The purpose of this study was to analyze heart rate variability (HRV) oscillations before and after a marathon which involved trans-meridian air travel and substantial time zone differences in a professional wheelchair athlete with Charcot-Marie-Tooth (CMT) disease. The natural logarithm of the root mean square difference between adjacent normal R-R intervals (Ln rMSSD) was measured daily on the days before, including and following the race. Relative to baseline, small (-3.8 – -4.6%) reductions in LnRMSSD were observed following relocation and on race-day, indicating only minor effects of travel on cardiac-autonomic activity. On the morning following the marathon, a 23.1% reduction in Ln rMSSD was observed, which returned to baseline by 48 h. The race time set by the athlete was the world-leading time in his class. This case study showed that Ln rMSSD responses to marathon in an elite wheelchair athlete with CMT was similar to those previously reported among unrestricted endurance athletes.

• Monitoring cardiac-autonomic activity leading up to a race and in response to travel may be useful for objectively monitoring the athlete’s condition for performance of the marathon.

• The intensity maintained by the athlete in the race, compared with a pre-race incremental test, can help coaches to optimize tapering in future events.

• A substantial reduction in Ln rMSSD was observed the morning after a marathon and subsequently returned to baseline by 48 h in an elite wheelchair athlete with Charcot-Marie-Tooth disease, which is consistent with responses reported among unrestricted endurance athletes.