Abstract: Ruddock, AD, Tew, GA, and Purvis, AJ. Reliability of intestinal temperature using an ingestible telemetry pill system during exercise in a hot environment. J Strength Cond Res 28(3): 861–869, 2014—Ingestible telemetry pill systems are being increasingly used to assess the intestinal temperature during exercise in hot environments. The purpose of this investigation was to assess the interday reliability of intestinal temperature during an exercise-heat challenge. Intestinal temperature was recorded as 12 physically active men (25 ± 4 years, stature 181.7 ± 7.0 cm, body mass 81.1 ± 10.6 kg) performed two 60-minute bouts of recumbent cycling (50% of peak aerobic power [watts]) in an environmental chamber set at 35° C 50% relative humidity 3–10 days apart. A range of statistics were used to calculate the reliability, including a paired t-test, 95% limits of agreement (LOA), coefficient of variation (CV), standard error of measurement (SEM), Pearson's correlation coefficient (r), intraclass correlation coefficient (ICC), and Cohen's d. Statistical significance was set at p ≤ 0.05. The method indicated a good overall reliability (LOA = ±0.61° C, CV = 0.58%, SEM = 0.12° C, Cohen's d = 0.12, r = 0.84, ICC = 0.84). Analysis revealed a statistically significant (p = 0.02) mean systematic bias of −0.07 ± 0.31° C, and the investigation of the Bland–Altman plot suggested the presence of heteroscedasticity. Further analysis revealed the minimum “likely” change in intestinal temperature to be 0.34° C. Although the method demonstrates a good reliability, researchers should be aware of heteroscedasticity. Changes in intestinal temperature >0.34° C as a result of exercise or an intervention in a hot environment are likely changes and less influenced by error associated with the method.