Health
Grip Strength Is a Crucial Vital Sign Your Doc Has Never Taken
Aug. 1, 2023 — Most people hear “firm handshake” and automatically think “business world.” A cursory search reveals articles with titles like “Seven Super-Revealing Things Your Handshake Says About You” (Forbes) and “How a Handshake Can Tell You Everything You Need to Know About a Person” (Inc.).
But those in the know understand what your handshake really reveals: Your current health, possible future illnesses, and how long you might live. In fact, grip strength may be the most revealing health measurement your doctor has never taken.
On a typical visit to your doctor, you expect them to record your temperature, weight, heart rate, and blood pressure. Those measurements are called “vital signs” for a reason. They offer a quick snapshot of your current condition, along with hints about your future health.
But there’s a fair argument to be made to include grip strength in that group. Grip-strength testing is easy, fast, and noninvasive. It can be monitored over time. All it requires is a handgrip dynamometer, a tool that may cost less than the doctor’s stethoscope, and a chair.
What does grip strength reveal? The amount of force you can generate with your hand is a valid proxy for total-body strength. And total-body strength is one key to healthy aging.
“Many studies have looked at strength as a predictor of positive health and weakness as a predictor of negative health outcomes,” said Mark Peterson, PhD, associate professor of physical medicine and rehabilitation research at the University of Michigan, who’s worked on dozens of those studies.
Among the health risks associated with low grip strength:
- Type 2 diabetes
- Heart disease
- Cancer
- Dementia and Alzheimer’s disease
- Depression
- Functional disability
- Osteoporosis
- Premature death from any cause
The predictive merits of grip strength have been documented across continents and cultures. Although most of those studies have focused on older adults, they aren’t the only age group researchers have looked at.
“We have several papers on the value of grip strength for predicting diabetes and cardiovascular disease in children and adolescents,” Peterson said.
Why grip strength? How could the amount of force generated by such small muscles in the hand and forearm be connected to so many life-and-death consequences?
Survival of the Strongest
The first thing to understand about grip-strength testing is that it’s only partially about grip. It’s mostly about strength. That’s what attracted Peterson to this line of research.
“I’m a former strength coach, so I wanted to make a case for why strength was important across populations, not just athletes,” he said. “I strongly believe in strength preservation and healthy living as a predictor for longevity.”
Consider a classic study of Swedish army recruits. Because of Sweden’s post-World War II conscription policy, virtually every young male in the country underwent a physical examination to see if they were fit for military service — an exam that included a grip-strength test.
That gave the researchers a database with more than a million participants. They followed up on them decades later through publicly available records.
What they found: The men with the weakest grip strength in their late teens were 20% more likely to have died by their mid-50s, compared to those with moderate to high grip strength. Even suicide rates were 20% to 30% higher for the weakest recruits.
There’s a brutal Darwinian logic to the idea that a stronger person with a more powerful grip would enjoy a longer, healthier life. To our ancient ancestors, stronger hands meant you were probably better at everything that aided survival: hunting, fighting, building shelter, and bearing and rearing children.
Those with such an advantage would be more desirable to potential mates. They would then conceive more children, and those children would be stronger and healthier, thanks to both genetics and nutrition.
Fast-forward to the 21st century where we must force ourselves to engage in physical activity even though science shows us again and again why it’s so important for health and longevity. The old rules still apply: Strength aids survival.
Grip Strength and the Aging Process
Some of the earliest grip-strength studies used it as a proxy for nutritional status in elderly men and women. Nourishment, in turn, predicted their ability to survive an illness or surgery.
And this makes sense: If an older person isn’t eating enough to maintain their health and vitality, their strength would decline. Declining strength would make them more susceptible to infections, hospitalizations, and postsurgical complications, leading to longer hospital stays, loss of independence, and ultimately a higher risk of death from any cause.
Along those lines, Peterson’s research team at the University of Michigan found that low grip strength is correlated with faster aging at the cellular level.
The study looked at DNA methylation, which Peterson describes as “a reflection of someone’s exposure to life events.”
For example, someone who smokes will have altered methylation patterns, compared to someone who doesn’t. Same with someone who’s had more exposure to environmental pollution.
Accelerated DNA methylation “means you’re essentially at higher risk for what are traditionally considered age-related chronic conditions,” Peterson said. Those conditions include Alzheimer’s, type 2 diabetes, chronic inflammation, and a higher risk of premature mortality.
As you may recall, those things are also linked to low grip strength, which we now know is linked to higher DNA methylation and faster biological aging.
But there’s still a missing piece of the puzzle: Why, exactly, would the strength of your grip be associated with so many health outcomes?
Grip Strength and Muscle Function
“Declining muscle function is the first step of the disabling process,” said Ryan McGrath, PhD, assistant professor of health, nutrition, and exercise sciences at North Dakota State University. “That’s what you can measure with a handgrip test. It helps you identify individuals at risk for the next step of the process, which is declines in physical performance.”
McGrath got involved in grip-strength research as a postdoctoral fellow at the University of Michigan, where he worked with Peterson. Like his mentor, he has published lots of studies using data obtained with a handgrip dynamometer.
“It can be a nice tool for assessing muscle function and muscle strength,” he explained. Because the test is so easy to administer — you sit in a chair with your arm at your side and your elbow bent 90 degrees, and squeeze the device as hard as you can — researchers can work with large groups of people and come away with statistically powerful data.
“There’s a lot of health outcomes it’s associated with, which is one of its greatest strengths and at the same time one of its key limitations,” McGrath said.
He compared the dynamometer to a tire gauge. Just as a tire gauge can alert you to a loss of air pressure without revealing the source of the leak, a dynamometer can’t tell you why your grip strength is deflated.
“It’s hard to specify the prognostic value,” he said. “You don’t know the next steps to take. As a standalone measurement, that’s a concern.”
That’s why his current research goes beyond simple tests of maximum grip strength to more sophisticated measurements of the rate of force development (how fast you can express strength), repeatability (how much your strength declines from your first to your second or third squeeze), and asymmetry (how big a gap there is between your right-hand and left-hand strength).
Any of those measures could detect a potential neural or neuromuscular issue.
In a 2020 study, for example, McGrath and his team at NDSU showed that older adults with both weakness and asymmetry in grip-strength tests were nearly four times more likely to experience functional limitations. Those limitations could affect their ability to do anything from routine chores to keeping themselves clean and fed.
That brings us to perhaps the most important question: once you have grip-strength data on a patient, client, or yourself, what do you do with it?
Waging War on Weakness
Defining weakness is easy. Using dynamometer readings, the generally accepted cutoffs for low grip strength are 26 kilograms for an adult male and 16 kilograms for a female. (It’s better to use kilograms instead of pounds, as you’ll see in a moment.)
But that’s way too simple, Peterson said.
For one thing, your age matters. Grip strength typically peaks for men in their late 20s and declines rapidly in middle age and beyond. For women, it plateaus in their 20s and gently declines until their 50s. So at a minimum, you should consult the age-based standards you’ll find included with a dynamometer.
Another caveat: Peterson said grip strength tests aren’t very meaningful for people who actively train for strength, though he suggests dedicated athletes make up a relatively small percentage of the population – even as low as 10%.
The size of the person taking the test is also important.
“You absolutely must account for body mass in the context of understanding how grip strength, or any strength measure, is reflective of health and function,” Peterson said.
To calculate your strength-weight ratio, (which Peterson calls “normalized grip strength”), simply divide your grip strength in kilograms by your body weight in kilograms. For men, a ratio greater than 0.70 puts you in the higher percentiles. For women it’s 0.50. (You can find a complete chart of normalized grip strength percentiles here.)
And if the results suggest that the person in question is objectively weak? “For me, that’s easy,” Peterson said. “They need to do exercise.”
Common sense suggests doing a lot of forearm exercises for grip strength. Not so, said Peterson. The strength of your hand and forearm muscles reflects what they can do along with all your other muscles moving together.
A 2019 study found that, for older adults, a variety of exercise programs can lead to modest but meaningful increases in participants’ grip strength – and they don’t necessarily have to include actual gripping exercises. The programs ranged from tai chi to water aerobics to walking, stretching, and all kinds of resistance training.
Peterson’s advice to everyone is pretty straightforward: Get stronger. It doesn’t really matter how you do it or how much strength you ultimately gain. Even a little more strength means a little less weakness and a little more life.
May 10, 2024 – When we’re young, we take our macula for granted. At the center of our retina – the deepest layer of the eye that’s chock-full of photoreceptors and that confers color to our world – the macula is like a high-resolution camera. As light hits our eyes, the retina’s macula recasts our world in a bloom of color with astoundingly high visual sharpness.
But as you age, your vision dulls. What once stood out sharply becomes foggy, like condensation on a windowpane. After some time, a coal-black smudge or cloudy circular area begins to affect your central vision.
This effective blind spot widens over time if left untreated. What remains is a “macular hole” in the center of your retina.
This unfortunate series of events marks the advanced stage of age-related macular degeneration, a dangerous retinal disease that affects about 20 million people in the U.S., and nearly 200 million people worldwide.
And it’s not getting better. Estimates are that by 2040, the disease may affect nearly 300 million people worldwide. We are very limited in our ability to treat or prevent it. Read on for what to know.
First, What Causes Age-Related Macular Degeneration?
AMD’s causes are varied, and whether it will affect you is mostly determined by age and genetics, said Marco Alejandro Gonzalez, MD, an ophthalmologist and vitreoretinal specialist in Delray Beach, FL.
Because of the different cocktails that we have in terms of our genetic makeup, some people’s photoreceptor cells in the macula “basically start to shut down,” he said.
AMD’s development involves over 30 genes, and if you have a first-degree relative – parent, sibling, child – who has the disease, you’re three times more likely to get it, too.
Gonzalez explained how the expected rise to 300 million cases by 2040 is due mostly to improved diagnostic tools, along with the fact that the world is getting older and living longer. (Usually, an optometrist can detect signs of AMD during a routine eye exam.)
Eye experts still struggle to stop AMD’s most harmful sign – the cause of those muddy, milky, or even coal-colored circles in your central vision: geographic atrophy.
Geographic atrophy can occur in either of the two forms of age-related AMD: “dry” AMD and “wet” AMD.
Nearly every case of AMD begins as the dry kind, affecting 80% to 90% of AMD patients.
Retinal disease expert Tiarnán Keenan, MD, PhD, offered a vivid image of geographic atrophy for those who have dry AMD.
“As time passes, the circular patches of GA expand like a brushfire, taking more and more vision with it, often to the point of legal blindness,” he said.
A researcher in the Division of Epidemiology and Clinical Applications at the National Eye Institute, Keenan recently led a study that tested the efficacy of the antibiotic minocycline in slowing geographic atrophy expansion in dry AMD. The study operated on the grounds that the body’s immune system could be at play in developing the disease.
When your body’s immune system is overactive, microglial cells (central nervous system immune cells) can get into the sub-retinal space and possibly eat away at the macula and its sensitive photoreceptors.
Though minocycline had been shown to reduce inflammation and microglial activity in the eye in diabetic retinopathy, it didn’t slow the expansion of geographic atrophy or vision loss in patients with dry AMD during Keenan’s study.
When asked if microglial activity could have very little to do with the atrophy expansion, Keenan said it’s something to consider: “Maybe microglia are just there as bystanders clearing up the debris … so inhibiting them is less likely to slow down progression.”
In future drug trials, “maybe it’s possible the minocycline or another approach to target microglia would be helpful, but it would be needed in combination with some other therapy and be ineffective by itself,” he said.
Two Sides of the Same Disease
In dry AMD, Gonzalez compares macular degeneration to the loss of pixels on a screen. “Some of those pixels burn out … and that’s the way you lose vision classically in the dry form.”
Wet AMD is a more progressive form of the disease. It causes abrupt vision loss due to abnormal blood vessel growth.
“If you don’t treat wet AMD quickly, it’s game over,” warned Gonzalez. “Wet macular degeneration is the quicker process of vision loss because these blood vessels wreak havoc.” These new blood vessels bleed, causing fluid to build in the macula, which ultimately leads to scarring.
Gonzalez shed light on why wet AMD develops. “The wet form, for some reason, is the body’s last-ditch effort to try to kind of ‘help’ a dying macula. … When these blood vessels start to grow under the retina, they quickly destroy the architecture of the macula.”
Stopping the Bleeding in Wet AMD
Though wet AMD is rarer, it’s more treatable than dry AMD. Signs and symptoms can be eased with various therapies injected into the eye.
Putting it simply, Gonzalez said these therapies to treat wet AMD “all basically do the same thing. They make these new blood vessels regress temporarily before they cause damage to the macula.”
The injected medication clears away those blood vessels and restores the architecture of the macula. People can recover some vision in this way, but it’s only a temporary tune-up, and shots must be given as often as once a month.
“Degeneration of the cells is still the main problem. You’re not stopping that. But degeneration itself is a lot slower than actual vision loss associated with these blood vessels.”
The Struggle in Developing New Treatments
According to Keenan, “nobody has been able to stop geographic atrophy from happening” in either form of AMD. “So, that’s the main work in the field with trials.”
In December 2023, the FDA approved two new drugs: Syfovre and Izervay, both of which only slow geographic atrophy. Degeneration still happens, regardless.
Keenan explained how these two new drugs are “complement inhibitors … given by injection into the eye once a month or so.”
“Complement” refers to the body’s complement pathway, a trigger that activates a cascade of proteins in enhancing immune response.
Clinical trials showed Syfovre slowing the rate of geographic atrophy by up to 22% over 2 years, and Izervay up to 14% over 1 year.
Though these drugs are a new weapon against this troublesome affliction, they aren’t without their complications.
“Anytime you give an injection in the eye, there’s always the risk of an infection because you’re introducing something from the outside. So that’s the biggest risk,” explained Gonzalez.
An infection is uncommon, but potentially devastating, as you can lose your eye altogether. There’s also the chance of a damaging reaction to the shot.
“You have to pick and choose your patients,” said Gonzalez. “Not everybody is a good candidate for those new shots … and the patient is never going to see better. … It’s a harder sell than the ones for wet AMD.”
A Common Protective Measure
Keenan and Gonzalez both have a fair degree of confidence in reducing the risk of AMD with vitamin therapy.
As a bit of background on how vitamins were found to act as a sort of preventive measure, Gonzalez said, “In the early and late ‘90s, there were series of studies which were called the age-related eye disease studies.” These are now referred to as AREDS 1 and AREDS 2.
Researchers proved that a certain cocktail of vitamins slowed down degeneration. The most is a combo of antioxidants: vitamins C and E and lutein and zeaxanthin, all of which are in the AREDS 2 formula.
People who took these vitamins had a lower chance of losing their vision over the next 2 to 5 years. “[The combo] seems to be complementary and additive … with a combined treatment effect of 55% to 60%, an excellent safety record, and very low cost,” Keenan said.
Gonzalez recommends the AREDS 2 formula of vitamins to every patient of his. “It’s such an easy thing to take, and the downside is minimal.”
Unfortunately, if your genes make you more likely to have the condition, a change in diet or vitamin use could have no effect.
Dire? Possibly. But not all is lost in this fight.
Vigilance with AMD and What to Do Next if You’re Diagnosed
Gonzalez is adamant in educating his patients before time has run out on treating AMD. Recognition is key. “The most common reason a lot of these people get to me ‘too late’ is they don’t realize there’s a problem.”
He explained a typical scenario: “Let’s say you have macular degeneration in both eyes at different stages. One of your eyes starts developing wet macular degeneration … so the better eye takes over and you may not notice there’s a problem.”
Even after a patient is diagnosed with AMD, they usually see a specialist only twice a year. Gonzalez often tells his patients to cover one of their eyes to make sure their vision is intact in both eyes. “You’ll be able to pick up on subtle differences” in each eye, he said.
This type of self-care and vigilance can be the difference between successfully living with and treating the disease for the rest of your life, and trying to get help when it’s simply too late.
For wet AMD, as mentioned before, a round of injections is basically what everyone does. Without quick, invasive treatment, the point of no return approaches rapidly.
May 16, 2024 – Multiple U.S. agencies are working to contain the recent bird flu outbreak among cattle to prevent further spread to humans (beyond one case reported in early April) and use what we learned before, during, and after the COVID-19 pandemic to keep farm workers and the general public safe.
Fingers crossed, the bird flu will be contained and peter out. Or the outbreak could continue to spread among dairy cattle and other animals, threatening the health and livelihoods of farmers and others who work with livestock.
Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.
With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.
Communication with the public “about what we know, what we don’t know, and ways you and your family can stay safe is a priority for us at CDC,” said Nirav D. Shah, MD, JD, the CDC’s principal deputy director. “We at the federal level are responding, and we want the public to be following along.”
People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.
It is essential to not only stay informed, but to seek trusted sources of information, Shah said during “Bird Flu 2024 – What You Need to Know,” an online briefing jointly sponsored by the CDC and WebMD.
An ‘Experimental Hamburger’
If one take-home message emerged from the event, it was that the threat to the general public remains low.
The retail milk supply is safe, although consuming raw or unpasteurized milk is not recommended. “While commercial milk supply is safe, we strongly advise against drinking raw milk,” said Donald A. Prater, DVM, acting director for the FDA’s Center for Food Safety and Applied Nutrition.
As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.
For years, federal inspectors have purchased and tested meat at retail stores, said Eric Deeble, DVM, USDA deputy assistant secretary for the Office of Congressional Relations. So far, H5N1, the virus behind bird flu, has not been detected in beef.
The USDA took testing a step further and recently cooked ground beef from dairy cows in their lab. Using what Deeble described as an “experimental hamburger,” the agency showed cooking beef to 165 F or higher kills the virus if it ever becomes necessary.
The federal government now requires all cattle be tested and be free of bird flu virus before crossing any state lines. The government is also reimbursing farmers for veterinary care and loss of business related to the outbreak, and supply personal protective equipment (PPE) like gloves, masks, and face shields to workers.
Vaccination Not Recommended Now
Federal scientists know enough about H5N1 virus to create vaccines against it quickly if the need arises. It’s more about planning ahead at this point. “Vaccines are not part of our response right now,” said David Boucher, PhD, director of infectious diseases preparedness and response at the Administration for Strategic Preparedness and Response.
If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.
An event attendee asked if the seasonal flu shot offers any protection. “Unfortunately, the flu shot you got last year does not provide great protection from the avian flu,” Shah responded. “It might do a little bit … but that is the vaccine for seasonal flu. This is something more novel.”
Treatments Stockpiled and Ready
Antiviral medications, which if given early in the course of bird flu infection could shorten the severity or duration of illness, are available now, Shah said. The dairy farmer who was infected with bird flu earlier this year responded to oseltamivir (Tamiflu) treatment, for example.
When it comes to bird flu symptoms, the fact that the only infected person reported so far this year developed pink eye, also known as conjunctivitis, is interesting, Shah said. Officials would have expected to see more typical seasonal flu symptoms, he added.
“Influenza is not a new virus,” Boucher said. “With this strain of influenza, we are not seeing any genetic markers associated with resistance to antivirals. That means the antivirals we take for seasonal influenza would also be available if needed to treat H5N1.”
ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.
“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”
Science in Action
The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.
“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.
Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”
For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.
May 16, 2024 – Multiple U.S. agencies are working to contain the recent bird flu outbreak among cattle to prevent further spread to humans (beyond one case reported in early April) and use what we learned before, during, and after the COVID-19 pandemic to keep farm workers and the general public safe.
Fingers crossed, the bird flu will be contained and peter out. Or the outbreak could continue to spread among dairy cattle and other animals, threatening the health and livelihoods of farmers and others who work with livestock.
Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.
With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.
Communication with the public “about what we know, what we don’t know, and ways you and your family can stay safe is a priority for us at CDC,” said Nirav D. Shah, MD, JD, the CDC’s principal deputy director. “We at the federal level are responding, and we want the public to be following along.”
People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.
It is essential to not only stay informed, but to seek trusted sources of information, Shah said during “Bird Flu 2024 – What You Need to Know,” an online briefing jointly sponsored by the CDC and WebMD.
An ‘Experimental Hamburger’
If one take-home message emerged from the event, it was that the threat to the general public remains low.
The retail milk supply is safe, although consuming raw or unpasteurized milk is not recommended. “While commercial milk supply is safe, we strongly advise against drinking raw milk,” said Donald A. Prater, DVM, acting director for the FDA’s Center for Food Safety and Applied Nutrition.
As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.
For years, federal inspectors have purchased and tested meat at retail stores, said Eric Deeble, DVM, USDA deputy assistant secretary for the Office of Congressional Relations. So far, H5N1, the virus behind bird flu, has not been detected in beef.
The USDA took testing a step further and recently cooked ground beef from dairy cows in their lab. Using what Deeble described as an “experimental hamburger,” the agency showed cooking beef to 165 F or higher kills the virus if it ever becomes necessary.
The federal government now requires all cattle be tested and be free of bird flu virus before crossing any state lines. The government is also reimbursing farmers for veterinary care and loss of business related to the outbreak, and supply personal protective equipment (PPE) like gloves, masks, and face shields to workers.
Vaccination Not Recommended Now
Federal scientists know enough about H5N1 virus to create vaccines against it quickly if the need arises. It’s more about planning ahead at this point. “Vaccines are not part of our response right now,” said David Boucher, PhD, director of infectious diseases preparedness and response at the Administration for Strategic Preparedness and Response.
If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.
An event attendee asked if the seasonal flu shot offers any protection. “Unfortunately, the flu shot you got last year does not provide great protection from the avian flu,” Shah responded. “It might do a little bit … but that is the vaccine for seasonal flu. This is something more novel.”
Treatments Stockpiled and Ready
Antiviral medications, which if given early in the course of bird flu infection could shorten the severity or duration of illness, are available now, Shah said. The dairy farmer who was infected with bird flu earlier this year responded to oseltamivir (Tamiflu) treatment, for example.
When it comes to bird flu symptoms, the fact that the only infected person reported so far this year developed pink eye, also known as conjunctivitis, is interesting, Shah said. Officials would have expected to see more typical seasonal flu symptoms, he added.
“Influenza is not a new virus,” Boucher said. “With this strain of influenza, we are not seeing any genetic markers associated with resistance to antivirals. That means the antivirals we take for seasonal influenza would also be available if needed to treat H5N1.”
ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.
“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”
Science in Action
The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.
“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.
Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”
For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.
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