BEFORE AUTOMATED DATABASE SEARCHES: LET’S NOT FORGET THE CLASSICS!!
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Since the late 1960s
automated (computerized) searches of the medical and scientific literature have
become increasingly available, practical, and user friendly. As these systems have
developed, more information is contained in them and the ease of complex
searches has increased. For recent publications, the scientific community has
the output of almost every major journal “at their fingertips” irrespective of
language of publication and country of origin. Medline and related products
have also vastly augmented the capabilities of smaller libraries that do not
possess extensive collections of journals. This trend has been reinforced by
the ability to download many recent key articles in various formats. However,
one key limitation of electronic databases, searches, and article retrieval is
the general absence of papers published before the late 1960s, before the
advent of the early electronic cataloging and retrieval systems. This is especially
true in areas related to physiology in general, and exercise physiology in
specific. Data from a variety of sources that track publication trends indicate
that many integrative (i.e., exercise) physiology articles have cited a
half-life of 10 yrs. This means that the relevance of key findings can remain
high for decades. In this context, in this Exercise and Sport Sciences Reviews
News Brief, four classic papers from the pre–electronic-database era will be
used to demonstrate the continuing relevance of papers that might be seen by
some as historical and to show how these classic papers continue to shape the
debate about a variety of topics in exercise and integrative physiology. There
are continuing interest and controversy about the many factors that govern the
autonomic nervous system during exercise in conscious humans. In the late
1930s, Alam and Smirk (1,2) published two papers on this topic. These papers
demonstrated that a powerful blood-pressure–raising reflex existed in skeletal
muscle and suggested that skeletal muscle afferents that were sensitive to
muscle metabolites could cause profound increases in arterial pressure during
exercise. They also suggested that skeletal muscle afferents affected blood
pressure and not heart rate. The second study also contained a key “experiment
in nature” that was conducted on a patient with a sensory deficit (but normal
motor function) in one leg; this patient showed in the normal leg a sustained
rise in blood pressure during postexercise ischemia that was absent in the
insensitive leg. Although there were many key observations made before World
War II on the autonomic control of the circulation during exercise in both
animals and humans, the mechanisms highlighted in these papers continue to be
explored at a variety of levels in various animal and human models. The second
paper also demonstrates the power of “experiments in nature” that can be
conducted in selected human patients and can provide unique insight into
various physiological mechanisms. By the late 1950s and early 1960s, several
classic studies were performed that attempted to understand better the
interaction of sympathetic vasoconstriction and metabolic vasodilation in
contracting skeletal muscles. In a series of observations in patients with
autonomic dysfunction for a variety of reasons, Marshall, Schirger, and
Shepherd (3) showed that supine or head-down cycle ergometry was associated
with a fall in blood pressure in these patients whose sympathetic nerves could
not “restrain” blood flow to active skeletal muscle. One observation was
particularly startling. It was made in a middle-aged male who had undergone
bilateral thoracolumbar sympathectomies. In this era, there was limited
pharmacologic therapy for high blood pressure, and when blood pressure could
not be controlled and reached life-threatening levels, surgical sympathectomies
were occasionally used as a last resort. This individual’s blood pressure fell
during supine exercise, and when he was placed in a 15° head-down tilt (to
maximize venous return and, hopefully, cardiac output) blood pressure still
fell during exercise. Again, these observations frame the ongoing discussion
and debate about functional sympatholysis and again demonstrate the power of
straightforward and elegant observations in unique patients. The fourth study
highlighted also concerns how the autonomic nervous system functions during
exercise, and focuses on the competition between sympathetic vasoconstriction
BEFORE AUTOMATED DATABASE SEARCHES: LET’S NOT FORGET THE CLASSICS!!
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