Exercise performance of subjects with ankylosing spondylitis and limited chest expansion

To examine the mechanism of exercise limitation associated with chest wall restriction (CWR), we compared the ramp (1 W/3 s) exercise performance of six untrained subjects with ankylosing spondylitis (AS) and six healthy subjects matched for age and body size. Subjects with AS had CWR (maximum rib cage expansion : 1.4 +/- 0.2 cm; means +/- sem). The maximum oxygen uptake (VO2max) of AS subjects (2.15 +/- 0.2 1-stpd) was less than their predicted VO2max (2.68 +/- 0.13 1-stpd; p less than 0.03) and the measured VO2max of matched healthy subjects (2.78 +/- 0.22 1-stpd; p less than 0.03). Subjects with AS achieved 95 percent of predicted maximum heart rate, and their maximum voluntary ventilation exceeded their maximum exercise ventilation by at least 15 l X min-1 unless parenchymal pulmonary disease was present. We conclude that maximum ramp exercise performance of AS subjects with CWR is decreased. Deconditioning or cardiovascular impairment rather than ventilatory impairment appears responsible for the observed reduction of VO2max.