Handgrip Strength: A Small Test with Big Clinical Value
Tools for Practice
Handgrip strength (HGS) is a simple, validated measure of muscle strength that provides valuable insights beyond weight and BMI alone. Increasingly recognised as a marker of sarcopenia, frailty and clinical risk, it offers a practical assessment of functional muscle status and can help identify patients at risk of poorer outcomes.
HGS is typically measured using a hand dynamometer, with the individual standing and can also be measured sitting or lying. Taking three measurements and using the mean value is recommended to improve reliability.1
Results should be interpreted against age- and sex-specific reference values. A value below 85% of the expected mean, or more than 2.5 standard deviations below the mean, may indicate impaired muscle function and increased clinical risk.1,2
Handgrip strength and Sarcopenia
Sarcopenia is a progressive muscle disease characterised by declining muscle strength, muscle mass and physical function. Importantly, patients can develop sarcopenia despite appearing weight stable, meaning traditional nutrition screening tools may not identify those at risk.
The European Working Group on Sarcopenia in Older People 2 (EWGSOP2)3 places low muscle strength at the centre of sarcopenia diagnosis and recommends HGS as a practical assessment tool, with suggested cut-off points for low HGS of <27 kg for men and <16 kg for women.
Handgrip strength and clinical outcomes
While HGS is increasingly recognised as a key tool in the assessment of sarcopenia and muscle function, its value extends far beyond diagnosis. Evidence suggests that low HGS is a strong predictor of important clinical outcomes across a range of healthcare settings.
For example, in a study of malnourished inpatients, every 10 kg decrease in HGS was associated with a significantly higher risk of both 30-day and 180-day mortality.4
Low HGS has been associated with:
- Increased postoperative complication rates5
- Longer hospital stays5, 6
- Reduced quality of life6
A responsive marker of nutritional intervention?
Muscle strength responds quickly to changes in nutritional status, making HGS a valuable tool for monitoring the effectiveness of nutrition interventions. Studies have shown that HGS can improve within as little as one week of commencing nutrition support, often before measurable changes in body composition are observed.7
Higher hand grip strength has been consistently associated with lower mortality risk. In a large meta-analysis, each 1 kg higher grip strength was associated with an approximately 3% lower risk of mortality.8
Practice pearl
Patients can lose muscle function while maintaining their weight. Incorporating HGS into routine assessment may help identify sarcopenia and monitor response to nutritional intervention earlier than changes in weight or body composition alone.
Bringing HGS into Practice
The British Dietetic Association (BDA) has developed an example competency framework for measuring HGS, available via the BDA Hand Grip Strength Competency Framework.
Already using HGS in practice?
We'd love to hear how you're incorporating it into nutritional assessment and monitoring. Share your experience with the Scientific Affairs team at scientific.affairsUK@fresenius-kabi.com.
References
1.Todorovic VE, Mafrici B, editors. A pocket guide to clinical nutrition. 5th ed. Birmingham: Parenteral and Enteral Nutrition Group of the British Dietetic Association; 2018.
2. Smith S, Madden AM. Body composition and functional assessment of nutritional status in adults: a narrative review of imaging, impedance, strength and functional techniques. Journal of human nutrition and dietetics. 2016 Dec;29(6):714-32
3. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31.
4.Kaegi-Braun N, Tribolet P, Baumgartner A, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Hoess C, et al. Value of handgrip strength to predict clinical outcomes and therapeutic response in malnourished medical inpatients: secondary analysis of a randomized controlled trial. Am J Clin Nutr. 2021;114(2):731-40.
5. Sultan P, Hamilton MA, Ackland GL. Preoperative muscle weakness as defined by handgrip strength and postoperative outcomes: a systematic review. BMC anesthesiology. 2012 Jan 17;12(1):1.
6. McNicholl T, Curtis L, Dubin JA, Mourtzakis M, Nasser R, Laporte M, Keller H. Handgrip strength predicts length of stay and quality of life in and out of hospital. Clin Nutr. 2020;39(8):2501-9
7. Norman K, Stobäus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clinical nutrition. 2011 Apr 1;30(2):135-42
8. Cooper R, Kuh D, Hardy R, Mortality Review Group. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010 Sep 9;341.