The short answer
In this large UK study, people with a weaker handgrip were more likely to die during follow-up. For every 5 kg lower grip strength, the hazard ratio for death from any cause was 1.20 (95% CI 1.17 to 1.23) in women and 1.16 (1.15 to 1.17) in men.
Grip strength is a marker that goes along with health. This study cannot show that building grip strength changes anyone’s risk.
What this study cannot tell us
It cannot show that a stronger grip lowers anyone’s risk of death. The authors say residual confounding is always possible and the associations may not imply causality, and that they cannot exclude reverse causality, where illness weakens the grip.
It cannot tell you what a stronger grip would do for you. Nobody in the study was asked to train their grip.
It cannot speak for everyone. The authors say UK Biobank is not representative of the general UK population in several ways.
Who was studied
The study used UK Biobank, a large research group of volunteers. It analysed 502,293 people, and 54% were women. They joined at ages 40 to 69 years.
On average they were followed for 7.1 years, and 13,322 of them died during that time.
What was compared
The authors looked at how mortality differed across grip-strength measurements. They report results for each 5 kg lower grip strength, and also compared people in age- and sex-specific quarters.
Women and men are shown separately because grip strength differs by sex.
What was measured
Grip strength was measured at the start of the study. The number used was the Mean of right and left hands, in kg.
The main outcome was death from any cause. The authors also looked at deaths from specific causes, such as respiratory disease and cancer, and at new disease diagnoses.
Results were adjusted for sociodemographic factors and several health and lifestyle measures, and the authors repeated the analysis after dropping events in the first 2 years to check for reverse causality.
The main finding
For death from any cause, each 5 kg lower grip strength went with a hazard ratio of 1.20 (95% CI 1.17 to 1.23) in women and 1.16 (1.15 to 1.17) in men. A hazard ratio above the neutral value means a higher rate of death during follow-up. The numbers in brackets are confidence intervals, which show uncertainty around each estimate.
For deaths from respiratory disease, the hazard ratios were 1.31 (1.22 to 1.40) in women and 1.24 (1.20 to 1.28) in men. For all cancers combined, they were 1.17 (1.13 to 1.21) in women and 1.10 (1.07 to 1.13) in men.
The pattern was not the same for every cancer. For prostate cancer deaths in men, the ratio was 1.05 (0.96 to 1.15), which the authors do not count as a clear association.
Limits of the study
The study is observational. Differences in health, diet, activity and income between people with strong and weak grips may explain part of the result.
Grip strength was measured at the start, so the study cannot tell how a person’s grip changed over time.
UK Biobank volunteers were, on average, healthier than the UK population as a whole. The authors say this calls for caution with summary figures, but they expect the size of the links to apply more widely.
If you are 70 or older
The oldest participants were 69 when they joined, so nobody older than that was enrolled. Participants did grow older during follow-up, but the main results do not separate them out.
The authors report that, for several outcomes, the links were modestly stronger in the younger age groups. The age-by-age numbers are in the paper’s supplementary tables, which we could not read here. For older readers, this paper is useful evidence, not a direct answer for your own age.
How it fits the other evidence
Other studies, and a pooled analysis of many studies, also found higher mortality with weaker grip. They include PURE, a study in countries of varying incomes, and SHARE, a survey of older adults across Europe and Israel. These studies are listed under “The paper” below.
This paper follows UK Biobank volunteers. PURE and SHARE recruited different people. The pooled analysis combines many earlier studies, and its reference list includes PURE and an earlier UK Biobank paper, so it may share participants with both. Its agreement is therefore not fully separate evidence.
What it means for your marker page
The grip strength page on MarkerScore shows how grip strength is used and lists its sources. This article reads a source in plain English.
The paper
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. The BMJ. Read the paper PMID 29739772
Other papers mentioned
- Leong et al. (PURE study) (2015). Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. Read the paper
- 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. Read the paper
- López-Bueno et al. (2022). Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries. Age and Ageing. Read the paper
Where every number comes from
Each number above links here. The words in quotation marks are copied from the paper (PMC5939721 (open-access full text from NCBI PMC)).
502,293 (people)
The analysis included 502,293 UK Biobank participants.
Found in: Abstract; Participants (article k1651)
“502 293 participants (54% women) aged 40-69 years.”
40 to 69 years (years)
Participants were aged 40 to 69 years when they joined.
Found in: Abstract; Participants (article k1651)
“502 293 participants (54% women) aged 40-69 years.”
13,322 (deaths)
There were 13,322 deaths (2.7% of participants).
Found in: Abstract; Results (article k1651)
“Of the participants included in analyses, 13 322 (2.7%) died over a mean of 7.1 (range 5.3-9.9) years’ follow-up.”
7.1 years (years)
Average follow-up was 7.1 years (range 5.3 to 9.9).
Found in: Abstract; Results (article k1651)
“Of the participants included in analyses, 13 322 (2.7%) died over a mean of 7.1 (range 5.3-9.9) years’ follow-up.”
5 kg (kg)
Results are reported per 5 kg lower grip strength.
Found in: Abstract; Results (article k1651)
“hazard ratios per 5 kg lower grip strength”
1.20 (95% CI 1.17 to 1.23) (hazard ratio)
All-cause mortality, women, per 5 kg lower grip strength.
Found in: Abstract; Results; Figure 1 (article k1651)
“In women and men, respectively, hazard ratios per 5 kg lower grip strength were higher (all at P<0.05) for all cause mortality (1.20, 95% confidence interval 1.17 to 1.23, and 1.16, 1.15 to 1.17)”
1.16 (1.15 to 1.17) (hazard ratio)
All-cause mortality, men, per 5 kg lower grip strength.
Found in: Abstract; Results; Figure 1 (article k1651)
“In women and men, respectively, hazard ratios per 5 kg lower grip strength were higher (all at P<0.05) for all cause mortality (1.20, 95% confidence interval 1.17 to 1.23, and 1.16, 1.15 to 1.17)”
1.31 (1.22 to 1.40) (hazard ratio)
Respiratory disease mortality, women, per 5 kg lower grip strength.
Found in: Abstract; Results; Figure 1 (article k1651)
“all respiratory disease (1.31, 1.22 to 1.40, and 1.24, 1.20 to 1.28)”
1.24 (1.20 to 1.28) (hazard ratio)
Respiratory disease mortality, men, per 5 kg lower grip strength.
Found in: Abstract; Results; Figure 1 (article k1651)
“all respiratory disease (1.31, 1.22 to 1.40, and 1.24, 1.20 to 1.28)”
1.17 (1.13 to 1.21) (hazard ratio)
All-cancer mortality, women, per 5 kg lower grip strength.
Found in: Abstract; Results; Figure 1 (article k1651)
“all cancer (1.17, 1.13 to 1.21, 1.10, 1.07 to 1.13), colorectal cancer (1.17, 1.04 to 1.32, and 1.18, 1.09 to 1.27)”
1.10 (1.07 to 1.13) (hazard ratio)
All-cancer mortality, men, per 5 kg lower grip strength.
Found in: Abstract; Results; Figure 1 (article k1651)
“all cancer (1.17, 1.13 to 1.21, 1.10, 1.07 to 1.13), colorectal cancer (1.17, 1.04 to 1.32, and 1.18, 1.09 to 1.27)”
Mean of right and left hands, in kg (no unit)
Grip strength was the mean of right- and left-hand measurements in kilograms.
Found in: Methods; Procedures (article k1651)
“the mean of the right and left values was expressed in absolute units (kg) for subsequent analysis.”
age- and sex-specific quarters (no unit)
Grip strength was also analysed as age- and sex-specific quarters.
Found in: Methods; Supplementary Table A (article k1651)
“with the exposure variable being grip strength (age and sex specific quarters and 5 kg increase in grip strength)”
the first 2 years (years)
A landmark analysis excluded events within the first two years after recruitment.
Found in: Statistical analyses; Figure 1 (article k1651)
“we did a landmark analysis excluding events occurring within the two years after recruitment in model 4”
1.05 (0.96 to 1.15) (hazard ratio)
Prostate cancer mortality, men, per 5 kg lower grip strength; not a clear association.
Found in: Abstract; Results; Figure 1 (article k1651)
“breast cancer (1.24, 1.10 to 1.39) but not prostate cancer (1.05, 0.96 to 1.15)”
For several outcomes, links were modestly stronger in younger age groups (no unit)
The authors report that, for several outcomes, the links with lower grip strength were modestly stronger in the younger age groups.
Found in: Discussion (article k1651)
“For several adverse health outcomes, we observed interactions with age, with the risk associated with lower grip strength modestly stronger in younger age groups.”
69 (years)
The oldest participants were aged 69 when they joined (the study enrolled ages 40 to 69).
Found in: Abstract; Participants (article k1651)
“502 293 participants (54% women) aged 40-69 years.”
UK Biobank is not representative of the UK population (no unit)
The authors say UK Biobank is not representative of the general population in several ways.
Found in: Discussion; Limitations (article k1651)
“The UK Biobank is not representative of the general population of the UK in several ways.”
Reverse causality cannot be excluded (no unit)
The authors say they cannot exclude reverse causality even after dropping events in the first two years.
Found in: Discussion; Limitations (article k1651)
“although our results were similar after a landmark analysis of events occurring from two years after recruitment, we cannot exclude the possibility of reverse causality”
Associations may not imply causality (no unit)
The authors say residual confounding is possible and associations may not imply causality.
Found in: Discussion; Limitations (article k1651)
“Similarly, residual confounding is always possible and the associations observed may not imply causality.”
Corrections
None recorded since publication.
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