The Lancet study on grip strength and mortality, explained
In 2015, a study of nearly 140,000 adults across 17 countries found that weaker grip tracked with a higher risk of death — and predicted it more strongly than systolic blood pressure. Here is what it showed, and what it did not.
What the PURE study was
The Prospective Urban Rural Epidemiology study — PURE — is one of the largest long-term population studies ever run across rich and poor countries alike. In July 2015, a team led by Darryl Leong at the Population Health Research Institute, McMaster University, published its grip strength findings in The Lancet1.
Between 2003 and 2009, researchers enrolled households in 17 countries of varying income and sociocultural settings. A household was eligible if at least one member was aged 35 to 70. Of 142,861 people enrolled, 139,691 with known vital status were included in the analysis. Each had grip strength measured with a Jamar dynamometer, the standard handheld device used in clinics.
What it found: every 5 kg counts
The researchers expressed risk per 5 kg reduction in grip strength. After adjusting for other factors, lower grip was associated with higher risk across several outcomes1:
| Outcome | Hazard ratio per 5 kg lower grip | 95% CI |
|---|---|---|
| All-cause mortality | 1.16 | 1.13–1.20 |
| Cardiovascular mortality | 1.17 | 1.11–1.24 |
| Non-cardiovascular mortality | 1.17 | 1.12–1.21 |
| Myocardial infarction | 1.07 | 1.02–1.11 |
| Stroke | 1.09 | 1.05–1.15 |
A hazard ratio of 1.16 means that, at any point during follow-up, the rate of death was about 16% higher for every 5 kg of weaker grip. It is a relative measure. Over the median four years, only 2% of participants died, so the absolute difference for any one person is far smaller than the headline percentage suggests.
For most outcomes, the association looked similar in high-, middle-, and low-income countries. Not everything lined up, though. The team found no significant link between grip strength and new diabetes, hospital admission for pneumonia or COPD, fall injuries, or fractures. And in high-income countries, stronger grip was associated with a slightly higher risk of cancer — a pattern not seen in middle- and low-income countries.
Stronger than blood pressure?
The finding that drew the most attention: grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure1.
That does not mean blood pressure matters less. High blood pressure is a well-established, treatable cause of cardiovascular disease. The point is narrower: a measurement that takes seconds and needs only a handheld dynamometer carries real prognostic information.
“Measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease.”
Leong et al., The Lancet, 2015
PURE was not an outlier. In the UK Biobank, a separate study of more than 500,000 adults, lower grip was again linked with higher all-cause and cardiovascular mortality, and adding grip strength improved an office-based risk score2. A 2017 meta-analysis pooling 42 studies arrived at the same per-5-kg estimate for all-cause mortality: a hazard ratio of 1.163.
Why would grip strength track with mortality?
PURE was not designed to answer why. A few explanations are commonly discussed, and they are not mutually exclusive:
- Grip reflects overall strength. A 2019 review found grip strength is a consistent marker of whole-body strength and physical function in older adults4.
- Grip reflects overall health. The same review linked low grip with multimorbidity, malnutrition, and poorer quality of life.
- Illness lowers strength. Some people may be weaker because an undiagnosed condition is already affecting them — a problem known as reverse causation.
The limitations worth knowing
PURE is large and carefully run, but its design sets clear limits on what it can say.
- It is observational. It shows that grip strength and mortality move together. It cannot show that one causes the other.
- Confounding is never fully removed. Statistical adjustment helps, but unmeasured factors can still shape the result.
- Grip was measured at baseline, and the median follow-up was four years. The study does not describe how changes in grip over time relate to risk.
- Raw numbers need context. Grip varies with age, sex, and body size, so a kilogram figure means little without a comparison group.
The authors were explicit: further research is needed to identify what determines muscular strength and to test whether improving strength reduces mortality and cardiovascular disease1.
What this means for you
Grip strength is not a diagnosis and not a countdown. It is a useful, low-cost signal that is easy to track. Start by knowing your number: our grip strength calculator places your result against people of your age and sex.
From there, the sensible move is the one the wider evidence already supports — build and keep strength over time, as part of an active life. Consistent, measurable grip training fits into that, and it is what we built Reclench Apex for.
Frequently asked questions
What did the Lancet grip strength study find?
The PURE study (Leong et al., The Lancet, 2015) found that each 5 kg lower grip strength was associated with a 16% higher risk of death from any cause and a 17% higher risk of cardiovascular death, after adjusting for other factors. Grip strength was also a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure.
How many people were in the PURE grip strength study?
PURE enrolled 142,861 adults aged 35 to 70 across 17 countries of varying incomes. The grip strength analysis included 139,691 participants with known vital status, followed for a median of 4 years.
Is grip strength a better predictor of death than blood pressure?
In PURE, grip strength predicted all-cause and cardiovascular mortality more strongly than systolic blood pressure. That does not make blood pressure less important: it remains a well-established, treatable risk factor. Grip strength is best seen as an additional, inexpensive signal.
Does improving grip strength lower mortality risk?
That has not been shown. PURE was observational, so it found an association, not cause and effect. The authors noted that further research is needed to test whether improving strength reduces mortality and cardiovascular disease.
Medical disclaimer. This article is for general education and is not medical advice. Grip strength research describes population-level associations and cannot diagnose or predict outcomes for an individual. Reclench products are not medical devices. Talk to a qualified clinician before starting a new training program, especially if you have an injury or a medical condition.
Sources
- Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. 2015;386(9990):266–273. doi:10.1016/S0140-6736(14)62000-6 · PubMed 25982160
- Celis-Morales CA, Welsh P, Lyall DM, et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants. BMJ. 2018;361:k1651. doi:10.1136/bmj.k1651 · PubMed 29739772
- Wu Y, Wang W, Liu T, Zhang D. Association of grip strength with risk of all-cause mortality, cardiovascular diseases, and cancer in community-dwelling populations: a meta-analysis of prospective cohort studies. J Am Med Dir Assoc. 2017;18(6):551.e17–551.e35. doi:10.1016/j.jamda.2017.03.011 · PubMed 28549705
- Bohannon RW. Grip strength: an indispensable biomarker for older adults. Clin Interv Aging. 2019;14:1681–1691. doi:10.2147/CIA.S194543 · PubMed 31631989