Cushing Syndrome

Overview of Cushing Syndrome

This condition results from excessive levels of cortisol, usually due to adrenocortical tumors or high doses of hydrocortisone or cortisol-derivative drugs. Excessive cortisol results in numerous physiological responses, which include muscle weakness, bone demineralization, weakening of elastic tissues, hyperglycemia, and obesity. Removal of adrenocortical tumors will reverse this syndrome, but patients who rely on hydrocortisone to control their inflammatory disease processes may be unable to reverse this syndrome completely. Removal of the tumor may affect other pituitary hormones, especially growth hormone.¹ The loss of muscle tissues will greatly affect tolerance for daily activities and lead to deconditioning with impaired endurance.

Comorbidities to Consider

• Excessive cortisol affects the cardiac, renal and endocrine systems and contributes to limited activity tolerance.

Client Examination

Keys to Examination of Clients

• Clients are assessed for levels of cortisol in the urine and blood serum.

• Imaging tests visualize the size and position of an adrenocortical tumor.

• Determine the client's weight and body composition before starting an exercise program.

• Bone mineral density tests are useful for clients who have osteopenia.

Recommended Baseline Testing of Fitness Levels

• Use a walking test for the client's exercise tolerance and aerobic capacity.

• Assess the client's muscle strength for large muscle groups with 1- or 10-repetition maximum testing.

Exercise Prescription

Type: Walking, cycling, aquatic exercise²

Intensity: Moderate intensities, starting at 40%–60% of maximum Vo₂

Duration: 30 minutes

Frequency: Five times per week

Getting Started

Along with a formal exercise program, clients should be encouraged to increase their daily activity level to increase their daily caloric output.³ Clients receiving ongoing treatment should avoid exercises that place increased stresses on the skeletal bone and joint structures or that increase the risk of falling. Clients may try other types of exercise as they develop increased strength and have less body fat. Weight lifting and running and stepping activities should be avoided if the cortisol levels are not controlled. Clients with controlled levels of cortisol can be encouraged to do weight-bearing activities to improve bone mineral densities.² Weight-bearing exercises should begin at low levels, with 15 to 20 repetitions, with caution to not overload joint structures. Clients can slowly increase the duration of their aerobic activities for up to 60 to 90 minutes. Exercise intensities can slowly progress up to 80% of maximum heart as the client improves aerobic capacity and decreases body weight.³ A variety of aerobic and resistive exercises can be combined to optimize the client's physical and mental health.

References