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International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years from 69 countries and regions

Tomkinson GR 1 , Lang JJ 2 , Rubín L 3 , McGrath R 4 , Gower B 5 , Boyle T 6 Show all authors , Klug MG 7 , Mayhew AJ 8 , Blake HT 5 , Ortega FB 9 , Cadenas-Sanchez C 10 , Magnussen CG 11 , Fraser BJ 12 , Kidokoro T 13 , Liu Y 14 , Christensen K 15 , Leong DP 16 , iGRIPS (international handGRIP Strength) Group

Affiliations 

  • 1 Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia. Electronic address: grant.tomkinson@unisa.edu.au
  • 2 Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
  • 3 Department of Physical Education and Sport, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec 461 17, Czech Republic; Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Olomouc 779 00, Czech Republic
  • 4 Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND 58102, USA; Department of Health, Nutrition and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; Fargo VA Healthcare System, Fargo, ND 58102, USA; Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
  • 5 Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
  • 6 Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
  • 7 Department of Population Health, University of North Dakota, Grand Forks, ND 58202, USA
  • 8 Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON L8P 0A1, Canada; McMaster Institute for Research on Aging, McMaster University, Hamilton, ON L8P 0A1, Canada
  • 9 Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, ES 18071, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada, ES 18071, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland
  • 10 Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, ES 18071, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada, ES 18071, Spain; Department of Cardiology, Stanford University, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
  • 11 Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku 20520, Finland
  • 12 Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
  • 13 Faculty of Sport Science, Nippon Sport Science University, Tokyo 158-8508, Japan
  • 14 School of Physical Education, Shanghai University of Sport, Shanghai 200438, China; Shanghai Research Center for Physical Fitness and Health of Children and Adolescents, Shanghai 200438, China
  • 15 Department of Public Health, Epidemiology Biostatistics and Biodemography, University of Southern Denmark, Odense 5230, Denmark
  • 16 The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
J Sport Health Sci, 2024 Dec 06;14:101014.
PMID: 39647778 DOI: 10.1016/j.jshs.2024.101014

Abstract

BACKGROUND: Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability. Handgrip strength (HGS) using isometric dynamometry is a convenient, feasible, and widely used method of assessing muscular strength among people of all ages. While adult HGS norms have been published for many countries, no study has yet synthesized available data to produce international norms. The objective of this study was to generate international sex- and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.

METHODS: Systematic searches were conducted in 6 databases/web search engines (MEDLINE, SPORTDiscus, Embase, Web of Science, CINAHL, and Google Scholar) up to December 1, 2023. We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age. Pseudo data were generated using Monte Carlo simulation following harmonization for methodological variation. Population-weighted Generalized Additive Models for Location, Scale, and Shape were used to develop sex- and age-specific norms for absolute HGS (kg) and HGS normalized by height (Ht, m) squared (i.e., HGS/Ht2 in kg/m2). Norms were tabulated as percentile values (5th to 95th) and visualized as smoothed percentile curves.

RESULTS: We included data from 100 unique observational studies representing 2,405,863 adults (51.9% female) aged 20 to 100+ years from 69 countries and regions tested from the year 2000 onward. On average, absolute and normalized HGS values negligibly improved throughout early adulthood, peaked from age 30-39 years (at 49.7 kg (males) and 29.7 kg (females) for absolute HGS or 16.3 kg/m2 (males) and 11.3 kg/m2 (females) for HGS/Ht2), and declined afterwards. The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.

CONCLUSION: This study provides the world's largest and most geographically comprehensive international norms for adult HGS by sex and age. These norms have utility for global peer-comparisons, health screening, and surveillance.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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