Tilt and dynamic terrain simulation systems are provided which are couplable to a wheelchair treadmill and are configured to dynamically tilt the wheelchair during use of the wheelchair treadmill for simulating an uneven terrain condition. In some embodiments, the dynamic tilt system includes one or more elevation devices placed under a platform for tilting the platform of the wheelchair treadmill from a horizontal plane to a non-horizontal plane, and each of the one or more elevation devices is controllably adjustable to extend an adjustable support that is mounted to the platform between a first height and a second height. In some embodiments, each of the one or more elevation devices includes one or more actuators for controllably adjusting a height of the adjustable support between the first height and the second height.
