Purpose: To examine the relationship between cardiorespiratory and accelerometer-derived measures of exercise during trail running and determine the influence of accelerometer location. Methods: Eight trail runners (7 males and 1 female; age 26 [5] y; maximal oxygen consumption [V˙O2] 70 [6] mL·kg−1·min−1) completed a 7-km trail run (elevation gain: 486 m), with concurrent measurements of V˙O2, heart rate, and accelerations recorded from 3 triaxial accelerometers attached at the upper spine, lower spine, and pelvis. External exercise intensity was quantified from the accelerometers using PlayerLoad™ per minute and accelerometry-derived average net force. External exercise volume was calculated using accumulated PlayerLoad and the product of average net force and duration (impulse). Internal intensity was calculated using heart rate and V˙O2-metrics; internal volume was calculated from total energy expenditure (work). All metrics were analyzed during both uphill (UH) and downhill (DH) sections of the trail run. Results: PlayerLoad and average net force were greater during DH compared with UH for all sensor locations (P ≤ .004). For all accelerometer metrics, there was a sensor position × gradient interaction (F2,1429.003; P <.001). The upper spine was lower compared with both pelvis (P ≤ .003) and lower spine (P ≤ .002) for all accelerometer metrics during both UH and DH running. Relationships between accelerometer and cardiorespiratory measures during UH running ranged from moderate negative to moderate positive (r = −.31 to .41). Relationships were stronger during DH running where there was a nearly perfect correlation between work and impulse (r = .91; P < .001). Conclusions: Simultaneous monitoring of cardiorespiratory and accelerometer-derived measures during trail running is suggested because of the disparity between internal and external intensities during changes in gradient. Sensor positioning close to the center of mass is recommended.