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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 doi: (Published 08 May 2018) Cite this as: BMJ 2018;361:k1651
  1. Carlos A Celis-Morales, research associate1,
  2. Paul Welsh, senior lecturer1,
  3. Donald M Lyall, research associate2,
  4. Lewis Steell, student1,
  5. Fanny Petermann, student1,
  6. Jana Anderson, research associate2,
  7. Stamatina Iliodromiti, clinical lecturer1,
  8. Anne Sillars, clinical fellow1,
  9. Nicholas Graham, clinical fellow2,
  10. Daniel F Mackay, reader2,
  11. Jill P Pell, professor2,
  12. Jason M R Gill, professor1,
  13. Naveed Sattar, professor1,
  14. Stuart R Gray, lecturer1
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
  2. 2Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
  1. Correspondence to: S R Gray stuart.gray{at}
  • Accepted 19 March 2018


Objective To investigate the association of grip strength with disease specific incidence and mortality and whether grip strength enhances the prediction ability of an established office based risk score.

Design Prospective population based study.

Setting UK Biobank.

Participants 502 293 participants (54% women) aged 40-69 years.

Main outcome measures All cause mortality as well as incidence of and mortality from cardiovascular disease, respiratory disease, chronic obstructive pulmonary disease, and cancer (all cancer, colorectal, lung, breast, and prostate).

Results Of the participants included in analyses, 13 322 (2.7%) died over a mean of 7.1 (range 5.3-9.9) years’ follow-up. In women and men, respectively, hazard ratios per 5 kg lower grip strength were higher (all at P<0.05) for all cause mortality (1.20, 95% confidence interval 1.17 to 1.23, and 1.16, 1.15 to 1.17) and cause specific mortality from cardiovascular disease (1.19, 1.13 to 1.25, and 1.22, 1.18 to 1.26), all respiratory disease (1.31, 1.22 to 1.40, and 1.24, 1.20 to 1.28), chronic obstructive pulmonary disease (1.24, 1.05 to 1.47, and 1.19, 1.09 to 1.30), all cancer (1.17, 1.13 to 1.21, 1.10, 1.07 to 1.13), colorectal cancer (1.17, 1.04 to 1.32, and 1.18, 1.09 to 1.27), lung cancer (1.17, 1.07 to 1.27, and 1.08, 1.03 to 1.13), and breast cancer (1.24, 1.10 to 1.39) but not prostate cancer (1.05, 0.96 to 1.15). Several of these relations had higher hazard ratios in the younger age group. Muscle weakness (defined as grip strength <26 kg for men and <16 kg for women) was associated with a higher hazard for all health outcomes, except colon cancer in women and prostate cancer and lung cancer in both men and women. The addition of handgrip strength improved the prediction ability, based on C index change, of an office based risk score (age, sex, diabetes diagnosed, body mass index, systolic blood pressure, and smoking) for all cause (0.013) and cardiovascular mortality (0.012) and incidence of cardiovascular disease (0.009).

Conclusion Higher grip strength was associated with a range of health outcomes and improved prediction of an office based risk score. Further work on the use of grip strength in risk scores or risk screening is needed to establish its potential clinical utility.


  • Contributors: The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. CCM, SG, JPP, NS, and JMRG contributed to the conception and design of the study, advised on all statistical aspects, and interpreted the data. CCM did the statistical analysis, assisted by SG, FP, AS, and PW. CCM and SG drafted the manuscript. All authors reviewed the manuscript and approved the final version to be published. CCM, SG, JPP, NS, and JMRG had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. JPP, JMRG, NS, and SG contributed equally to this work and are joint senior authors. CACM, SG, JPP, JMRG, and NS are the guarantors.

  • Funding: The UK Biobank was supported by the Wellcome Trust, Medical Research Council, Department of Health, Scottish government, and Northwest Regional Development Agency. It has also had funding from the Welsh Assembly government and British Heart Foundation. The research was designed, conducted, analysed, and interpreted by the authors entirely independently of the funding sources.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: UK Biobank received ethical approval from the North West Multi-centre Research Ethics Committee (REC reference: 11/NW/03820). All participants gave written informed consent before enrolment in the study, which was conducted in accordance with the principles of the Declaration of Helsinki.

  • Data sharing: Researchers can apply to use the UK Biobank resource and access the data used. No additional data are available.

  • Transparency: The manuscript’s guarantors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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