Longevity

Grip strength: the ageing marker in your hand

Grip strength is one of the simplest markers of how a body is ageing. In the PURE study of 139,691 adults aged 35 to 70 in 17 countries, every 5 kg less grip strength went with a 16 percent higher risk of death from any cause over a median of 4 years, and grip predicted death better than systolic blood pressure. Grip peaks at about 51 kg in men and 31 kg in women in the thirties and falls from the fifth decade to a median of 39 kg and 24 kg at 70; below 27 kg for men and 16 kg for women, the European sarcopenia definition speaks of low muscle strength, though normal values differ by region.

What a grip test measures

A grip test asks you to squeeze a hand dynamometer as hard as you can and reports the force in kilograms. It takes under 2 minutes, needs no laboratory and works in a village clinic as well as a hospital, which is why the large cohort studies could use it on hundreds of thousands of people. The number stands in for more than the hand: the muscles of the hand and forearm lose mass and nerve supply along with the rest of the body, so grip tracks whole-body strength, and the processes that thin the forearm also weaken the thighs you stand up with.

The protocol matters, because posture and device change the reading. The PURE investigators, who measured 125,462 healthy adults in 21 countries, had participants hold the dynamometer with the arm at the side and the elbow bent to 90 degrees, squeeze as hard as possible for 3 seconds, and repeat twice more with at least 30 seconds of rest. They kept the highest value from each hand and averaged the two. The European sarcopenia group (EWGSOP2) recommends a calibrated hydraulic dynamometer for the same reason: comparisons only hold when readings were taken the same way.

Grip strength is a marker, not a diagnosis. A low reading can come from arthritis in the hand, a wrist injury, a nerve problem or a device that was never calibrated, and none of those says anything about your heart. What the studies below show is a statistical pattern across large groups, useful for spotting risk early, not a verdict on any one person.

How grip strength changes with age

The clearest map of grip across life comes from Dodds and colleagues, who pooled 60,803 measurements from 49,964 people aged 4 to over 90 in 12 British population studies, taken between 1990 and 2012. Three phases emerge: a rise to a peak in early adulthood, a broad plateau through midlife, and a decline from the fifth decade onward. Men peaked at 51 kg between ages 29 and 39, women at 31 kg between 26 and 42; the peak means at age 32 were 51.9 kg and 31.4 kg.

The fall is slow at first and then steeper. Median grip for men was 50 kg at 40, 48 kg at 50, 45 kg at 60, 39 kg at 70, 32 kg at 80 and 25 kg at 90; for women it was 31, 29, 27, 24, 19 and 14 kg at the same ages. Men lose about 5 kg between 40 and 60 and about 13 kg between 60 and 80. The spread within one age is wide: at 40, the 10th and 90th centiles for men were 38 and 63 kg and for women 23 and 39 kg; at 70 they were 29 and 49 kg for men and 16 and 31 kg for women. A strong 70-year-old outgrips a weak 40-year-old by a comfortable margin.

Weak grip, defined as at least 2.5 standard deviations below the sex-specific peak, works out at 27 kg for men and 16 kg for women. By age 80, 23.0 percent of men and 26.6 percent of women in these studies fell below that line. Two limits apply. The data are cross-sectional, comparing different people at different ages rather than following the same people, and the authors state that the centiles underestimate individual decline and should not be used to track one person over time. And each ten-year age group spans at most 32 birth years, so part of the age pattern may be a cohort effect.

What a weaker grip predicts

Two very large cohorts supply the headline numbers. The Prospective Urban Rural Epidemiology (PURE) study enrolled households in 17 countries of high, middle and low income and analysed 139,691 adults aged 35 to 70. Over a median follow-up of 4.0 years, 3,379 participants (2 percent) died. After adjustment, each 5 kg less grip strength was associated with a 16 percent higher risk of death from any cause, 17 percent higher cardiovascular mortality, 17 percent higher non-cardiovascular mortality, a 7 percent higher risk of myocardial infarction and a 9 percent higher risk of stroke, and the pattern was similar across income strata. Grip predicted all-cause and cardiovascular death better than systolic blood pressure. It did not predict new diabetes, hospital admission for pneumonia or COPD, injury from a fall, or fracture.

UK Biobank, published in the BMJ in 2018, followed 502,293 people aged 40 to 69, 54 percent of them women, for a mean of 7.1 years, during which 13,322 (2.7 percent) died. Per 5 kg lower grip, all-cause mortality was 20 percent higher in women and 16 percent higher in men, cardiovascular mortality 19 and 22 percent higher, respiratory mortality 31 and 24 percent higher, and cancer mortality 17 and 10 percent higher. Per standard deviation, grip carried hazard ratios of 1.48 for all-cause and 1.57 for cardiovascular mortality, against 1.03 and 1.26 for systolic blood pressure. Adding grip to a standard office risk score improved discrimination by a C index change of 0.013, a real but modest gain, and the associations were modestly stronger in the younger age groups.

These are associations. People with weaker grip may already carry an illness that is both weakening them and shortening their life, a reverse causation the BMJ authors name explicitly, and UK Biobank participants were healthier than the general population, with less obesity and smoking. The PURE authors add that no study has yet tested whether raising grip strength reduces mortality or cardiovascular disease. Grip is best read as a summary of accumulated fitness, nutrition and disease, which is exactly why it works as a marker.

Cut-offs, and why region changes them

The 2019 European consensus on sarcopenia (EWGSOP2) uses grip as its first test. Grip below 27 kg in men or below 16 kg in women counts as low muscle strength, and low strength alone is enough for probable sarcopenia; adding low muscle quantity confirms it, and adding poor physical performance, such as a walking speed of 0.8 metres per second or slower, makes it severe. The cut-offs come from the British life-course data above, set 2.5 standard deviations below the young adult mean. Where no dynamometer is at hand, the same guideline uses the chair stand test: more than 15 seconds for five rises from a chair without using the arms also indicates low strength. A 5-question screen (SARC-F) asks about strength, walking, rising from a chair, stairs and falls.

A single global cut-off has a weakness. When the PURE group published reference ranges from 125,462 healthy adults aged 35 to 70 in 21 countries, median grip at 35 to 40 was 50 kg for men and 30 kg for women in Europe and North America, 45 and 28 kg in China, 45 and 29 kg in South America, 35 and 23 kg in South Asia and 37 and 21 kg in Africa, a spread of up to 33 percent between regions. At 61 to 70 the medians were 42 and 25 kg in Europe and North America but 27 and 19 kg in South Asia. The authors concluded that individual readings should be interpreted against region-specific reference ranges. A man in Chennai with 30 kg at 65 sits above his regional median; the same reading in Manchester sits well below it.

What to do with your number

Getting tested is easy: physiotherapists, geriatric clinics and many sports centres have a dynamometer. Test both hands in the standard position, take the best of 3 attempts per hand, and repeat on the same device once or twice a year; the trend is more telling than a single value, and Dodds and colleagues warn that cross-sectional centiles cannot track one person's decline. Compare against a table for your sex, age and region rather than against the single European cut-off.

If the number is low or falling, the answer is not hand squeezers. Grip is a proxy for whole-body muscle, and the evidence in the guide on strength training after 40 is that progressive resistance training on 2 or more days a week raises strength in adults into their eighties, alongside enough protein (the protein by age guide gives the figures). Walking speed is the companion marker; the walking speed guide explains the 0.8 metres per second threshold that the sarcopenia definition also uses.

See a doctor rather than a table if one hand is suddenly much weaker than the other, if weakness came on over days or weeks, or if it comes with numbness, tingling, unexplained weight loss or breathlessness: these point to nerve, joint or systemic disease, not ordinary ageing. If you have heart disease, uncontrolled blood pressure or a recent hand or wrist injury, ask before squeezing at maximal effort, since a hard squeeze with the breath held raises blood pressure briefly. A single low reading in an otherwise well person is a prompt to build strength and retest, not a diagnosis.

Testing grip strength the standard way

Frequently asked

What is a normal grip strength for my age?

In 12 British studies the median was 50 kg for men and 31 kg for women at 40, 45 and 27 kg at 60, and 39 and 24 kg at 70. The spread is wide: at 70, the 10th to 90th centile range was 29 to 49 kg for men and 16 to 31 kg for women.

Is 27 kg for men and 16 kg for women the threshold everywhere?

No. Those are the 2019 European cut-offs for low muscle strength, derived from British data. Medians differ by up to 33 percent between world regions in the PURE reference ranges, so the authors advise region-specific tables.

Can I raise my grip strength?

Yes. Grip mirrors overall muscle, so progressive resistance training on 2 or more days a week, with enough protein, is the route rather than hand squeezers alone. Whether a stronger grip in itself lowers mortality has not been tested in a trial, as the PURE authors note.

Is grip strength really a better predictor than blood pressure?

For death, yes, in both PURE and UK Biobank: per standard deviation, grip carried hazard ratios of 1.48 for all-cause and 1.57 for cardiovascular mortality against 1.03 and 1.26 for systolic blood pressure. For new cardiovascular disease the two were similar, and blood pressure remains the one you can treat directly.

Does a weak grip mean I am likely to fall?

Not in PURE, which found no significant association between grip and injury from falls or fractures over a median of 4 years. The European sarcopenia guideline still treats low grip as a marker of poor outcomes and pairs it with a chair stand test, where more than 15 seconds for five rises signals low strength.

Do I need a dynamometer?

For the number, yes, and it should be the same calibrated device each time. Without one, the chair stand test from the European guideline is the substitute: time five rises from a chair without using your arms, and more than 15 seconds indicates low strength.

Sources

• Leong et al. 2015, The Lancet: Prognostic value of grip strength, findings from the Prospective Urban Rural Epidemiology (PURE) study · 139,691 adults aged 35 to 70 in 17 countries, median follow-up 4.0 years, 3,379 deaths; hazard ratio per 5 kg reduction 1.16 all-cause, 1.17 cardiovascular, 1.17 non-cardiovascular, 1.07 myocardial infarction, 1.09 stroke; stronger predictor than systolic blood pressure; no association with diabetes, falls or fractures. DOI resolves to the publisher page
• Celis-Morales et al. 2018, BMJ: Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality, prospective cohort study of half a million UK Biobank participants · 502,293 participants aged 40 to 69, 54 percent women, mean follow-up 7.1 years, 13,322 deaths; hazard ratio per 5 kg lower grip 1.20 women and 1.16 men for all-cause mortality; per standard deviation 1.48 and 1.57 against 1.03 and 1.26 for systolic blood pressure; C index change 0.013. Open access copy on PubMed Central
• Dodds et al. 2014, PLOS ONE: Grip strength across the life course, normative data from twelve British studies · 60,803 observations from 49,964 participants aged 4 to 90 plus; peak 51 kg men aged 29 to 39, 31 kg women aged 26 to 42; medians by decade; weak grip at 2.5 standard deviations below peak equals 27 kg men and 16 kg women; 23.0 percent of men and 26.6 percent of women weak by 80; cross-sectional data. Open access copy on PubMed Central
• Cruz-Jentoft et al. 2019, Age and Ageing: Sarcopenia, revised European consensus on definition and diagnosis (EWGSOP2) · Low muscle strength below 27 kg men and 16 kg women; chair stand more than 15 seconds for five rises; gait speed 0.8 metres per second or slower; probable, confirmed and severe sarcopenia; SARC-F screen. Open access copy on PubMed Central
• Leong et al. 2016, Journal of Cachexia, Sarcopenia and Muscle: Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries, a PURE study · Median grip by age band and region for men and women; up to 33 percent variation between regions; protocol with elbow at 90 degrees, 3 second squeeze, 3 attempts per hand with at least 30 seconds rest; region-specific reference ranges advised. Open access copy on PubMed Central

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This guide is for general information. It does not replace medical advice or an examination.