Hand Grip Strength: age and gender stratified normative data in a population-based study

Hand grip strength can be quantified by measuring the amount of static force that the hand can squeeze around a dynamometer. The force has most commonly been measured in kilograms and pounds, but also in millilitres of mercury and in Newtons.

Hand grip strength is a reliable measurement when standardised methods and calibrated equipment are used, even when there are different assessors [1] or different brands of dynamometers [2].There are different methods of positioning patients during measurement, and for calculating their grip strength from repeated measures, so the American Society for Surgery of the Hand and the American Society of Hand Therapists [3] have standardized positioning, instruction and calculation of grip strength.

Published normative data for hand grip strength are available from many countries, and in most cases, data are divided into age and gender subgroups [4–7]. Analysis of grip strength by gender shows higher grip by males at all ages, and analysis by age group demonstrates a peak of grip strength in the fourth decade and then a gradual decline in grip strength for both genders [4–7]. This trend is always present even though some studies divide participants by age gender, and then by right and left hand, while a small number of studies divide participants by age gender and then dominant and non-dominant hand (5).

Grip strength is related to and predictive of other health conditions, although the relationship is not stated to be causative [4, 8]. Normal hand grip strength is positively related to normal bone mineral density in postmenopausal women, [9] with some researchers suggesting that grip strength be a screening tool for women at risk of osteoporosis [10]. Longitudinal studies suggest that poor grip strength is predictive of increased mortality from cardiovascular disease and from cancer in men, even when factors of muscle mass and body mass index are adjusted for [11, 12]. Hand grip strength is negatively associated with physical frailty even when the effects of body mass index (BMI) and arm muscle circumference are removed [13]. Researchers have suggested that the factor related to frailty and disability in later life is the manner in which muscles are used, and this can be measured by hand dynamometry [13].

Disparity exists in the literature over the relationship between hand grip strength and BMI, many researchers claiming a positive relationship between grip strength and BMI in both genders and all ages, while other researchers found no relationship [14–17]. The studies were from different countries, and involved participants of different ages, genders, ethnicities, types of work and access to food. There is one study of hand grip strength in Australian adults [18], but no exploration of the relationship between grip strength and BMI in an Australian population.

The aim of this study was to describe normative data for hand grip strength of an Australian population. Secondary aims were to investigate the relationship between BMI and hand grip strength, and to compare Australian data with international hand grip strength norms.

Prior to the study commencing, approval for the research was obtained from the North West Adelaide Health Service Ethics of Human Research Committee and informed consent was obtained from each participant, conforming to the Helsinki Declaration.

Data were obtained from the North West Adelaide Health Study (NWAHS). In stage one (2000-2003), participants over the age of 18 years were randomly selected using the electronic white pages telephone directory, interviewed and invited to attend a clinic for physical assessment. In stage two (2004-2006), participants were re-contacted, invited to complete telephone interview, complete a self-administered questionnaire and have a clinical assessment. Overall, 3 206 (81% of those recruited) participants returned to the clinic during the second stage (2004-2006) which specifically focused on the collection of information relating to musculoskeletal conditions [19].

Participants were asked if they had ever had pain or aching in their shoulder, arm or hand at rest or when moving, on most days for at least a month and if they had ever had stiffness when getting out of bed in the morning on most days for at least a month as part of the Computer Assisted Telephone Interview. Participants who answered positively to either of these questions were removed from the grip strength analysis. BMI was calculated from height and weight measurements taken at the clinic assessment. Information relating to hand dominance (participants were asked "What is your dominant hand") was also collected as part of the clinic assessment.

Overall, 3206 men and women aged 20 years and over participated in clinical assessment in Stage 2. Of these, 436 persons were excluded from this analysis due to the presence of arthritis and/or hand pain hand lasting over one month. Ninety-two respondents did not undertake a grip strength test, resulting in a total of 1314 men and 1315 women participants who provided a strength measurement. The participant group was relatively young, with 41.5% under 40 years; and the mean BMI was 28.1(5.5), with a range of 14.6 to 60.1. The standard deviations for all group means were small, therefore, using this data it is reasonable to predict a (pain-free) individual's grip strength if their age and gender are known.

A very weak positive relationship was found between higher BMI and right hand grip strength the youngest and oldest adults in the sample. For young adults and those in their fourth, fifth and sixth decade, a higher BMI was inversely related to hand grip strength, (Table 1).

Seven published studies [7, 20–25] were accepted for comparison with the current data and eighteen studies were excluded as they used different equipment, measurement position, or they did not divide subjects by age or by which hand was measured. There are considerable differences between the grip data (Figures 1 and 2), even though all participants were screened to exclude those with upper limb conditions. In addition, no studies were included if participants had chronic illness or malnutrition. Possible reasons for the differences are in the recruitment locations; for example the lowest and highest results were obtained from the USA, but the strongest were recruited in public places [7] and the lowest were recruited from doctor's offices [17].

Past research exploring the relationship between BMI and hand grip strength has provided incongruent findings. Published data suggests that higher BMI in adults under 25 and over 70 years is positively correlated with higher grip strength, and being overweight (BMI over 25) and obese ranges (BMI over 30), in adults between the age of 25 and 70 is correlated with lower hand grip strength. These trends can be seen in the current study also, but there are no moderate or large correlations. The current study cannot fully investigate the relationship of BMI and strength, as only 27 participants exhibited low BMI. Conversely, published studies set in India [15, 16] Africa [17] and Japan [20] could not fully explore the relationship between BMI and hand grip strength because none of the subjects' BMI exceeded 25.

The relationship between BMI and low hand grip strength is further explored in a study that divided participants with low BMI (≤18.5) into two health status groups of 'chronically undernourished' and 'underweight' [15]. The chronically undernourished groups have significantly lower hand grip strength than the underweight groups, both being significantly less strong than the 'well nourished' groups of BMI higher than 18.5. Analysis of this subgroup was not feasible in the current study as there were only four men and 27 women with a BMI under 18.5.

This study provides a large sample of normative data for clinical use in hand and upper limb rehabilitation, and possible screening for other health issues. It explores the relationship of grip strength with elevated BMI and found no significant relationships. The study compares the Australian sample with international grip strength norms, finding these population-based norms to be lower than international convenience samples.