Handgrip Strength Cannot Be Assumed a Proxy for Overall Muscle Strength

Suey S.Y. Yeung, Esmee M. Reijnierse, Marijke C. Trappenburg, Jean Yves Hogrel, Jamie S. McPhee, Mathew Piasecki, Sarianna Sipila, Anu Salpakoski, Gillian Butler-Browne, Mati Pääsuke, Helena Gapeyeva, Marco V. Narici, Carel G.M. Meskers, Andrea B. Maier*

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

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OBJECTIVES: 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.

DESIGN: 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.

MEASURES: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)703-709
Number of pages7
JournalJournal of the American Medical Directors Association
Issue number8
Early online date20 Jun 2018
Publication statusPublished - Aug 2018


This study was supported by the seventh framework program MYOAGE (HEALTH-2007-2.4.5-10), the United Kingdom Medical Research Council (MR/K025252/1) as part of the Lifelong Health and Wellbeing initiative, the Dutch Technology Foundation STW, and The Ministry of Education and Culture, Kela-The Social Insurance Institution of Finland, Juho Vainio Foundation. This study has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 675003. http://www.birmingham.ac.uk/panini

FundersFunder number
Kela-The Social Insurance Institution of Finland
Horizon 2020 Framework Programme
H2020 Marie Skłodowska-Curie Actions675003
Medical Research CouncilMR/K025252/1
Stichting voor de Technische Wetenschappen
Juho Vainion Säätiö
Kementerian Pendidikan dan Kebudayaan
Horizon 2020
seventh framework program MYOAGEHEALTH-2007-2.4.5-10


    • aged
    • geriatric assessment
    • knee extension strength
    • Muscle strength


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