Grip Strength as a Vital Sign: Testers, Averages, and Longevity

Grip strength is a core occupational therapy assessment—and a vital sign of your health. 

This simple metric offers unique, holistic insight into your current health status and your risk for future health challenges.

As you’ll see below, this measure is about so much more than your hand strength! Grip strength can tell a story of your health over time.

Hand Grip Strength Testers & Measurement

One of the perks of hand grip strength measurement is that it is relatively simple.

All you need is a simple piece of grip strength equipment called a “dynamometer” (which means “power measure”). To get your grip strength measurement, you will squeeze this handheld device with your full strength.

You can do this with your therapist or purchase your own dynamometer to test your grip strength at home.

It is important to note that norms for each dynamometer are slightly different. 

Comparison of Grip Strength Dynamometers (Testers)

Grip Strength Norms and Averages

As mentioned above, it’s important to know the norms for your specific dynamometer. According to Gabriella Francis, OTR/L, ATC, CEO of Squegg, those norms are as follows for the Squegg Smart Dynamometer.

Squegg Grip Strength Norms

Jamar has suggested separate norms for the overall population as well as the pediatric population. Those norms are as follows.

Jamar Grip Strength Norms

Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, R. (1985). Grip and pinch strength: Normative data for adults. Archives of Physical Medicine and Rehabilitation, 66(2), 69-74.

Mathiowetz, V., Weimer, D. M., & Federman, S. M. (1986). Grip and pinch strength: Norms for 6-19 year olds. American Journal of Occupational Therapy, 40(10), 705-711.

Jamar Pediatric Grip Strength Norms

Ploegmakers, J. J. W., Hepping, A. M., Geertzen, J. H. B., Bulstra, S. K., & Stevens, M. (2013). Grip strength is strongly associated with height, weight and gender in childhood: A cross sectional study of 2241 children and adolescents providing reference values. Journal of Physiotherapy, 59(4), 255-261. https://doi.org/10.1016/S1836-9553(13)70202-9

It is important to note that many countries have published their own norms. For example, Great Britain, Australia, Canada, Korea, Germany, and Japan each have their own distinct normative values.

There are also different cut points in percentiles for weakness based on country of origin (please see the chart here for more details).

How to Measure Grip Strength

When using your dynamometer, the way you position your arm will affect your test results—and testing while seated will produce different results than testing while standing. Different positions measure different things, so it’s important to follow the testing protocol closely to ensure you are testing for the right factor.

Testing in a seated position targets the strength of smaller muscle groups of the hand and wrist, with the result being an indicator of upper body strength. (See the ASHT and Southampton protocols for seated grip strength compared here.)

Testing in a standing position, on the other hand, captures lower body and core strength (which is used in balance and exertion of force). Results of this testing method are indicative of overall strength.

As this research article explains, there are four commonly used grip strength testing positions:

1. Standing with the elbow fully extended

2. Standing with arms raised

3. Sitting with the elbow flexed 90 degrees

4. Sitting with the elbow extended

Note that the two most-used testing positions are seated with the elbow flexed and standing with the elbow extended.

According to the above-linked study, grip strength is typically greater when standing versus sitting—and subjects typically test highest when standing with their elbow fully extended. Average grip strength values for the two seated testing positions do not differ significantly.

Factors Influencing Hand Grip Strength

The authors of this article⁸ go in-depth on different factors that can influence grip strength, including:

• hand dominance

• age

• gender

• socio-economic status

• ethnicity

• education level

• employment

• physical fitness

• nutritional status

For example, several studies showed grip strength peaking in people ages 30–39. According to this study, the majority of right-handed subjects tested 10% higher in grip strength on their dominant side. Men also consistently had higher overall grip strength than women.⁹ In this study from Brazil, for example, men had 57% higher grip strength than women.¹⁰

Associations of Hand Grip Strength with Longevity Metrics

Grip strength is associated with so many aspects of overall health and longevity that it’s hard to sum it up briefly. So, I’m going to borrow from this study,¹¹ and divide the associations into two overall categories: what grip strength tells us about a client right now, and what it may predict about their future health.

What Grip Strength Tells Us About Current Health

• Strength

  • Research shows strong correlations between grip strength and knee extension strength.¹² In patients with hemiparetic stroke, grip strength on the unaffected side also correlates with the strength of other muscle groups in that same arm.¹³

  • That said, it’s important to take caution when using grip strength as a marker of overall strength. A recent systematic review found that the relationship between grip strength and trunk or lower extremity muscle strength varied depending on the population and study methods.¹⁴

• Upper limb function

  • Researchers have identified grip strength thresholds that older adults need to complete heavy tasks.¹⁵

  • One study found significant correlations between grip strength measurements and scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for women with postmastectomy edema (i.e., swelling).¹⁶

  • Similarly, another study linked DASH scores to grip strength measurements for patients recovering from cardiac surgery.¹⁷

  • A recent cross-sectional study also suggests an association between grip strength and upper limb function.¹⁸

• Bone mineral density

  • Higher grip strength is strongly associated with higher bone mineral density—a finding supported by a recent cross-sectional study.¹⁹

• Fracture susceptibility

  • A systematic review found that lower grip strength is associated with higher hip fracture risk, with grip strength declining around the time of fracture.²⁰

  • A more recent longitudinal study of adults 45 and older confirmed that as grip strength went up, hip fracture risk went down.²¹

• Fall risk

  • That same longitudinal study found that stronger grip was associated with fewer falls.²¹

  • Another study compared average grip strength in people who hadn’t fallen in the past year (20.7 kg / 45.6 lbs) to those who had recently fallen (17.6 kg / 38.8 lbs), further supporting the connection between grip strength and fall risk.²² 

• Malnutrition risk

  • The evidence here is mixed. One study found that higher grip strength was associated with lower malnutrition risk among elderly inpatients in China.²³

  • But a more recent cohort study found that grip strength wasn’t a reliable predictor of nutritional status in hospitalized pediatric patients—though it did correlate with other malnutrition indicators, suggesting it may still be useful as part of a broader nutritional assessment.²⁴

• Cognitive impairment

  • Low grip strength has been linked to cognitive impairment, with research suggesting that cognitive decline can itself lead to reduced grip strength.²⁵

  • Other studies connect grip strength to mild cognitive impairment,²⁶ Mini-Mental State Examination scores,²⁷ information processing speed, and executive functioning.²⁸

• Depression risk

  • A cross-sectional study using WHO data found that individuals with weak grip strength—under 30 kg (66 lbs) for men and under 20 kg (44 lbs) for women—had a higher prevalence of depression compared to those with stronger grip (8.8% vs. 3.8%).²⁹

• Sleep quality

  • Lower grip strength has been associated with longer sleep duration,³⁰ moderate sleep impairment,³¹ and reduced quality of sleep.³²

• Risk of diabetes

  • Higher grip strength is associated with lower rates of insulin resistance and type 2 diabetes—and the reverse is also true. Grip strength may even be predictive of prediabetes.³⁴

• Multimorbidity

  • A longitudinal study of middle-aged and older adults in China found that higher grip strength was associated with a lower risk of developing multiple metabolic conditions at once—including hypertension-diabetes, hypertension-diabetes-hyperlipidemia, and diabetes-hyperlipidemia.³⁵

• Quality of life

  • Grip strength is associated with quality of life in older adults.³⁶ One study identified specific grip strength thresholds linked to good quality of life, broken down by gender, weight, and age in adults over 60—including a separate grouping for those with a BMI over 30 kg/m².³⁷ See the chart below for details.

Grip Strength and Quality of Life

Meng, F., Zhang, Y., Liu, C., & Zhou, C. (2024). Quantitative relationship between grip strength and quality of life in the older adult based on a restricted cubic splin model. Frontiers in Public Health, 12, 1-8. https://doi.org/10.3389/fpubh.2024.1417660

What Grip Strength May Predict About Future Health

• Mortality

  • A meta-analysis found that every 5 kg (11 lbs) reduction in grip strength was associated with a 16% higher risk of all-cause mortality.³⁸

  • The same analysis found an even stronger association between reduced grip strength and cardiovascular disease.³⁸

  • Leong et al. also linked grip strength to all-cause mortality, stroke, and myocardial infarction.³⁹

  • Beyond that, grip strength may also predict rheumatoid arthritis, type 2 diabetes, pneumonia, renal disease, and chronic obstructive pulmonary disease (COPD).¹¹

• Function

  • Grip strength is associated with the ability to stand from a chair, complete heavy household tasks, dress, bathe, and walk at a normal pace.⁴⁰

  • It’s also linked to ADL performance in older adults living in nursing facilities.⁴¹

• Bone mineral density

  • In adolescent athletes, grip strength of the non-dominant arm was the strongest predictor of bone mineral density—particularly for the spine and legs.⁴² However, recent research in this area is lacking.¹¹

• Fractures

  • Low grip strength (under 231 mmHg, or about 4.5 lbs/sq inch) is associated with an increased risk of vertebral fractures in European women ages 50 and over.⁴³

  • Grip strength may be a more cost-effective fracture predictor than some current tools.⁴

• Cognition and depression

  • Low grip strength is associated with increased dementia risk, poorer verbal and working memory, slower processing speed, lower cognitive assessment scores, and cognitive impairment overall. (See this narrative review for detailed information on populations and specific grip strength measurements.)⁴⁵

  • A cross-sectional study of over 50,000 participants across six countries also found that lower grip strength was associated with higher depression risk.⁴⁶

• Hospitalization

  • A prospective cohort study found that low grip strength—under 12 kg (26 lbs) in men and under 8 kg (18 lbs) in women—was associated with mortality, hospital readmission, delirium, pressure ulcers, and healthcare-associated infections in hospitalized adults.⁴⁷

Specific Diagnoses Worth Exploring Further

The research covers a lot of ground when it comes to grip strength and specific conditions. A few worth diving deeper into:

• Type 2 diabetes

• Cardiovascular disease

• Chronic kidney disease

• Chronic liver disease

• Stroke

• Some cancers

• Sarcopenia

Conclusion: Hand grip strength as a vital sign of health

Given the many associations between grip strength and other health conditions, it’s no surprise that it has already been deemed an important biomarker of health.¹¹

And, as outlined in this article, grip strength deserves your consideration as a vital sign based on its value in:

Comprehensive Health Assessment: Grip strength offers additional insight into musculoskeletal health, adding to other cardiovascular and respiratory vital signs.

Early Disease Detection: Because low grip strength is associated with so many chronic conditions, it could help practitioners identify health issues early—enabling more timely interventions.

Predictive Value: Because grip strength also has predictive value, it could aid in risk stratification and prevention strategies.

Serial Measurements: Grip strength lends itself to continuous tracking over time.

Patient Engagement: Because grip strength measurement is so easy to perform and understand, it offers a simple way for patients to monitor changes in their own wellbeing. It also gives them a motivating number to track.

Cost-effective and Non-invasive: Again, the simplicity of this measure enables data collection without any significant burden on the healthcare system.

Diverse Applications: Grip strength has been studied throughout the lifespan and can be adapted to support healthy aging or track rehabilitative progress.

References

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