There is a piece of equipment that costs less than a stethoscope, takes ninety seconds to use, requires no consumables, needs no interpretation by a specialist, and produces a number with a stronger relationship to all-cause mortality than blood pressure.
Almost no Australian over 60 has ever had it used on them.
It is a hand dynamometer. And the number it produces is grip strength.
The PURE study
In 2015, Darryl Leong and colleagues published the grip strength analysis from the PURE study in The Lancet. It followed 139,691 adults across 17 countries at every income level.
The findings, after adjustment for age, sex, education, physical activity, smoking, alcohol and other factors:
Each 5 kilogram reduction in grip strength was associated with approximately a 16% higher risk of death from any cause, a 17% higher risk of cardiovascular death, and increased risk of heart attack and stroke.
And the line that made it famous: in that dataset, grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure.
Not more important as a treatment target. But as a predictor — a signal about the state of the organism — the handshake outperformed the cuff.
Why a hand grip predicts anything
Because grip strength is not really about your hands.
It is a low-cost proxy for whole-body muscle strength, and whole-body muscle strength reflects:
- Total muscle mass, the body’s largest metabolic organ and its amino acid reserve during illness
- Neuromuscular function, including motor unit health and central drive
- Nutritional status, since protein-energy malnutrition shows up in strength early
- Cumulative physical activity over years
- Systemic inflammation and underlying disease burden, both of which erode strength
Grip strength is a summary statistic for physical robustness. It goes down before people notice they are declining.
The clinical thresholds
The European Working Group on Sarcopenia in Older People uses grip strength cut-offs of approximately 27 kg for men and 16 kg for women as an indicator of probable sarcopenia. Other consensus groups use slightly different figures.
Below those values, sarcopenia investigation is warranted — and sarcopenia is associated with falls, fractures, longer hospital stays, poorer surgical outcomes, loss of independence, and higher mortality.
Why it isn’t measured
Grip strength does not fit the model.
It is not billable in any meaningful way. It does not generate a pathology request. There is no pharmaceutical intervention that raises it, so no commercial interest in promoting its measurement. And the only effective treatment is resistance training, which sits outside most standard consultations.
Meanwhile, Australians over 60 have their cholesterol, blood pressure and blood glucose measured repeatedly — all reasonable — while a metric with comparable predictive power sits unmeasured because it does not fit the workflow.
The measurement matters
Grip strength must be measured properly to mean anything. The standard protocol: seated, shoulder adducted, elbow at 90 degrees, forearm neutral, three trials each hand, record the maximum.
Recorded consistently, it becomes a tracking measure. A decline over two years is a signal worth acting on, regardless of the absolute value.
At Longevity Physio Studio in Eagle Heights, Mt Tamborine, grip strength is part of every longevity assessment, alongside sit-to-stand, gait speed, balance and calf capacity. Numbers you can chase.
How to actually improve it
Squeezing a rubber ball will not do it. Grip strength reflects whole-body strength, so the training has to be whole-body — with some specific grip work layered on.
The high-value exercises:
- Deadlifts and Romanian deadlifts. The most efficient grip loading available, because the grip demand rises with the whole-body load.
- Farmer’s carries. Pick up two heavy objects, walk. Trains grip, trunk, shoulders, hips and gait simultaneously. Probably the single best exercise for an older adult that nobody prescribes.
- Dead hangs. Hanging from a bar. Trains grip, decompresses the shoulder, and builds shoulder-girdle capacity. Start with assisted or partial-weight versions.
- Rows and pull-downs. Loaded pulling.
- Pinch and towel grip variations for specific weakness.
Progress is measurable within weeks and continues for years. Grip strength responds to training at every age tested, including in the very old.
The framing that matters
If you are 68 and your grip strength is at the sarcopenia threshold, this is not a hand problem and it is not a life sentence. It is an early warning about total body strength, and total body strength is one of the most modifiable things about you.
Book a strength assessment
Ask your GP what your grip strength is. If the answer is “we don’t measure that,” come and find out.
Longevity Physio Studio, Eagle Heights, Mt Tamborine — serving Tamborine Mountain, North Tamborine, Canungra and the Gold Coast hinterland. Book an assessment.
