Introduction: The neural circuitry controlling the cardiovascular response to exercise, ‘central command’, has been sought for a century. The anterior cingulate cortex (ACC) stands at the intersection of cognition, arousal, autonomic and motor control and has been implicated as a component in the central command network indirectly by non-invasive neuro-imaging studies. However it has never been possible to verify this by physiological interrogation of ACC neural activity. This is the first study to directly evaluate ACC electrical activity during the cardiovascular response to exercise. Method: Local field potentials (LFPs) were recorded from the ACC via externalized deep brain electrodes in patients with chronic pain syndromes during performance of a task designed to dissociate exercise from peripheral feedback mechanisms. Patients sat upright at rest for three minutes followed by performance of exercise for two minutes entailing bicep curls against a 2kg wrist weight. In anticipation of exercise, a ten second countdown was performed. A 3-lead electrocardiogram recorded heart rate. Six trials were completed. LFP power spectral density was derived by Fast Fourier Transform and compared between Rest and Anticipation using paired samples Student’s t-tests within the following frequency bands: 4-8Hz, 8-12Hz, 12-25Hz, 25-60Hz and 60-90Hz. Results: Recordings from six ACCs were performed in four patients, yielding 102 channels of LFP data from 36 trials. Heart rate increased significantly between Rest and Anticipation (p=0.002), and Rest and Exercise (p=0.014). LFP power spectral density increased significantly between Rest and Anticipation in the 25-60Hz band (mean 62.7µV2/Hz +SE 4.9 versus 76.0µV2/Hz +7.24, p=0.004). Conclusions: The electrical activity of the ACC changed in anticipation of exercise compared to rest, coincident with changing cardiovascular activity. This occurred in the 25-60Hz band. Therefore this study provides the first direct electrophysiological evidence in humans of ACC activation during the cardiovascular response to exercise.