Grip Strength as a Longevity Biomarker: What the PURE Study Found

TL;DR — The Prospective Urban-Rural Epidemiology (PURE) study — a prospective cohort of nearly 140,000 adults across 17 countries — found that each 5 kg decrement in handgrip strength was associated with a 17% higher risk of all-cause mortality and significant increases in cardiovascular mortality and cardiovascular disease events. Grip strength is inexpensive to measure, trainable, and one of the most validated simple biomarkers in longevity research.

Why a hand squeeze predicts mortality

Handgrip strength is measured with a simple device called a dynamometer. The test takes seconds and costs almost nothing, yet it consistently outperforms more complex measurements in predicting long-term health outcomes.

The reason isn't that the hand itself is special. Grip strength is a proxy for total-body neuromuscular function. It correlates with overall muscle mass, neuromuscular signaling, and the integrity of the systems that allow muscle to generate force. Those systems decline with age, inactivity, and many chronic illnesses — so grip strength acts as a low-cost window into whole-body resilience.

→ For the broader framework, see our pillar: The Science of Longevity.

The PURE study findings

The landmark 2015 paper by Leong and colleagues, published in The Lancet, examined handgrip strength as a predictor of mortality and cardiovascular events in 139,691 adults from 17 countries followed for a median of four years [1]. Key results:

• Each 5 kg decrease in grip strength was associated with a 17% higher risk of all-cause mortality.
• The same 5 kg decrement was associated with a 17% higher risk of cardiovascular mortality and a 7% higher risk of myocardial infarction.
• Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure in this cohort.
• The association held across countries, income levels, and baseline health status.

Like all observational data, this cannot prove causation. But the size of the effect, the cross-population consistency, and the dose-response pattern make grip strength one of the most robust simple markers in the aging literature.

Grip strength and sarcopenia

Low grip strength is one of the diagnostic criteria in several widely used definitions of sarcopenia, alongside low muscle mass and low physical performance. A declining grip is not just a signal about the hands — it reflects the same underlying loss of neuromuscular function that drives falls, frailty, and loss of independence with age.

→ Read more: Protein Intake and Sarcopenia Prevention After 40

How grip strength relates to other longevity variables

Grip strength rarely acts in isolation. In the research literature, it tends to travel with other markers that matter:

• Cardiorespiratory fitness. People with higher grip strength tend to have higher VO2 max, though the two measure different physiological capacities.
• Muscle mass. Grip strength correlates with appendicular lean mass, though the relationship is imperfect — neural factors also matter.
• Functional capacity. Chair-rise time, gait speed, and grip strength together form a picture of overall physical resilience.

→ Read more: VO2 Max as a Longevity Biomarker

How to measure it

Handgrip dynamometers are inexpensive and widely available. A standardized protocol used in research:

1. Seated, elbow at 90 degrees, wrist in neutral position.
2. Three maximal squeezes per hand, with a brief rest between.
3. Record the highest value for the dominant hand (or the average of both hands, depending on the protocol).

Published reference ranges exist by age and sex and should be used for interpretation. A trend over time is often more informative than a single absolute number.

Can grip strength be trained?

Yes. Grip strength responds to:

• Resistance training — particularly movements that load the grip directly, such as deadlifts, rows, farmer carries, and pull-ups.
• Grip-specific work — dead hangs, thick-bar holds, and dynamometer protocols.
• Overall muscle-preservation strategies — adequate protein intake and sleep, which support the broader neuromuscular system.

The goal isn't to maximize grip strength as an end in itself — it's to improve the underlying neuromuscular function that grip strength reflects.

→ Read more: Sleep Architecture and Biological Aging

Frequently asked questions

What is a "normal" grip strength? Normative values vary by age, sex, and population. Published reference tables are the best source for interpreting an individual result; percentile rank for age and sex is more informative than the raw number.

Does grip strength decline with age? Yes. Grip strength typically peaks in the 30s and declines gradually thereafter, with a more rapid decline after 60 in sedentary individuals. Resistance training meaningfully slows this trajectory.

Can I measure grip strength at home? Yes. Consumer-grade dynamometers are inexpensive and reasonably accurate for tracking trends. For clinical baselines, a calibrated device used with a standardized protocol is preferred.

Is grip strength a better longevity predictor than blood pressure? In the PURE study cohort, grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure [1]. Both remain useful.

About the author

Charles Kamen, MD earned his medical degree from Albert Einstein College of Medicine and completed his internal medicine internship at Yale-New Haven Hospital, followed by a neurology residency at Loma Linda University. He is board-certified by the American Board of Psychiatry and Neurology.

Citations

1. Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-273. PMID: 25982160
2. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. Hallmarks of aging: An expanding universe. Cell. 2023;186(2):243-278. PMID: 36599349

This article is for educational purposes and does not constitute medical advice.