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Objectively measured physical capability levels and mortality: systematic review and meta-analysis

BMJ 2010; 341 doi: (Published 09 September 2010) Cite this as: BMJ 2010;341:c4467
  1. Rachel Cooper, MRC career development fellow,
  2. Diana Kuh, professor of life course epidemiology and MRC unit director,
  3. Rebecca Hardy, MRC programme leader,
  4. Mortality Review Group,
  5. on behalf of the FALCon and HALCyon study teams
  1. 1MRC Unit for Lifelong Health and Ageing and Division of Population Health, University College London, London WC1B 5JU
  1. Correspondence to: R Cooper r.cooper{at}
  • Accepted 16 June 2010


Objective To do a quantitative systematic review, including published and unpublished data, examining the associations between individual objective measures of physical capability (grip strength, walking speed, chair rising, and standing balance times) and mortality in community dwelling populations.

Design Systematic review and meta-analysis.

Data sources Relevant studies published by May 2009 identified through literature searches using Embase (from 1980) and Medline (from 1950) and manual searching of reference lists; unpublished results were obtained from study investigators.

Study selection Eligible observational studies were those done in community dwelling people of any age that examined the association of at least one of the specified measures of physical capability (grip strength, walking speed, chair rises, or standing balance) with mortality.

Data synthesis Effect estimates obtained were pooled by using random effects meta-analysis models with heterogeneity between studies investigated.

Results Although heterogeneity was detected, consistent evidence was found of associations between all four measures of physical capability and mortality; those people who performed less well in these tests were found to be at higher risk of all cause mortality. For example, the summary hazard ratio for mortality comparing the weakest with the strongest quarter of grip strength (14 studies, 53 476 participants) was 1.67 (95% confidence interval 1.45 to 1.93) after adjustment for age, sex, and body size (I2=84.0%, 95% confidence interval 74% to 90%; P from Q statistic <0.001). The summary hazard ratio for mortality comparing the slowest with the fastest quarter of walking speed (five studies, 14 692 participants) was 2.87 (2.22 to 3.72) (I2=25.2%, 0% to 70%; P=0.25) after similar adjustments. Whereas studies of the associations of walking speed, chair rising, and standing balance with mortality have only been done in older populations (average age over 70 years), the association of grip strength with mortality was also found in younger populations (five studies had an average age under 60 years).

Conclusions Objective measures of physical capability are predictors of all cause mortality in older community dwelling populations. Such measures may therefore provide useful tools for identifying older people at higher risk of death.


  • We thank the following people who helped to provide data for this review: Kaarin Anstey (Ageing Research Unit and Centre for Mental Health Research, Australian National University, Canberra, Australia), Cora L Craig (Canadian Fitness Survey), Peter Katzmarzyk (Canadian Fitness Survey, Pennington Biomedical Research Center), Ronald Klein, Michael D Knutson, Kristine E Lee (Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA), Kevin Morgan (School of Sport, Exercise and Health Sciences, Loughborough University, UK), Michiko Yamada, and Shoichiro Fujita.

  • We also thank all other members of the FALCon study team (Eleni Bakra, Michaela Benzeval, Fiona Matthews, and Graciela Muniz Terrera) for their helpful comments and Hugh McGuire (National Collaborating Centre for Women’s and Children’s Health), who provided advice on systematic reviews and performing literature searches.

  • The HALCyon study team also includes Yoav Ben-Shlomo, Cyrus Cooper, Leone Craig, Ian Day, Richard Martin, Kate Tilling, Tamuno Alfred, Mike Gardner, John Gallacher, Ian Deary, John Starr, Paul Shiels, Thomas von Zglinicki, Humphrey Southall, Paula Aucott, Jane Elliott, Andrew Steptoe, Chris Power, Geraldine McNeill, Alison Lennox, Marcus Richards, Gita Mishra, Zeinab Mulla, Emily Lemelin, and James Goodwin.

  • The following are members of the Mortality Review Group, all of whom contributed equally to this work: Rabiah Ahmad (Universiti Teknologi Malaysia), Avan Aihie Sayer (MRC Epidemiology Resource Centre, University of Southampton), Soham Al Snih (Sealy Center on Aging), Peter A Bath (University of Sheffield), Peggy M Cawthon (California Pacific Medical Center Research Institute), J David Curb (Kuakini Medical Center and University of Hawaii), Kristine E Ensrud (University of Minnesota), Luigi Ferrucci (National Institute on Aging), Catharine R Gale (MRC Epidemiology Resource Centre, University of Southampton), Jack M Guralnik (National Institute on Aging), Suzanne Ho (Chinese University of Hong Kong), Fumiyoshi Kasagi (Radiation Effects Research Foundation, Japan), Barbara E K Klein (University of Wisconsin-Madison), Valerie Lauwers-Cances (Service d’Epidémiologie, CHU Toulouse), Debbie A Lawlor (MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol), E Jeffrey Metter (National Institute on Aging), Kushang V Patel (National Institute on Aging), Taina Rantanen (University of Jyväskylä), Yves Rolland (University of Toulouse III), Hideo Sasaki (Hiroshima University School of Medicine), Holly Syddall (MRC Epidemiology Resource Centre, University of Southampton), Annewieke van den Beld (Erasmus Medical Center), Bradley Willcox (Kuakini Health System), Andrew K Wills (MRC Unit for Lifelong Health and Ageing), and Jean Woo (Chinese University of Hong Kong).

  • Contributors: RC, RH, and DK were involved in developing the study concept and design. RC and RH did the literature review and data extraction. RC, RH, Rabiah Ahmad, Avan Aihie Sayer, Soham Al Snih, Peter A Bath, Peggy M Cawthon, J David Curb, Kristine E Ensrud, Luigi Ferrucci, Catharine R Gale, Jack M Guralnik, Suzanne Ho, Fumiyoshi Kasagi, Barbara E K Klein, Valerie Lauwers-Cances, E Jeffrey Metter, Kushang V Patel, Taina Rantanen, Yves Rolland, Hideo Sasaki, Holly Syddall, Annewieke van den Beld, Bradley Willcox, and Jean Woo were involved in acquisition of results. Rabiah Ahmad (Nottingham Longitudinal Study of Activity and Ageing), Avan Aihie Sayer (Hertfordshire Ageing Study), Soham Al Snih (H-EPESE), Peter A Bath (Nottingham Longitudinal Study of Activity and Ageing), Peggy M Cawthon (MrOS and SOF), Kristine E Ensrud (MrOS and SOF), Catharine R Gale (Department of Health and Social Security Survey follow-up), Jack M Guralnik (EPESE), Suzanne Ho (Hong Kong Old Old Study), Barbara E K Klein (Beaver Dam Eye Study Cohort), Valerie Lauwers-Cances (EPIDOS study), E Jeffrey Metter (BLSA), Kushang V Patel (EPESE), Taina Rantanen (Honolulu Heart Program), Yves Rolland (EPIDOS study), Hideo Sasaki (Adult Health Study Cohort), Holly Syddall (Hertfordshire Ageing Study), Annewieke van den Beld (Zoetermeer Study), Bradley Willcox (Honolulu Heart Program and Honolulu Asia Aging Study), and Jean Woo (Hong Kong Old Old Study) were involved in analysing data. RC did the meta-analysis of results. RC, RH, and DK were involved in interpretation of results. RC drafted the manuscript. All authors critically revised and approved the manuscript. RC is the guarantor.

  • Funding: This project was funded by a grant from the UK Medical Research Council Population Health Sciences Research Network. RC originally received support from this grant but is now receiving support from the HALCyon programme funded by the New Dynamics of Ageing (RES-353-25-0001). DK, RH, and Andrew K Wills are supported by the UK Medical Research Council. Debbie A Lawlor also works in a centre that is supported by the UK Medical Research Council. Work was also supported in part by the Intramural Research Program, National Institute on Aging, NIH. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR), and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01 AG18197, U01-AG027810, and UL1 RR024140. The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: AG05407, AR35582, AG05394, AR35584, AR35583, R01 AG005407, R01 AG027576-22, 2 R01 AG005394-22A1, and 2 R01 AG027574-22A1. This research is also supported in part by National Institutes of Health grants EY03083 and EY016379 (Barbara E K Klein) and by the Research to Prevent Blindness (B E K Klein, senior scientific investigator award), New York, NY. The study sponsors played no role in study design; the collection, analysis, and interpretation of data; the writing of the article; or the decision to submit it for publication. The researchers have independence from their funders.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that (1) no author has received support for the submitted work from any source other than those listed under the heading funding above; (2) Peggy M Cawthon has had relationships with Merck and Amgen, and Yves Rolland has had relationships with Amgen, Pierre Fabre, Cheisy, Novartis, and Servier, all of whom might have an interest in the submitted work in the previous 3 years; (3) no author’s spouses, partners, or children have financial relationships that may be relevant to the submitted work; (4) no authors have any non-financial interests that may be relevant to the submitted work.

  • Ethical approval: All included studies had received the relevant ethical approval. No additional approval was required for this review.

  • Data sharing: No additional data available.

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