The effect on the middle cerebral artery blood flow velocity (VMCA) of moderate and hard physical exercise on an ergometer cycle was examined in 10 healthy volunteers using transcranial Doppler sonography (TCD). During exercise, the heart rate increased by 136% and the systolic blood pressure by 37% (mean values). During initial moderate exercise, VMCA increased by 51%; in a following period of maximal physical work, VMCA decreased again by 20% in 9 of 10 volunteers although the heart rate continued to increase by 10% and the systolic blood pressure by 5% (mean values). Constriction of the MCA may explain the initial increase of VMCA, suggesting a role for large cerebral arteries in autoregulation. Our data indicate that the subsequent decrease of VMCA is caused by arteriolar constriction, a likely cause of which was hyperventilation during the excessive work period.