Squeeze a dynamometer as hard as you can for five seconds. That is it. This simple test — measuring maximum grip strength in kilograms — turns out to be a remarkably robust predictor of future health outcomes. It is cheap, it is fast, and the data behind it is extensive.
The PURE study: 142,000 people, 17 countries
The Prospective Urban Rural Epidemiology (PURE) study, published in The Lancet in 2015, enrolled 142,861 adults across 17 countries; 139,691 with known vital status were analysed over a median of four years. The researchers measured grip strength at baseline and then tracked outcomes.
The findings were striking. Each 5 kg lower grip strength was associated with:
- 16% increase in all-cause mortality
- 17% increase in cardiovascular mortality
- 7% increase in heart attack risk
- 9% increase in stroke risk
These associations held after adjusting for demographic factors, education, physical activity, smoking, alcohol, diet, body mass index, blood pressure and other cardiovascular risk factors and comorbidities. Grip strength was not associated with incident diabetes, falls or fractures in this study. Grip strength predicted mortality more accurately than systolic blood pressure.
An inexpensive dynamometer, five seconds of effort, and you have a predictor of mortality that outperforms blood pressure. Sometimes simple measurements are the most powerful.
Why grip strength works as a predictor
Grip strength is not just about the hands. It is a proxy measurement for total-body skeletal muscle mass and function. Low grip strength signals sarcopenia — age-related loss of muscle mass and quality — which is associated with falls, fractures, disability, metabolic dysfunction, and death.
Like VO₂max, grip strength reflects the integrated function of multiple systems: the neuromuscular system, hormonal status, nutritional state, and inflammatory burden. When these systems start to decline, grip strength declines with them — often years before clinical symptoms appear.
What good grip strength looks like
Grip strength norms depend on age and sex. As a rough guide:
- Peak values: in large British normative data, median grip strength peaks at about 51 kg in men and 31 kg in women between the late 20s and around 40
- Sarcopenia threshold (EWGSOP2): below 27 kg in men and below 16 kg in women indicates low muscle strength (probable sarcopenia)
- With age: values decline steadily, so results are best compared with age- and sex-specific reference values
In clinical practice, the Jamar dynamometer is considered the gold standard. A sound measurement takes the best of three attempts with the dominant hand and compares the result to age- and sex-matched reference values, together with the EWGSOP2 sarcopenia cut-offs.
The encouraging part
Unlike many risk markers, grip strength is modifiable. Resistance training — even starting in your 60s or 70s — can meaningfully improve grip strength and muscle mass. It is one of the most exercise-responsive biomarkers available.
What this means for you
Grip strength testing takes five seconds and costs very little. It provides an independent mortality predictor that adds information beyond what blood tests and imaging can tell you. A sensible check-up measures it alongside cardiorespiratory fitness and body composition — and if yours does not, it is reasonable to ask for it.
If grip strength is low, the logical response is a structured resistance training programme. If low grip strength is combined with low muscle mass on body composition analysis (for example BIA), sarcopenia risk should be considered and a targeted intervention discussed with your physician.
References
- Leong DP, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-273.
- Cruz-Jentoft AJ, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.
- Dodds RM, et al. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014;9(12):e113637.
- Bohannon RW. Grip strength: an indispensable biomarker for older adults. Clin Interv Aging. 2019;14:1681-1691.
This article is general information and not individual medical advice. Decisions about tests and treatment belong in a conversation with your own physician.