Grip strength, why and how ?

Handgrip strength is a simple, low-cost, and quick-to-measure biomarker of musculoskeletal health and functional performance. Measured with a dynamometer using standardized protocols, it reflects overall strength well and is an important component of sarcopenia screening. Beyond muscle, low handgrip strength predicts major outcomes: all-cause mortality, cardiovascular and respiratory incidence and mortality, certain cancers, functional decline, cognitive decline, and depressive symptoms, with strong evidence from large cohorts and European studies. Its added value is twofold: it improves risk stratification in clinical and public health contexts, and it can be modified through resistance training and physical activity.

Despite its utility, handgrip strength remains underused. The main reasons lie in the heterogeneity of measurements and cut-offs. Analyses recommend standardizing equipment and protocol (position, hand, trials, best score) to ensure comparability.

In practice, systematically integrating handgrip strength into clinical assessments enables early detection of muscle weakness and frailty and guides referral to targeted exercise programs. It also allows tracking changes in performance and response to intervention. At the interface of health and performance, this simple measure provides an actionable indicator linking muscle, inflammation, and functional capacity, justifying broader adoption in clinical and epidemiological settings.

What is handgrip strength?

Let’s start by clearly defining handgrip strength. It is the maximal voluntary force exerted by the hand during an isometric grip contraction on a dynamometer. It is a simple, non-invasive indicator of overall muscle strength and physical capacity, with strong predictive power for health and longevity. Studies involving large cohorts and meta-analyses show that higher handgrip strength is associated with lower mortality, less cardiovascular and metabolic morbidity, and better functional capacity1-5.

How is handgrip strength measured?

Procedure and best practices

  • Equipment: A dynamometer is used to measure grip force. The Jamar dynamometer is frequently used; its use is well documented with excellent validity and inter-instrument reliability6. Other devices are also available, some with more advanced features allowing measurement of the rate of force development.
  • Standardized position and protocol6,7:
    1. Person seated on a standard chair, feet flat; use the same chair/height for subsequent tests.
    2. Shoulders in neutral adduction, elbow flexed at 90°, forearm in neutral; wrist between 0–30° extension and 0–15° ulnar deviation.
    3. Hand on the handle (thumb on one side, four fingers on the other), typically handle setting 2 on the Jamar; adjust for very small hands.
    4. Support only the weight of the dynamometer without constraining movement; do not rest the forearm.
    5. Standardized instructions without visual feedback (cover the dial): “Are you ready? Squeeze as hard as you can.” Provide consistent verbal encouragement, then “Release” as soon as the needle stops rising (3–6 s contraction; exhale during the effort) or when the digital indicator confirms the value.
    6. Three trials per hand, alternating sides, with at least 60 s rest between trials/hands.
    7. Record to the nearest 1 kg; note handedness (right/left/ambidextrous).
    8. Use the highest value for statistical analysis; a single trial may suffice if time-constrained, but three trials increase reliability6,8.

Considerations

  • Dominance: the dominant hand is often ~10% stronger (but not always in left-handers)9.
  • Long fingernails can reduce the measurement, especially on Jamar position 110.
  • Posture/angles affect values; hence the importance of strict standardization6,11,12.
  • Interval and timing: allow ≥1 min between trials; avoid back-to-back measures without rest13. There is slight circadian variation14.

How to interpret the results?

Interpretation initially relies on the maximal force generated by the dominant hand or on the sum of the best result from each hand. Values can be expressed in kilograms or Newtons, relative to body weight, lean mass, height, or BMI.

However, associations with mortality, cardiovascular disease, and cancers do not change meaningfully when expressing grip strength relative to height, weight, BMI, lean mass, or as z-scores. The improvement in predictive performance for these conditions is negligible3,15.

The handgrip strength z-score is a standardized measure that expresses how far an individual’s strength deviates from the reference mean for their age and sex, in units of standard deviation. By enabling fair comparisons across individuals and groups, the z-score facilitates identification of strength deficits, longitudinal tracking, and the integration of grip strength as a biomarker of overall health and prognosis4,16,17.

Regarding norms, the PURE study4 established reference ranges across 21 countries (n=125,462), showing marked differences by region, age, and sex in Europe/North America. Typical median values are ~28–30 kg in women and ~45–50 kg in men around ages 35–40, with age-related decline thereafter. Comparing results to these large cohorts helps contextualize findings against extensive datasets.

Sarcopenia and handgrip strength

Sarcopenia is a geriatric syndrome characterized by reduced muscle strength and muscle mass/quality, leading to decreased physical performance and increased risk of falls, frailty, morbidity, and mortality.

Sarcopenia can be linked to threshold values. In this context, grip strength thresholds help identify the functional effects of muscle mass loss. Commonly used thresholds are <27 kg in men and <16 kg in women18. For follow-up, a change of about 5–6 kg is generally considered clinically meaningful at the individual level, indicating a substantial decline in muscle strength6,19.

Mortality, morbidity, and handgrip strength

Low handgrip strength is consistently linked to greater risk of all-cause mortality and increased vulnerability to disease. Studies show that grip strength predicts cardiovascular mortality and, more variably, cancer mortality, independently of factors such as age, sex, BMI, or socioeconomic status. For example, large cohorts like PURE have shown that each 5 kg reduction in grip strength is associated with increased mortality risk4. Similarly, in UK Biobank, lower strength is associated with higher risk of all-cause mortality and cardiovascular events1. The clinical utility of handgrip strength lies in its ability to quickly and non-invasively identify individuals at risk of disease or frailty, making it a useful tool for assessing overall health2,4.

Cognition, mental health, and handgrip strength

Higher handgrip strength is associated with better overall cognitive performance across several domains (attention, language, memory) and a lower risk of cognitive decline. In NHANES 2011–2014, participants with the highest handgrip strength had significantly lower risks of poor overall performance, attention, language, and delayed memory20. Longitudinal meta-analyses confirm that lower handgrip strength predicts greater cognitive decline and dementia21. Plausible shared pathways include neuroinflammation, oxidative stress, and neuroplasticity20,21.

Depression and handgrip strength

Lower handgrip strength is associated with more depressive symptoms in middle-aged and older adults. The association is inverse and robust in the general population and among people with metabolic diseases (diabetes, obesity)22. In the SHARE study, being in the highest strength tertile was linked to about 41–42% lower depression risk among people without disease or with metabolic diseases22.

Muscle weakness and sarcopenia are accompanied by inflammation (IL-6, TNF-α) and reduced myokines (molecules produced by muscle activity) involved in neuroplasticity. It is plausible that a drop in strength is caused by a progressive or sudden decrease in physical activity, thereby reducing the collateral mental health benefits of exercise.

Practical recommendations

  • Standardize device and protocol; train assessors; record handedness, handle position, and conditions (time of day, posture).
  • Use 3 trials per hand and retain the best; allow ≥1 min rest; avoid visual feedback.
  • Interpret in kg, comparing to age/sex references; in research or follow-up, supplement with z-scores and relative indicators if needed.
  • Integrate handgrip strength into assessments of sarcopenia, frailty, and cardiovascular risk; pair with lower-limb and performance tests.

Measuring handgrip strength helps guide and individualize interventions aimed at improving a person’s overall health. Its simplicity, safety, and ease of interpretation make it a tool of choice for interventions targeting healthier lifestyles and better health.

References

  1. Celis-Morales, C.A., et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants. BMJ, k1651 (2018).
  2. Cooper, R., et al. Between-study differences in grip strength: a comparison of Norwegian and Russian adults aged 40–69 years. Journal of Cachexia, Sarcopenia and Muscle 12, 2091–2100 (2021).
  3. Ho, F.K.W., et al. The association of grip strength with health outcomes does not differ if grip strength is used in absolute or relative terms: a prospective cohort study. Age and Ageing 48, 684–691 (2019).
  4. Leong, D.P., et al. Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: a prospective urban rural epidemiologic (PURE) study. Journal of Cachexia, Sarcopenia and Muscle 7, 535–546 (2016).
  5. Strand, B.H., et al. The association of grip strength from midlife onwards with all-cause and cause-specific mortality over 17 years of follow-up in the Tromsø Study. Journal of Epidemiology and Community Health 70, 1214–1221 (2016).
  6. Roberts, H.C., et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and Ageing 40, 423–429 (2011).
  7. Wilkinson, T.J., et al. A Systematic Review of Handgrip Strength Measurement in Clinical and Epidemiological Studies of Kidney Disease: Toward a Standardized Approach. Journal of Renal Nutrition 32, 371–381 (2022).
  8. Coldham, F., Lewis, J. & Lee, H. The reliability of one vs. three grip trials in symptomatic and asymptomatic subjects. Journal of Hand Therapy 19, 318–327 (2006).
  9. Bohannon, R.W. Grip strength: a summary of studies comparing dominant and nondominant limb measurements. Perceptual and motor skills 96, 728–730 (2003).
  10. Jansen, C.W.S., Patterson, R. & Viegas, S.F. Effects of fingernail length on finger and hand performance. Journal of Hand Therapy 13, 211–217 (2000).
  11. Richards, L.G., Olson, B. & Palmiter-Thomas, P. How forearm position affects grip strength. The American Journal of Occupational Therapy 50, 133–138 (1996).
  12. Su, C.-Y., Lin, J.-H., Chien, T.-H., Cheng, K.-F. & Sung, Y.-T. Grip strength in different positions of elbow and shoulder. Archives of physical medicine and rehabilitation 75, 812–815 (1994).
  13. Watanabe, T., et al. The short-term reliability of grip strength measurement and the effects of posture and grip span. The Journal of hand surgery 30, 603–609 (2005).
  14. Jasper, I., Häußler, A., Baur, B., Marquardt, C. & Hermsdörfer, J. Circadian variations in the kinematics of handwriting and grip strength. Chronobiology international 26, 576–594 (2009).
  15. Parra‐Soto, S., Pell, J.P., Celis‐Morales, C. & Ho, F.K. Absolute and relative grip strength as predictors of cancer: prospective cohort study of 445552 participants in UK Biobank. Journal of Cachexia, Sarcopenia and Muscle 13, 325–332 (2022).
  16. Dodds, R.M., et al. Global variation in grip strength: a systematic review and meta-analysis of normative data. Age and Ageing 45, 209–216 (2016).
  17. Huemer, M.-T., et al. Grip strength values and cut-off points based on over 200,000 adults of the German National Cohort – a comparison to the EWGSOP2 cut-off points. Age and Ageing 52(2023).
  18. Cruz-Jentoft, A.J., et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing 48, 16–31 (2019).
  19. Nitschke, J.E., McMeeken, J.M., Burry, H.C. & Matyas, T.A. When is a change a genuine change?: a clinically meaningful interpretation of grip strength measurements in healthy and disabled women. Journal of Hand Therapy 12, 25–30 (1999).
  20. Yang, J., et al. Association Between Grip Strength and Cognitive Function in US Older Adults of NHANES 2011–2014. Journal of Alzheimer’s Disease 89, 427–436 (2022).
  21. Cui, M., Zhang, S., Liu, Y., Gang, X. & Wang, G. Grip Strength and the Risk of Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis of Longitudinal Cohort Studies. Frontiers in Aging Neuroscience 13(2021).
  22. Marconcin, P., et al. The Association of Grip Strength with Depressive Symptoms among Middle-Aged and Older Adults with Different Chronic Diseases. International journal of environmental research and public health 17, 6942 (2020).