Grip Strength

Objective[edit | edit source]

Grip .jpg

Grip strength is a measure of muscular strength or the maximum force/tension generated by one’s forearm muscles. It can be used as a screening tool for the measurement of upper body strength and overall strength. It is most useful when multiple measurements are taken over time to track performance.

Research indicates that grip strength may have use as a prognostic indicator for health outcomes, as further discussed below. Grip strength is normally measured by a handheld dynamometer.

Intended Population[edit | edit source]

Grip strength can be used in numerous situations to evaluate and track many health-related conditions, as further discussed below.

The Elderly[edit | edit source]

Grip strength weakens as we age, which eventually begins to affect day-to-day activities, such as opening jars, carrying groceries, and turning doorknobs. These activities can become much more difficult with reduced grip strength.

It is also a reliable indicator of many health conditions associated with ageing, suggesting its utility as an inexpensive form of risk stratification for all-cause mortality and physical frailty. [1][2] Implementation of grip strength measurement for older people wards as part of routine admission assessment was recommended [3] as low grip strength in older inpatients is associated with poor healthcare outcomes including longer length of stay and mortality.  A high percentage of older patients were identified to be at risk of poor healthcare outcomes as a result of low grip strength and would benefit from nutritional and exercise interventions.

  • Studies have found grip strength to be a tool for diagnosing sarcopenia, as well as a proxy for overall muscle strength[4][5][6][7][8].
  • A 2018 prospective study found better handgrip strength was associated with cardiac structure and function in a pattern indicative of less cardiac hypertrophy and remodelling. These characteristics are known to be associated with a lower risk of cardiovascular events.[9]
  • In older patients with hip fractures, early grip strength evaluation might provide important prognostic information regarding the patient's future functional trajectory.[10]
  • A 2017 scoping review reported the use of handgrip strength as a way to monitor cognitive changes was important and that reduced handgrip strength over time may serve as a predictor of cognitive loss with advancing age. [11] Similarly, a 2016 review found that handgrip strength has a predictive validity for the decline in cognition, mobility, functional status and mortality in older community-dwelling populations. [12]
  • A 2015 study also found weak grip strength to be associated with all-cause mortality, coronary heart disease, hypertension, heart failure, stroke, and chronic obstructive pulmonary disease. [1]
  • A cross-sectional study (2020) shows a low correlation between the handgrip strength and standard strength measures of the lower limbs (hip, knee, and ankle extensor/flexor muscles), and functional capacity in older women. [13]
  • A 2021 systematic review found low grip strength to be associated with increased risk of cognitive decline and dementia. [14]

In Conditions of the Upper Limb[edit | edit source]

Method of Measurement[edit | edit source]

To assess grip strength, the Jamar dynamometer is recommended by the American Society for Surgery of the Hand and the American Society of Hand Therapists.

  • The client is seated with shoulder adducted, elbow flexed to 90 degrees, and forearm and wrist neutral. The therapist places the dynamometer in the client’s hand while gently supporting the base of the dynamometer, and he/she instructs the client to squeeze as hard as possible. Grip force should be applied smoothly, without a rapid jerking motion. Allow the wrist to extend during the grip.
  • Standard grip test: Three trials on the second handle-width setting.
  • Normative data exists for grip and pinch strength testing. In addition, compare readings with the client’s opposite extremity.
  • Before performing strength testing check whether there are any healing tissues that can be damaged by this test and use another outcome measure.

The study measuring the validity of the digital MicroFET3 dynamometer with Jamar dynamometer suggests good validity for the MicroFET3 dynamometer. The comparison showed that the MicroFET3 dynamometer indicated age-related declines in the maximum grip-force and showed slower and more inconsistent maximal hand-grip strength generation by the elderly. [15]

A meta-analysis suggests a change of 1.6kg and above in grip strength to be real change, due to the potential technical error of measurement. [2]

Suggested Exercises[edit | edit source]

A meta-analysis found that studies with large effects in favour of the intervention group adopted a multimodal approach to exercise training. [2] Presumably, handgrip strength capacity benefits more from integrating different training aspects, such as strength, balance, flexibility and endurance.[2] Due to the high variance in exercise dosage parameters across the literature, it is unclear what constitutes the best effect intervention for improving grip strength[2]. Nevertheless, the meta-analysis suggests at least 9 weeks of task-specific training with variable heart frequency, at 75% 1 RM, and at a perceived exertion level of “somewhat hard” or “hard”.[2]

References[edit | edit source]

  1. 1.0 1.1 Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The lancet. 2015 Jul 18;386(9990):266-73.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Labott BK, Bucht H, Morat M, Morat T, Donath L. Effects of Exercise Training on Handgrip Strength in Older Adults: A Meta-Analytical Review. Gerontology. 2019;65(6):686-698. doi: 10.1159/000501203. Epub 2019 Sep 9. PMID: 31499496.
  3. Ibrahim K, May CR, Patel HP, Baxter M, Sayer AA, Roberts HC. Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention. BMC geriatrics. 2018; 18(1):79. doi: 10.1186/s12877-018-0768-5.
  4. Chen LK, Lee WJ, Peng LN, Liu LK, Arai H, Akishita M, for Sarcopenia AW. Recent advances in sarcopenia research in Asia: 2016 update from the Asian Working Group for Sarcopenia. Journal of the American Medical Directors Association. 2016 Aug 1;17(8):767-e1.
  5. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019 Jan 1;48(1):16-31.
  6. Wiśniowska-Szurlej A, Ćwirlej-Sozańska A, Wołoszyn N, Sozański B, Wilmowska-Pietruszyńska A. Association between handgrip strength, mobility, leg strength, flexibility, and postural balance in older adults under long-term care facilities. BioMed research international. 2019 Sep 23;2019.
  7. Miljkovic N, Lim JY, Miljkovic I, Frontera WR. Aging of skeletal muscle fibers. Annals of rehabilitation medicine. 2015 Apr;39(2):155.
  8. Porto JM, Nakaishi APM, Cangussu-Oliveira LM, Freire Júnior RC, Spilla SB, Abreu DCC. Relationship between grip strength and global muscle strength in community-dwelling older people. Arch Gerontol Geriatr. 2019 May-Jun;82:273-278. doi: 10.1016/j.archger.2019.03.005. Epub 2019 Mar 6. PMID: 30889410.
  9. Beyer SE, Sanghvi MM, Aung N, Hosking A, Cooper JA, Paiva JM, et al. Prospective association between handgrip strength and cardiac structure and function in UK adults. PloS one. 2018;13(3):e0193124.
  10. Savino E, Martini E, Lauretani F, Pioli G, Zagatti AM, Frondini C, et al. Handgrip strength predicts persistent walking recovery after hip fracture surgery. The American journal of medicine. 2013;126(12):1068-75.
  11. Fritz NE, McCarthy CJ, Adamo DE. Handgrip strength as a means of monitoring progression of cognitive decline–a scoping review. Ageing research reviews. 2017;35:112-23.
  12. Rijk JM, Roos PR, Deckx L, van den Akker M, Buntinx F. Prognostic value of handgrip strength in people aged 60 years and older: a systematic review and meta‐analysis. Geriatrics & gerontology international. 2016;16(1):5-20.
  13. Rodacki AL, Moreira NB, Pitta A, Wolf R, Melo Filho J, Rodacki CD, Pereira G. Is Handgrip Strength a Useful Measure to Evaluate Lower Limb Strength and Functional Performance in Older Women?. Clinical Interventions in Aging. 2020;15:1045.
  14. Cui M, Zhang S, Liu Y, Gang X, Wang G. Grip Strength and the Risk of Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis of Longitudinal Cohort Studies. Front Aging Neurosci. 2021 Feb 4;13:625551. doi: 10.3389/fnagi.2021.625551. PMID: 33613270; PMCID: PMC7890203.
  15. Lee SC, Wu LC, Chiang SL, Lu LH, Chen CY, Lin CH, Ni CH, Lin CH. Validating the Capability for Measuring Age-Related Changes in Grip-Force Strength Using a Digital Hand-Held Dynamometer in Healthy Young and Elderly Adults. BioMed Research International. 2020 Apr 21;2020.