Hand Grip Strength: Putting International Norms into Practice

Evidence Snapshot

International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years

Hand grip strength (HGS) is widely used in clinical practice as a proxy measure of wider muscular function. As a convenient and cost-effective tool, HGS is recommended by the European Working Group of Sarcopenia in Older People as a key step in the diagnosis of sarcopenia.1

A systematic review published in 2025 looked to synthesise international norms for hand grip measures based on gender and age, examined 100 studies internationally and included over 2.4million adults in the review.2

These reference values may help clinicians identify individuals with lower-than-expected muscle strength and support interpretation of HGS measurements across different ages and body sizes.

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Key results:

  • Below are the normative values for males and females with adjustments made for body size (the authors recommend doing this to reduce variability introduced by body size). In practice, a height-adjusted result can be derived  by dividing the measured hand grip result by the patient’s height squared.
  • Most studies measured HGS while seated (51%), with testing arm adducted (97%), elbow flexed (68%) with forearm (98%) and wrist (100%) in neutral positions.
  • Hand grip strength generally peaked in early-to-mid adulthood (30–39 years) before gradually declining with advancing age.
  • A negligible-to-small decline in HGS was seen per decade between 40-64 years of age (-2.8kg for males, -1.4kg for females)
  • A moderate decline per decade was seen in late adulthood (>65years), -5.6kg for males, -3.5kg for females.
  • There was large variability in late adulthood, evidenced by an increase in distributional variability for hand grip measures. HGS also varied more for females than males. This should be considered when using the values within practice.
  • Although the large international dataset improves generalisability, differences in measurement protocols between studies may contribute to variation in the reported reference value.

Interpreting normative data:

What is the value of normative data? Normative data provides a reference range from a large population, allowing clinicians to compare an individual patient's result against what would be expected for someone of the same age and sex.

How to interpret the norms in clinical practice? A result at the 50th percentile represents the median value for that age group. Results around the 10th percentile indicate lower-than-expected strength, while results around the 90th percentile indicate higher-than-expected strength relative to the reference population.

What does this mean for clinical practice? HGS can be incorporated into routine nutritional assessment and monitoring, providing an objective measure of muscle function alongside other clinical and nutritional indicators.

Normative Values (percentiles) for Males adjusted for height (hand grip measure divided by height squared)
Normative Values (percentiles) for Females adjusted for height (hand grip measure divided by height squared)

Clinical recommendations:

  • The authors emphasised the importance of standardised measurement protocols and highlighted the Southampton protocol as a practical and widely used approach (hand grip measurement taken with participant sat at a table with arm at 90o and with forearm supported by the table).  
  • Perform 3 measurements of hand grip per arm and use the highest of the measures.
  • To avoid influence of body size, consider using body size adjustments (e.g. hand grip divided by height squared) for best comparison of with the norms given in the study.
  • Due to greater age variability, comparing older adults’ (> 65years) results to normative values may be less reliable. For these patients, it may be more beneficial to compare their results over time with a measured baseline. 

We're interested to hear from you!

We’re interested to hear about your perceptions and experiences measuring HGS. Please reach out to us! By working collaboratively, together we can improve nutritional care and achieve better results for patients. If you are interested in having one of the Fresenius Kabi Scientific Affairs team participate in your team meeting, please reach out to us; scientific.affairsUK@fresenius-kabi.com 

References:

1)     Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; 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;48(1):16-31. doi:10.1093/ageing/afy169.

2)     Tomkinson GR, Lang JJ, Rubín L, McGrath R, Gower B, Boyle T, Klug MG, Mayhew AJ, Blake HT, Ortega FB, Cadenas-Sanchez C, et al.; iGRIPS (international handGRIP Strength) Group. International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years from 69 countries and regions. J Sport Health Sci. 2025;14:101014. doi:10.1016/j.jshs.2024.101014.

GB-NP-2600081 July 2026
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