Original Study| Volume 19, ISSUE 8, P703-709, August 2018

Handgrip Strength Cannot Be Assumed a Proxy for Overall Muscle Strength



      Dynapenia, low muscle strength, is predictive for negative health outcomes and is usually expressed as handgrip strength (HGS). Whether HGS can be a proxy for overall muscle strength and whether this depends on age and health status is controversial. This study assessed the agreement between HGS and knee extension strength (KES) in populations differing in age and health status.


      Data were retrieved from 5 cohorts.

      Setting and Participants

      Community, geriatric outpatient clinics, and a hospital. Five cohorts (960 individuals, 49.8% male) encompassing healthy young and older individuals, geriatric outpatients, and older individuals post hip fracture were included.


      HGS and KES were measured according to the protocol of each cohort. Pearson correlation was performed to analyze the association between HGS and KES, stratified by sex. HGS and KES were standardized into sex-specific z scores. The agreement between standardized HGS and standardized KES at population level and individual level were assessed by intraclass correlation coefficients (ICC) and Bland-Altman analysis.


      Pearson correlation coefficients were low in healthy young (male: 0.36 to 0.45, female: 0.45) and healthy older individuals (male: 0.35 to 0.37, female: 0.44), and moderate in geriatric outpatients (male and female: 0.54) and older individuals post hip fracture (male: 0.44, female: 0.57) (P < .05, except for male older individuals post hip fracture [P = .07]). Intraclass correlation coefficient values were poor to moderate in all populations (ie, healthy young individuals [0.41, 0.45], healthy older individuals [0.37, 0.41, 0.44], geriatric outpatients [0.54], and older individuals post hip fracture [0.54]). Bland-Altman analysis showed that within the same population of age and health status, agreement between HGS and KES varied on individual level.


      At both population and individual level, HGS and KES showed a low to moderate agreement independently of age and health status. HGS alone should not be assumed a proxy for overall muscle strength.


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        • Welsh T.J.
        • Gordon A.L.
        • Gladman J.R.
        Comprehensive geriatric assessment—a guide for the nonspecialist.
        Int J Clin Pract. 2014; 68: 290-293
        • Rijk J.M.
        • Roos P.R.
        • Deckx L.
        • et al.
        Prognostic value of handgrip strength in people aged 60 years and older: A systematic review and meta-analysis.
        Geriatr Gerontol Int. 2016; 16: 5-20
        • Taekema D.G.
        • Ling C.H.
        • Kurrle S.E.
        • et al.
        Temporal relationship between handgrip strength and cognitive performance in oldest old people.
        Age Ageing. 2012; 41: 506-512
        • Bijlsma A.Y.
        • Pasma J.H.
        • Lambers D.
        • et al.
        Muscle strength rather than muscle mass is associated with standing balance in elderly outpatients.
        J Am Med Dir Assoc. 2013; 14: 493-498
        • Bohannon R.W.
        Hand-grip dynamometry predicts future outcomes in aging adults.
        J Geriatr Phys Ther. 2008; 31: 3-10
        • Ling C.H.
        • Taekema D.
        • de Craen A.J.
        • et al.
        Handgrip strength and mortality in the oldest old population: The Leiden 85-plus study.
        CMAJ. 2010; 182: 429-435
        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • et al.
        Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People.
        Age Ageing. 2010; 39: 412-423
        • Martin H.J.
        • Yule V.
        • Syddall H.E.
        • et al.
        Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Biodex dynamometry.
        Gerontology. 2006; 52: 154-159
        • Frontera W.R.
        • Hughes V.A.
        • Fielding R.A.
        • et al.
        Aging of skeletal muscle: A 12-year longitudinal study.
        J Appl Physiol (1985). 2000; 88: 1321-1326
        • Lynch N.A.
        • Metter E.J.
        • Lindle R.S.
        • et al.
        Muscle quality. I. Age-associated differences between arm and leg muscle groups.
        J Appl Physiol. 1999; 86: 188-194
        • Candow D.G.
        • Chilibeck P.D.
        Differences in size, strength, and power of upper and lower body muscle groups in young and older men.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 148-156
        • Samson M.M.
        • Meeuwsen I.B.
        • Crowe A.
        • et al.
        Relationships between physical performance measures, age, height and body weight in healthy adults.
        Age Ageing. 2000; 29: 235-242
        • Bohannon R.W.
        • Magasi S.R.
        • Bubela D.J.
        • et al.
        Grip and knee extension muscle strength reflect a common construct among adults.
        Muscle Nerve. 2012; 46: 555-558
        • Samuel D.
        • Wilson K.
        • Martin H.J.
        • et al.
        Age-associated changes in hand grip and quadriceps muscle strength ratios in healthy adults.
        Aging Clin Exp Res. 2012; 24: 245-250
        • Chan O.Y.A.
        • van Houwelingen A.H.
        • Gussekloo J.
        • et al.
        Comparison of quadriceps strength and handgrip strength in their association with health outcomes in older adults in primary care.
        Age. 2014; 36: 9714
        • McPhee J.S.
        • Hogrel J.Y.
        • Maier A.B.
        • et al.
        Physiological and functional evaluation of healthy young and older men and women: Design of the European MyoAge study.
        Biogerontology. 2013; 14: 325-337
        • Piasecki M.
        • Ireland A.
        • Stashuk D.
        • et al.
        Age-related neuromuscular changes affecting human vastus lateralis.
        J Physiol. 2016; 594: 4525-4536
        • Baulieu E.E.
        • Thomas G.
        • Legrain S.
        • et al.
        Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge Study to a sociobiomedical issue.
        Proc Natl Acad Sci U S A. 2000; 97: 4279-4284
        • Reijnierse E.M.
        • Trappenburg M.C.
        • Leter M.J.
        • et al.
        The association between parameters of malnutrition and diagnostic measures of sarcopenia in geriatric outpatients.
        Plos One. 2015; 10: e0135933
        • Salpakoski A.
        • Tormakangas T.
        • Edgren J.
        • et al.
        Effects of a multicomponent home-based physical rehabilitation program on mobility recovery after hip fracture: A randomized controlled trial.
        J Am Med Dir Assoc. 2014; 15: 361-368
      1. Fess EE. Clinical Assessment recommendations. 2 ed. Chicago: American Society of Hand Therapists; 1992.

        • Reijnierse E.M.
        • de Jong N.
        • Trappenburg M.C.
        • et al.
        Assessment of maximal handgrip strength: How many attempts are needed?.
        J Cachexia Sarcopenia Muscle. 2017; 8: 466-474
        • Mukaka M.M.
        Statistics corner: A guide to appropriate use of correlation coefficient in medical research.
        Malawi Med J. 2012; 24: 69-71
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: Uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Ikenaga M.
        • Yamada Y.
        • Takeda N.
        • et al.
        Dynapenia, gait speed and daily physical activity measured using triaxial accelerometer in older Japanese men.
        J Sports Med Phys Fitness. 2014; 3: 147-154
        • Aoyagi Y.
        • Park H.
        • Watanabe E.
        • et al.
        Habitual physical activity and physical fitness in older Japanese adults: The Nakanojo Study.
        Gerontology. 2009; 55: 523-531
        • Nogueira F.R.D.
        • Libardi C.A.
        • Vechin F.C.
        • et al.
        Comparison of maximal muscle strength of elbow flexors and knee extensors between younger and older men with the same level of daily activity.
        Clin Interv Aging. 2013; 8: 401-407
        • Macaluso A.
        • De Vito G.
        Muscle strength, power and adaptations to resistance training in older people.
        Eur J Appl Physiol. 2004; 91: 450-472
        • Kallman D.A.
        • Plato C.C.
        • Tobin J.D.
        The Role of Muscle Loss in the Age-Related Decline of Grip Strength - Cross-Sectional and Longitudinal Perspectives.
        J Gerontol. 1990; 45: M82-M88
        • Guadalupe-Grau A.
        • Carnicero J.A.
        • Gomez-Cabello A.
        • et al.
        Association of regional muscle strength with mortality and hospitalisation in older people.
        Age Ageing. 2015; 44: 790-795
        • Stark T.
        • Walker B.
        • Phillips J.K.
        • et al.
        Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: A systematic review.
        PM R. 2011; 3: 472-479
        • Hartmann A.
        • Knols R.
        • Murer K.
        • et al.
        Reproducibility of an isokinetic strength-testing protocol of the knee and ankle in older adults.
        Gerontology. 2009; 55: 259-268
        • Bohannon R.W.
        Manual muscle testing: Does it meet the standards of an adequate screening test?.
        Clin Rehabil. 2005; 19: 662-667
        • Xue Q.L.
        • Beamer B.A.
        • Chaves P.H.
        • et al.
        Heterogeneity in rate of decline in grip, hip, and knee strength and the risk of all-cause mortality: The Women's Health and Aging Study II.
        J Am Geriatr Soc. 2010; 58: 2076-2084