Hand Grip Strength – The Vitality Meter

How Hand Grip Strength Predicts Your Quality of Life

Think how much you rely on a strong grip every day. It helps you open doors, open a can or a jar, carry a water bottle, hold a steering wheel, carry shopping bags or pick up a grandchild. These seemingly simple tasks all require grip strength.

Your ability to grab, hold, twist, and squeeze is essential for many everyday functions, but have you ever stopped to wonder how yours measures up? Until you begin to lose strength in your hands, you probably never really think about how important your grip strength is and how it relates to your overall health.

Handgrip strength (HGS) is a simple and reliable measurement of maximum voluntary muscle strength. It can predict not only muscle mass and physical activity, but also the incidence of chronic diseases, nutritional status, quality of life, independence of daily life, length of hospital stay, and even mortality.

Muscle weakness, often indicated by low grip strength, is an important indicator of poor muscle function and one of the key criteria for Sarcopenia. Sarcopenia is a progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes including falls, functional decline, frailty, and mortality.

Reduction of muscle mass and strength, is considered one of the most important components in the causal pathway, leading to frailty and disability. As a consequence, many patients at an early stage of sarcopenia are undetected. This is a major problem, because there is strong evidence that sarcopenia is a reversible cause of disability. Diagnosis, treatment, and prevention of sarcopenia MUST be a part of routine clinical practice.

Muscle mass and muscle strength changes dynamically with factors such as physical activity, disease, and ageing. According to the latest epidemiological surveys, the prevalence of sarcopenia caused by population ageing is increasing every year, and the decline in muscle mass leads to serious disability and mortality. 

How Good is Your Grip on Your Health?

Screening of sarcopenia can be performed by using a simple, rapid, non-invasive method. The HGS is measured easily by a hand-held dynamometer (HHD). It is a handheld device you squeeze as hard as you can. The HHD produces a measure of isometric strength that allows identifying not only muscle weakness of the upper limb but also how strong the rest of your body is.

Normative values for hand grip strength can vary based on age, gender, and population. Generally, grip strength tends to peak in the third decade of life and gradually declines with age. Below are some approximate norms for men and women over 50 years of age:

Men: 

• 50-59 years: 38-52 kg
• 60-69 years: 34-48 kg
• 70-79 years: 29-43 kg

Women:

• 50-59 years: 20-34 kg
• 60-69 years: 18-32 kg
• 70-79 years: 16-29 kg

Men aged 20-30 typically have the greatest strength, while women over 75 have the lowest.

Muscle Weakness is the ‘New Smoking’

It turns out, your grip strength — the amount of force you have when you clench your hand around an object — is a huge indication of your overall health. Grip strength and single leg balance are two of four markers for physical strength. The other factors are sit-stand test and walking pace.

Handgrip strength acts as a biomarker for general health because of its relationship with so many other health-related variables, including bone-mineral density, nutrition status, cognitive impairment, sleep disturbances and quality of life.

Those momentary losses of balance that we all experience are more likely to turn into a fall if you have weaker hands and arms. Or a weaker grip might preclude being able to assist getting up or down from sitting without straining or stumbling. Or from preventing an object you were holding from dropping onto your foot. Or more.

Your grip strength is essentially an indication of your overall health and longevity. In a way, your grip strength can almost predict your future health.

An Important Biomarker of Disease and Ageing

Research continues to link a decline in grip strength to a range of adverse health issues, including: heart disease. arthritis, osteoporosis, Type 2 diabetes, and mental health problems.

Previous studies have shown that chronic inflammation in aging — known as “inflammaging” – is a significant risk factor for mortality among older adults. This inflammation is also associated with lower grip strength and may be a significant predictor on the pathway between lower grip strength and both disability and chronic disease multimorbidity.

A strong or weak hand grip carries more than just social cues. It may also help measure an individual’s risk for having a heart attack or stroke, or dying from cardiovascular disease. 

Using data from nearly 5,000 people enrolled in the UK Biobank study, the team found that people with low grip strength had weaker hearts that were less able to pump blood around the body. Low hand grip strength was also associated with having enlarged, damaged hearts. Participants in the study underwent heart scans that allowed the researchers to precisely work out the volume of blood that was pumped by their heart with every heartbeat.

They found that better hand grip strength was linked to higher volumes and proportions of blood being pumped by the heart and healthier heart muscle – which is associated with a lower risk of cardiovascular events like heart attacks and strokes.

A 2015 study, monitoring nearly 140,000 older adults in 17 countries following their health over four years, found that a frail grip was related to higher incidences of heart attack, stroke, cardiovascular disease and even death. In fact, it predicted the risk of an early death more effectively than blood pressure. 

Researchers at Michigan Medicine modelled the relationship between biological age and grip strength of 1,274 middle aged and older adults using three “age acceleration clocks” based on DNA methylation, a process that provides a molecular biomarker and estimator of the pace of ageing. The clocks were originally modelled from various studies examining diabetes, cardiovascular disease, cancer, physical disability, Alzheimer’s disease, inflammation and early mortality.

Results revealed that both older men and women showed an association between lower grip strength and biological age acceleration across the DNA methylation clocks.

As skeletal muscle is the largest insulin-sensitive tissue in the body, low muscle mass in sarcopenia likely results in reduced capacity for glucose disposal. Age-related declines in muscle quality, including increased mitochondrial dysfunction and fat infiltration, are also implicated in skeletal muscle inflammation and subsequent insulin resistance.

Studies have shown that low muscle mass and strength are associated with increased risk of incident type 2 diabetes. Prevalent type 2 diabetes also appears to exacerbate progression of sarcopenia in older adults.

A meta-analysis found that upper limb muscle weakness (primarily measured by handgrip strength (HGS)) was associated with 53% higher risk for falls.

Hip fracture is a major health problem associated with high mortality, morbidity, and cost. A study followed up 10,092 participants (4471 men and 5621 women) for a period of 4 years, demonstrated a significant association between HGS and the risk of hip fracture and falls in both males and females aged 45  years and above. HGS was significantly lower in individuals who experienced hip fractures.

Immune dysfunction and chronic inflammation are combined risk factors for sarcopenia and decreased muscle strength. A lowered muscle mass means your body loses some of its ability to mount a response to the viruses and bacteria that get you sick. Research shows that poor grip strength is an indication of a weaker immune system, which can leave you more vulnerable to getting sick. A weaker grip strength can be a sign that you are more prone to infectious diseases, like COVID-19, RSV or the flu.

Grip strength also may predict your future loss of mobility. A 2014 study analysed data from more than 20,000 adults ages 65 and older to evaluate the link between weak grip strength and lack of mobility, in this case slow walking speed. Among the men in the group, those with a weak grip—less than 26 kg were seven times more likely to be facing mobility issues compared with men who had normal grip strength.

Considerable research notes a link between grip strength with cognition, depression, and sleep as well.

Grip strength is a predictor of numerous future outcomes. Mortality is probably the most widely studied outcome, with studies published as far back as the 1980s and at least 3 meta-analyses supporting the association of weak grip strength with all-cause mortality in the general population. 

References:

1. Mark D. Peterson, Stacey Collins, Helen C.S. Meier, Alexander Brahmsteadt, Jessica D. Faul. Grip strength is inversely associated with DNA methylation age acceleration. Journal of Cachexia, Sarcopenia and Muscle, 2022; DOI: 
2. Raju Vaishya, Anoop Misra, Abhishek Vaish, Nicola Ursino & Riccardo D’Ambrosi , Hand grip strength as a proposed new vital sign of health: a narrative review of evidences, Journal of Health, Population and Nutrition volume 43, Article number: 7 (2024)
3. Research paper: ‘Prospective association between handgrip strength and cardiac structure and function in UK adults’ by Beyer et al. doi 1371/journal.pone.0193124
4. Bohannon RW. Are hand-grip and knee extension strength reflective of a common construct? Percept Mot Skills. 2012;114(2):514–518. doi: 10.2466/03.26.PMS.114.2.514-518.David Scott, Barbora de Courten and Peter R Ebeling, Sarcopenia: a potential cause and consequence of type 2 diabetes in Australia’s ageing population?, Med J Aust 2016; 205 (7): 329-333. || doi: 10.5694/mja16.00446 , Published online: 3 October 2016
5. Moreland JD, Richardson JA, Goldsmith CH, Clase CM. Muscle weakness and falls in older adults:a systematic review and meta-analysis. J Am Geriatr Soc. 2004;52(7):1121–1129. 
6. Faulkner J.A., Larkin L.M., Claflin D.R., Brooks S.V. Age-related changes in the structure and function of skeletal muscles. Clin. Exp. Pharmacol. Physiol. 2007;34:1091–1096. doi: 10.1111/j.1440-1681.2007.04752.x.
7. Cruz-Jentoft A.J., Sayer A.A. Sarcopenia. Lancet. 2019;393:2636–2646. doi: 10.1016/S0140-6736(19)31138-9
8. Tianting Guo, et al., Association of Handgrip Strength with Hip Fracture and Falls in Community‐dwelling Middle‐aged and Older Adults: A 4‐Year Longitudinal Study 
9. Kobayashi-Cuya KE, Sakurai R, Suzuki H, Ogawa S, Takebayashi T, Fujiwara Y. Observational evidence of the association between handgrip strength, hand dexterity, and cognitive performance in community-dwelling older adults: a systematic review. J Epidemiol. 2018; 28(9):373–381. doi: 10.2188/jea.JE20170041
10. Lee M-R, Jung SM, Bang H, Kim HS, Kim YB. Association between muscle strength and type 2 diabetes mellitus in adults in Korea: data from Korea national health and nutrition examination survey (KNHANES) VI. Medicine. 2018;97(23):e10984. doi: 10.1097/MD.0000000000010984

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