Purpose: To compare peak work rate (WRpeak) and associated physiological and biomechanical performance-determining variables between flat and uphill cross-country (XC) sit-skiing. Methods: Fifteen able-bodied male XC skiers completed 2 test sessions, each comprising four 4-minute submaximal stages, followed by an incremental test to exhaustion and a verification test in a sit-ski on a roller-ski treadmill. The test sessions were counterbalanced by the incline, being either 0.5% (FLAT) or 5% (UPHILL). The authors compared WRpeak and peak oxygen uptake, as well as physiological variables, rating of perceived exertion, gross efficiency, and cycle characteristics at identical submaximal work rate, between FLAT and UPHILL. Results: In UPHILL, WRpeak was 35% higher compared to FLAT (P < .001), despite no difference in peak oxygen uptake (P = .9). The higher WRpeak in UPHILL was achieved through more work per cycle, which was enabled by the twice as long poling time, compared to FLAT (P < .001). Submaximal gross efficiency was 0.5 to 2 percentage points lower in FLAT compared to UPHILL (P < .001), with an increasing difference as work rate increased (P < .001). Neither cycle rate nor work per cycle differed between inclines when compared at identical submaximal work rate (P > .16). Conclusions: The longer poling times utilized in uphill XC sit-skiing enable more work per cycle and better gross efficiency, thereby allowing skiers to achieve a higher WRpeak compared to flat XC sit-skiing. However, the similar values of peak oxygen uptake between inclines indicate that XC sit-skiers can tax their cardiorespiratory capacity similarly in both conditions.