Skip to main content
SpringerLink
Log in

The association between physical activity, sleep, and quality of life in patients in bio-chemical remission from Cushing’s syndrome

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Cushing’s syndrome can negatively affect patient’s quality of life (QoL) after treatment and remission. Exposure to increased cortisol over time can result in visceral obesity, which makes this population vulnerable to cardiovascular risk factors associated with visceral obesity. Sleep disturbances are present in patients in remission from Cushing’s syndrome, impacting QoL. Moderate intensity physical activity performed 3 times a week decreases visceral obesity and improves sleep quality, therefore, engaging in physical activity after remission may improve patient’s QoL. The current study aims to explore the association between sleep quality, physical activity, and QoL in patients in remission of Cushing’s syndrome.

Methods

Patients in bio-chemical remission from Cushing’s syndrome (N = 147) were recruited through the Cushing’s Support and Research Foundation. Quality of life was assessed using the Cushing Quality of Life Questionnaire (CushingQoL), sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), and physical activity levels were assessed with the Godin-Sheppard Leisure-Time Physical Activity Questionnaire (GSLTPAQ).

Results

Sleep quality was significantly associated with both subscales of the CushingQoL (both p < .001), but physical activity was not significantly associated with either subscale. Sleep was not significantly associated with physical activity engagement in this sample.

Conclusion

Results suggest that patients in remission from Cushing’s syndrome experience sleep disturbances that are significantly associated with impaired QoL. Future research should focus on ameliorating the persisting clinical features of Cushing’s syndrome that are associated with impaired QoL after bio-chemical remission to improve QoL and expedite complete functional remission.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boscaro, M., Barzon, L., Fallo, F., & Sonino, S. (2001). Cushing’s Syndrome. Lancet,357, 783–791. https://doi.org/10.1016/S0140-6736(00)04172-6.

    Article  CAS  PubMed  Google Scholar 

  2. Valassi, E., Crespo, I., Santos, A., & Webb, S. M. (2012). Clinical consequences of Cushing’s syndrome. Pituitary,15, 319–329. https://doi.org/10.1007/s11102-012-0394-8.

    Article  PubMed  Google Scholar 

  3. Newell-Price, J., Bertagna, X., Grossman, A. B., & Nieman, L. K. (2006). Cushing’s syndrome. Lancet,367, 1605–1617. https://doi.org/10.1016/S0140-6736(06)68699-6.

    Article  CAS  PubMed  Google Scholar 

  4. van Aken, M. O., Pereira, A. M., Biermasz, N. R., van Thiel, S. W., Hoftijzer, H. C., Smit, J. W. A., et al. (2005). Quality of life in patients after long-term biochemical cure of Cushing’s disease. The Journal of Clinical Endocrinology & Metabolism,90(6), 3279–3286. https://doi.org/10.1210/jc.2004-1375.

    Article  CAS  Google Scholar 

  5. Lindsay, J. R., Nansel, T., Baid, S., Gumowski, J., & Nieman, L. K. (2006). Long-term impaired quality of life in Cushing’s syndrome despite initial improvement after surgical remission. The Journal of Clinical Endocrinology & Metabolism,91(2), 447–453. https://doi.org/10.1210/jc.2005-1058.

    Article  CAS  Google Scholar 

  6. Sonino, N., Bonnini, S., Fallo, F., Boscaro, M., & Fava, G. A. (2006). Personality characteristics and quality of life in patients treated for Cushing’s syndrome. Clinical Endocrinology,64(3), 314–318. https://doi.org/10.1111/j.1365-2265.2006.02462.x.

    Article  PubMed  Google Scholar 

  7. Colao, A., Pivonello, R., Spiezia, S., Faggiano, A., Ferone, D., & Filippella, M. (1999). Persistence of increased cardiovascular risk in patients with Cushing's disease after five years of successful cure. The Journal of Clinical Endocrinology and Metabolism,84, 2664–2672. https://doi.org/10.1210/jcem.84.8.5896.

    Article  CAS  PubMed  Google Scholar 

  8. Forget, H., Lacroix, A., & Cohen, H. (2002). Persistent cognitive impairment following surgical treatment of Cushing’s syndrome. Psychoneuroendocrinology,27, 376–382. https://doi.org/10.1016/S0306-4530(01)00059-2.

    Article  Google Scholar 

  9. Czepielewski, M. A., Rollin, G. A., Casagrande, A., & Ferreira, N. P. (2007). Criteria of cure and remission in Cushing’s disease: An update. Arquivos Brasileiros de Endocrinologia & Metabologia,51(8), 1362–1372. https://doi.org/10.1590/S0004-27302007000800023.

    Article  Google Scholar 

  10. Webb, S. M., Crespo, I., Santos, A., Resmini, E., Aulinas, A., & Valassi, E. (2017). Quality of life tools for the management of pituitary disease. European Journal of Endocrinology,177, R13–26. https://doi.org/10.1530/EJE-17-0041.

    Article  CAS  PubMed  Google Scholar 

  11. Hays, R. D. (2008). Reeve B (2010) Measurement and modeling of health-related quality of life. In K. Heggenhougen & S. Quah (Eds.), International encyclopedia of public health (Vol. 4, pp. 241–252). San Diego: Academic Press.

    Chapter  Google Scholar 

  12. Pivonello, R., Faggiano, A., Lombardi, G., & Colao, A. (2005). The metabolic syndrome and cardiovascular risk in Cushing’s syndrome. Endocrinology and Metabolism Clinics of North America,34(2), 327–339. https://doi.org/10.1016/j.ecl.2005.01.010.

    Article  CAS  PubMed  Google Scholar 

  13. Resmini, E., Minuto, F., Colao, A., & Ferone, D. (2009). Secondary diabetes associated with principal endocrinopathies: The impact of new treatment modalities. Acta Diabetologica,46(2), 85–95. https://doi.org/10.1007/s00592-009-0112-9.

    Article  CAS  PubMed  Google Scholar 

  14. Shipley, J. E., Schteingart, D. E., Tandon, R., & Starkman, M. N. (1992). Sleep architecture and sleep apnea in patients with Cushing’s disease. Sleep,15(6), 514–518. https://doi.org/10.1093/sleep/15.6.514.

    Article  CAS  PubMed  Google Scholar 

  15. Lipsky, R. H., & Marini, A. M. (2007). Brain-derived neurotrophic factor in neuronal survival and behavior-related plasticity. Annals of the New York Academy of Sciences,1122(1), 130–143. https://doi.org/10.1196/annals.1403.009.

    Article  CAS  PubMed  Google Scholar 

  16. Huang, E. J., & Reichardt, L. F. (2001). Neurotrophins: Roles in neuronal development and function. Annual Review of Neuroscience,24(1), 677–736. https://doi.org/10.1146/annurev.neuro.24.1.677.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bourdeau, I., Bard, C., Noël, B., Leclerc, I., Cordeau, M. P., Bélair, M., et al. (2002). Loss of brain volume in endogenous Cushing’s syndrome and its reversibility after correction of hypercortisolism. The Journal of Clinical Endocrinology & Metabolism,87(5), 1949–1954. https://doi.org/10.1210/jcem.87.5.8493.

    Article  CAS  Google Scholar 

  18. Giese, M., Unternährer, E., Hüttig, H., Beck, J., Brand, S., Calabrese, P., et al. (2014). BDNF: An indicator of insomnia? Molecular Psychiatry,19(2), 151–152. https://doi.org/10.1038/mp.2013.10.

    Article  CAS  PubMed  Google Scholar 

  19. Pires, P., Santos, A., Vives-Gilabert, Y., Webb, S. M., Sainz-Ruiz, A., Resmini, E., et al. (2017). White matter involvement on DTI-MRI in Cushing’s syndrome relates to mood disturbances and processing speed: A case-control study. Pituitary,20(3), 340–348. https://doi.org/10.1007/s11102-017-0793-y.

    Article  PubMed  Google Scholar 

  20. Valassi, E., Crespo, I., Keevil, B. G., Aulinas, A., Urgell, E., Santos, A., et al. (2017). Affective alterations in patients with Cushing’s syndrome in remission are associated with decreased BDNF and cortisone levels. European Journal of Endocrinology,176(2), 221–231. https://doi.org/10.1530/EJE-16-0779.

    Article  CAS  PubMed  Google Scholar 

  21. Martinez-Momblan, M. A., Gomez, C., Santos, A., Porta, N., Esteve, J., Ubeda, I., et al. (2015). A specific nursing educational program in patients with Cushing’s syndrome. Endocrine,53(1), 199–209. https://doi.org/10.1007/s12020-015-0737-0.

    Article  CAS  PubMed  Google Scholar 

  22. van der Klaauw, A. A., Kars, M., Biermasz, N. R., Roelfsema, F., Dekkers, O. M., Corssmit, E. P., et al. (2008). Disease-specific impairments in quality of life during long-term follow up of patients with different pituitary adenomas. Clinical Endocrinology,69, 775–784. https://doi.org/10.1111/j.1365-2265.2008.03288.x.

    Article  PubMed  Google Scholar 

  23. Biermasz, N. R., Joustra, S. D., Donga, E., Pereira, A. M., van Duinen, N., van Dijk, M., et al. (2011). Patients previously treated for nonfunctioning pituitary macroadenomas have disturbed sleep characteristics, circadian movement rhythm and subjective sleep quality. Journal of Clinical Endocrinology and Metabolism,96, 1524–1532. https://doi.org/10.1111/j.1365-2265.2008.03288.x.

    Article  CAS  PubMed  Google Scholar 

  24. Xiao, Q., Keadle, S. K., Hollenbeck, A. R., & Matthews, C. E. (2014). Sleep duration and total and cause-specific mortality in a large US cohort: Interrelationships with physical activity, sedentary behavior, and body mass index. American Journal of Epidemiology,15, 997–1006. https://doi.org/10.1093/aje/kwu222.

    Article  Google Scholar 

  25. Holfeld, B., & Ruthig, J. C. (2014). A longitudinal examination of sleep quality and physical activity in older adults. Journal of Applied Gerontology,33, 791–807. https://doi.org/10.1177/0733464812455097.

    Article  PubMed  Google Scholar 

  26. Reid, K. J., Baron, K. G., Lu, B., Naylor, E., Wolfe, L., & Zee, P. C. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep medicine,11(9), 934–940. https://doi.org/10.1016/j.sleep.2010.04.014.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Martin, C. K., Church, T. S., Thompson, A. M., Earnest, C. P., & Blair, S. N. (2009). Exercise dose and quality of life. Archives of Internal Medicine,169(3), 269. https://doi.org/10.1001/archinternmed.2008.545.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ohkawara, K., Tanaka, S., Miyachi, M., Ishikawa-Takata, K., & Tabata, I. (2007). A dose–response relation between aerobic exercise and visceral fat reduction: Systematic review of clinical trials. International Journal of Obesity,31(12), 1786–1797. https://doi.org/10.1038/sj.ijo.0803683.

    Article  CAS  PubMed  Google Scholar 

  29. Ballor, D. L., & Keesey, R. E. (1991). A meta-analysis of the factors affceting exercise-induced changes in body mass, fat mass, and fat-free mass in males and females. International Journal of Obesity,15, 717–726.

    CAS  PubMed  Google Scholar 

  30. Wallace, B., & Cumming, R. (2000). Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcified Tissue International,67, 10–18. https://doi.org/10.1007/s00223001089.

    Article  CAS  PubMed  Google Scholar 

  31. Liu, C., Shiroy, D. M., Jones, L. Y., & Clark, D. O. (2014). Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. European Review of Aging and Physical Activity,11, 95–106. https://doi.org/10.1007/s11556-014-0144-1.

    Article  Google Scholar 

  32. Smith, P. J., Blumenthal, J. A., Hoffman, B. M., Cooper, H., Strauman, T. A., Welsh-Bohmer, K., et al. (2010). Aerobic exercise and neurocognitive performance: A meta-analytic review of randomized controlled trials. Psychosomatic Medicine,72(3), 239–252. https://doi.org/10.1097/PSY.0b013e3181d14633.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dunn, A. L., Trivedi, M. H., & ONeal, H. A. (2001). Physical activity dose-response effects on outcomes of depression and anxiety. Medicine & Science in Sports & Exercise,33(6Suppl), S587–S597. https://doi.org/10.1097/00005768-200106001-00027.

    Article  CAS  Google Scholar 

  34. Rao, G. H. (2018). Prevention or reversal of cardiometabolic diseases. Journal of Clinical and Preventive Cardiology,7(1), 22. https://doi.org/10.4103/JCPC.JCPC_41_17.

    Article  Google Scholar 

  35. Zoladz, J. A., Pilc, A., Majerczak, J., Grandys, M., Zapart-Bukowska, J., & Duda, K. (2008). Endurance training increases plasma brain-derived neurotrophic factor concentration in young healthy men. Journal of Physiology and Pharmacology,59(7), 119–132.

    PubMed  Google Scholar 

  36. Seifert, T., Brassard, P., Wissenberg, M., Rasmussen, P., Nordby, P., Stallknecht, B., et al. (2010). Endurance training enhances BDNF release from the human brain. AJP: Regulatory, Integrative and Comparative Physiology,298(2), R372–R377. https://doi.org/10.1152/ajpregu.00525.2009.

    Article  CAS  Google Scholar 

  37. Erickson, K. I., Miller, D. L., & Roecklein, K. A. (2012). The aging hippocampus: Interactions between exercise, depression, and BDNF. The Neuroscientist: A Review Journal Bringing Neurobiology, Neurology and Psychiatry,18(1), 82–97. https://doi.org/10.1177/1073858410397054.

    Article  CAS  Google Scholar 

  38. Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., & Smith, B. K. (2009). Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine & Science in Sports & Exercise,41(2), 459–471. https://doi.org/10.1249/mss.0b013e3181949333.

    Article  Google Scholar 

  39. Webb, S. M., Badia, X., Barahona, M. J., Colao, A., Strasburger, C. J., Tabarin, A., et al. (2008). Evaluation of health-related quality of life in patients with Cushing’s syndrome with a new questionnaire. European Journal of Endocrinology,158(5), 623–630. https://doi.org/10.1530/EJE-07-0762.

    Article  CAS  PubMed  Google Scholar 

  40. Tiemensma, J., Depaoli, S., & Felt, J. M. (2016). Using subscales when scoring the Cushing’s quality of life questionnaire. European Journal of Endocrinology,174(1), 33–40. https://doi.org/10.1530/EJE-15-0640.

    Article  CAS  PubMed  Google Scholar 

  41. Santos, A., Resmini, E., Martínez-Momblán, M. A., Crespo, I., Valassi, E., Roset, M., et al. (2012). Psychometric performance of the CushingQoL questionnaire in conditions of real clinical practice. European Journal of Endocrinology,167(3), 337–342. https://doi.org/10.1530/eje-12-0325.

    Article  CAS  PubMed  Google Scholar 

  42. Godin, G. (2011). The Godin-Shephard Leisure Time Physical Activity Questionnaire. The Health & Fitness Journal of Canada,4(1), 18–22. https://doi.org/10.14288/hfjc.v4i1.82.

    Article  Google Scholar 

  43. Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., et al. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults. Medicine & Science in Sports & Exercise,43(7), 1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb.

    Article  Google Scholar 

  44. Amireault, S., Godin, G., Lacombe, J., & Sabiston, C. M. (2015). Validation of the Godin-Shephard Leisure-Time Physical Activity Questionnaire classification coding system using accelerometer assessment among breast cancer survivors. Journal of Cancer Survivorship,9(3), 532–540. https://doi.org/10.1007/s11764-015-0430-6.

    Article  PubMed  Google Scholar 

  45. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research,28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4.

    Article  CAS  PubMed  Google Scholar 

  46. Backhaus, J., Junghanns, K., Broocks, A., Riemann, D., & Hohagen, F. (2002). Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research,53(3), 737–740. https://doi.org/10.1016/S0022-3999(02)00330-6.

    Article  PubMed  Google Scholar 

  47. Buysse, D. J., Reynolds, C. F., Monk, T. H., Hoch, C. C., Yeager, A. L., & Kupfer, D. J. (1991). Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep,14(4), 331–338. https://doi.org/10.1093/sleep/14.4.331.

    Article  CAS  PubMed  Google Scholar 

  48. Irwin, M. L., Ainsworth, B. E., & Conway, J. M. (2001). Estimation of energy expenditure from physical activity measures: Determinants of accuracy. Obesity Research,9(9), 517–525. https://doi.org/10.1038/oby.2001.68.

    Article  CAS  PubMed  Google Scholar 

  49. Prince, S. A., Adamo, K. B., Hamel, M. E., Hardt, J., Gorber, S. C., & Tremblay, M. (2008). A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. International journal of behavioral nutrition and physical activity,5(1), 56. https://doi.org/10.1186/1479-5868-5-56.

    Article  Google Scholar 

  50. Wagenmakers, M. M., Netea-Maier, R. T., Prins, J., Dekkers, T., Den Heijer, M., & Hermus, A. M. (2012). Impaired quality of life in patients in long-term remission of Cushing’s syndrome of both adrenal and pituitary origin: A remaining effect of long-standing hypercortisolism? European Journal of Endocrinology,167(5), 687–695. https://doi.org/10.1530/EJE-12-0308.

    Article  CAS  PubMed  Google Scholar 

  51. Valassi, E., Santos, A., Yaneva, M., Tóth, M., Strasburger, C., Chanson, P., et al. (2011). The European Registry on Cushing’s syndrome: 2-year experience Baseline demographic and clinical characteristics. European Journal of Endocrinology,165(3), 383–392. https://doi.org/10.1530/EJE-11-0272.

    Article  CAS  PubMed  Google Scholar 

  52. United States Center for Disease Control. (2005). Morbidity and mortality weekly report: MMWR. Morbidity and mortality weekly report (Vol. 54). U.S. Dept. of Health, Education, and Welfare, Public Health Service, Center for Disease Control. Retrieved November 11, 2017 from https://www.cdc.gov/mmwr/index.html.

  53. Jabonwska-Lietz, B., Wrzosek, M., Wodarczyk, M., & Nowicka, G. (2017). New indexes of body fat distribution, visceral adiposity index, body adiposity index, waist-to-height ratio, and metabolic disturbances in the obese. Kardiologia Polska,759110, 1185–1191. https://doi.org/10.5603/KP.a2017.0149.

    Article  Google Scholar 

  54. Sallis, J. F., & Saelens, B. E. (2005). Assessment of physical activity by self-report: Status, limitations, and future directions. Research Quarterly for Exercise and Sport,71(sup2), 1–14. https://doi.org/10.1080/02701367.2000.11082780.

    Article  Google Scholar 

  55. Adams, S. A., Matthews, C. E., Ebbeling, C. B., Moore, C. G., Cunningham, J. E., Fulton, J., et al. (2005). The effect of social desirability and social approval on self-reports of physical activity. American Journal of Epidemiology,161(4), 389–398. https://doi.org/10.1093/aje/kwi054.

    Article  PubMed  Google Scholar 

  56. Barreto, P., Ferrandez, A., & Saliba-Serre, B. (2013). Are older adults who volunteer to participate in an exercise study fitter and healthier than non-volunteers? The participation bias of the study population. Journal of Physical Activity and Health,10(3), 359–367. https://doi.org/10.1123/jpah.10.3.359.

    Article  Google Scholar 

  57. D'Angelo, V., Beccuti, G., Berardelli, R., Karamouzis, I., Zichi, C., Giordano, R., et al. (2015). Cushing’s syndrome is associated with sleep alterations detected by wrist actigraphy. Pituitary,18(6), 893–897. https://doi.org/10.1007/s11102-015-0667-0.

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Psychological Sciences, University of California, Merced, CA, USA

    Susette A. Moyers

  2. Department of Anesthesiology, Center for Pain Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

    Jitske Tiemensma

Authors
  1. Susette A. Moyers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jitske Tiemensma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jitske Tiemensma.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Ethical approval

This research was approved by the institutional review board at University of California, Merced. IRB #: UCM15-0027.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moyers, S.A., Tiemensma, J. The association between physical activity, sleep, and quality of life in patients in bio-chemical remission from Cushing’s syndrome. Qual Life Res 29, 2089–2100 (2020). https://doi.org/10.1007/s11136-020-02480-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-020-02480-y

Keywords

Search

Navigation