Key numbers
1.22
hazard ratio for cardiovascular death per 5 kg lower grip strength, men aged 40-69 (1.19 in women)
What we mean by strength
The long-term studies on this page measured strength as grip: how hard you can squeeze a handheld dynamometer. Grip strength has been linked to the risk of poor health outcomes.
Grip is not the same task as hanging from a bar or carrying a load. Kilograms of squeeze force cannot be converted to seconds on a bar, so none of these studies gives norms for a Systematic test.
What the long-term data show
In UK Biobank, an observational study of adults aged 40-69, each 5 kg lower grip strength (the study's unit) was associated with a higher risk of dying from cardiovascular disease: a hazard ratio of 1.19 (1.13 to 1.25) in women and 1.22 (1.18 to 1.26) in men. For death from chronic obstructive pulmonary disease the figures were 1.24 (1.05 to 1.47) in women and 1.19 (1.09 to 1.30) in men.
The researchers also asked whether grip strength adds anything to a simple office-based risk score. Adding it raised the C index, a measure of prediction accuracy, by 0.013 for all-cause mortality, 0.012 for cardiovascular mortality and 0.009 for new cardiovascular disease. The authors say more work is needed before grip strength has a proven clinical use in risk screening.
How consistent the pattern looks
A meta-analysis of prospective cohorts in community-dwelling people found the links between grip strength and both all-cause mortality and cardiovascular disease followed a straight line across grip strengths up to 56 kg. The associations did not differ by sex, and adjusting for other factors could not fully explain them.
The pooled results did not show a statistically significant link with cancer. Each 5 kg lower grip strength gave a hazard ratio of 1.01 (95% CI 0.98-1.05) for cancer, and the lowest versus highest grip group gave 0.89 (95% CI 0.66-1.20).
An earlier systematic review found the grip and mortality link in younger groups too, with five studies having an average age under 60 years. The results varied a great deal from study to study (I2 of 84.0 percent), so there is no single fixed estimate.
Not every cohort shows a clear effect. In a Canadian cohort, men in the lowest quarter of grip strength had a 49% higher risk of death than those in the highest (relative risk 1.49, 95% CI 0.86 to 2.59), but that estimate was not statistically significant, and grip did not predict mortality in women.
In this capacity
- What did Leong et al. (2015) find? Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study
- What did Newman et al. (2006) find? Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort
- Is muscle strength linked to mortality?
- Is grip strength linked to how long people live?
- Is strength training linked to lower death rates?
The evidence
Each cited source is labeled according to how it supports the particular claim on this page. Direct test evidence, underlying-capacity findings and population reference values are distinguished from Systematic-defined protocols and standards. Historical development notes are retained internally rather than presented as public evidence. A study of an underlying capacity is never presented as validation of the Systematic test itself.
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Underlying-capacity evidence New source
Celis-Morales et al. (2018). 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 (Clinical research ed.).
What it found. In UK Biobank adults aged 40-69, lower grip strength was associated with higher risk of cardiovascular and COPD death, and adding grip to an office-based risk score improved prediction slightly.
What it does not show. It is observational, it is not hang or carry evidence (squeeze force cannot be converted to hang seconds), and the authors say clinical use needs further work.
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Underlying-capacity evidence New source
Wu et al. (2017). Association of Grip Strength With Risk of All-Cause Mortality, Cardiovascular Diseases, and Cancer in Community-Dwelling Populations: A Meta-analysis of Prospective Cohort Studies. Journal of the American Medical Directors Association.
What it found. Lower grip strength was associated with higher risk of all-cause mortality and cardiovascular disease, in a straight line up to 56 kg, with no difference by sex.
What it does not show. There was no statistically significant link with cancer, and it is not evidence for hang or carry tests.
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Underlying-capacity evidence New source
Cooper et al. (2010). Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ (Clinical research ed.).
What it found. The grip strength and mortality link was also found in younger groups (five studies averaged under 60 years).
What it does not show. Results varied widely between studies (I2 84.0 percent), and it does not validate the Systematic battery or set a clinical cutoff.
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Underlying-capacity evidence
Leong et al. (2015). Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet.
What it found. Studied the value for predicting health outcomes of grip strength measured with a dynamometer.
What it does not show. It gives no dead-hang norms and no way to convert grip kilograms to hang seconds.
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Underlying-capacity evidence New source
Katzmarzyk et al. (2002). Musculoskeletal fitness and risk of mortality. Medicine and science in sports and exercise.
What it found. Men in the lowest quarter of grip strength had a relative risk of death of 1.49 (95% CI 0.86 to 2.59) compared with the highest; grip did not predict mortality in women.
What it does not show. The men's estimate was not statistically significant, and the study does not show cause.
The Systematic Healthspan Assessment is a physical baseline. It is not a diagnosis, and it does not estimate a biological age, a disease risk or a lifespan.