaline, noradrenaline, extracellular heat shock protein 72 37 (eHsp72) and interleukin-6 (IL-6). A sit-up tilt test was performed to assess autonomic 38 function at rest. CSCI showed a lower supine ratio of the low and high frequency power of 39 the variability in RR intervals (LF/HF RRI, p=0.038), total and low frequency power of the 40 systolic blood pressure variability (TP SBP, p<0.001; LF SBP, p=0.005) compared to NON-41 CSCI. Following the race, catecholamine concentrations increased only in NON-CSCI 42 (p<0.036). The increase in IL-6 post-race was larger in NON-CSCI (p=0.040). Post-race 43 catecholamine levels explained 60% of the variance in the IL-6 response (r=0.77, p=0.040), 44which was further increased when the resting autonomic function indices were added to the 45 regression model (R 2 >81%, p<0.012). In summary, the dampened acute inflammatory 46 response to a wheelchair half-marathon in CSCI was strongly associated with the autonomic 47 dysfunction present in this group.