Key points
- Grip strength is measured with a handheld dynamometer; the Southampton protocol uses three trials per hand with the patient seated and records the best of all six.
- In pooled British data from twelve studies (including ELSA), median grip peaks at about 51 kg in men and 31 kg in women, then declines from midlife onwards.
- EWGSOP2 defines low grip strength as below 27 kg for men and 16 kg for women; AWGS 2019 uses below 28 kg and 18 kg for Asian populations.
Why grip strength matters
Grip strength is one of the quickest strength measures in clinic, and it says more than how strong the hand is. The European Working Group on Sarcopenia in Older People (EWGSOP2) makes low muscle strength the primary parameter of sarcopenia, noting that grip correlates moderately with strength elsewhere in the body and can serve as a reliable surrogate for arm and leg strength.
It is also prognostic. In the PURE study of 139,691 adults in 17 countries, each 5 kg lower grip was associated with higher all-cause mortality (hazard ratio 1.16, 95% CI 1.13–1.20).
How grip strength is measured
EWGSOP2 calls for a calibrated handheld dynamometer under well-defined conditions; the Jamar is validated and widely used. One standard is the Southampton protocol (Roberts et al., 2011), as summarized in a systematic review of grip protocols:
- Seat the patient in the same chair at every visit, with forearms resting on the arms of the chair.
- Position the wrist just over the end of the chair arm, in a neutral position with the thumb facing upwards.
- Adjust the handle so the thumb is round one side and the four fingers are around the other, and the instrument feels comfortable in the hand.
- Instruct: "I want you to squeeze as hard as you can for as long as you can until I say stop. Squeeze, squeeze, squeeze, stop" — stopping when the needle stops rising.
- Perform three trials on each side, alternating hands and starting with the right.
- Record the maximum grip score from all six trials.
Protocols vary in posture, number of trials and whether the mean or maximum is reported, which makes results harder to compare. Whichever you use, use it the same way every time.
Normative values by age and sex
Dodds et al. pooled 60,803 observations from 49,964 people in twelve British general-population studies, including the English Longitudinal Study of Ageing (ELSA), using the best of each person's trials. The table shows the 10th centile and median, in kg, at the exact ages listed:
| Age | Men, 10th | Men, median | Women, 10th | Women, median |
|---|---|---|---|---|
| 50 | 35 | 48 | 21 | 29 |
| 55 | 34 | 47 | 19 | 28 |
| 60 | 33 | 45 | 18 | 27 |
| 65 | 31 | 43 | 17 | 25 |
| 70 | 29 | 39 | 16 | 24 |
| 75 | 26 | 35 | 14 | 21 |
| 80 | 23 | 32 | 13 | 19 |
| 85 | 19 | 29 | 11 | 17 |
| 90 | 16 | 25 | 9 | 14 |
The centiles were robust to dynamometer type and to seated versus standing measurement. They are British reference values; other populations may differ.
Low-grip cut-offs for sarcopenia
| Consensus | Men | Women | Population |
|---|---|---|---|
| EWGSOP2 (2019) | < 27 kg | < 16 kg | European |
| AWGS 2019 | < 28 kg | < 18 kg | Asian |
The EWGSOP2 thresholds come from the Dodds data: 2.5 standard deviations below the young-adult peak mean (51.9 kg in men, 31.4 kg in women). By age 80, 23.0% of men and 26.6% of women fell at or below them. Under EWGSOP2, low strength makes sarcopenia probable; low muscle quantity or quality confirms it. AWGS 2019 adds "possible sarcopenia" (low strength or low performance alone) for primary care and community settings.
Pairing grip with mobility tests
Grip shows strength, not how the patient moves, and both consensus statements pair it with performance tests. EWGSOP2 lists a five-rise chair stand over 15 seconds as a strength alternative and gait speed of 0.8 m/s or less as low performance; AWGS 2019 uses a 6-metre walk below 1.0 m/s, an SPPB of 9 or less, or a five-time chair stand of 12 seconds or more.
For the lower-limb side, see gait velocity as the sixth vital sign, the 30-Second Chair Stand Test, our functional test reference values and the movement assessment tests overview. Recording grip alongside them, the same way at every visit, gives a fuller picture over time.
A low grip score is a reason to look further, not a diagnosis; interpreting it remains a matter of clinical judgment.
References
- Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169
- Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. 2015;386(9990):266-273. doi:10.1016/S0140-6736(14)62000-6
- Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and Ageing. 2011;40(4):423-429. doi:10.1093/ageing/afr051
- Sousa-Santos AR, Amaral TF. Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review. BMC Geriatrics. 2017;17(1):238. doi:10.1186/s12877-017-0625-y
- Dodds RM, Syddall HE, Cooper R, et al. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014;9(12):e113637. doi:10.1371/journal.pone.0113637
- Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. Journal of the American Medical Directors Association. 2020;21(3):300-307.e2. doi:10.1016/j.jamda.2019.12.012