Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: a prospective urban rural epidemiologic (PURE) study.
The measurement of handgrip strength (HGS) has prognostic value with respect to all-cause mortality, cardiovascular mortality and cardiovascular disease, and is an important part of the evaluation of frailty. Published reference ranges for HGS are mostly derived from Caucasian populations in high-income countries. There is a paucity of information on normative HGS values in non-Caucasian populations from low- or middle-income countries. The objective of this study was to develop reference HGS ranges for healthy adults from a broad range of ethnicities and socioeconomically diverse geographic regions.



HGS was measured using a Jamar dynamometer in 125,462 healthy adults aged 35-70 years from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study.



HGS values differed among individuals from different geographic regions. HGS values were highest among those from Europe/North America, lowest among those from South Asia, South East Asia and Africa, and intermediate among those from China, South America, and the Middle East. Reference ranges stratified by geographic region, age, and sex are presented. These ranges varied from a median (25th-75thpercentile) 50 kg (43-56 kg) in men <40 years from Europe/North America to 18 kg (14-20 kg) in women >60 years from South East Asia. Reference ranges by ethnicity and body-mass index are also reported.



Individual HGS measurements should be interpreted using region/ethnic-specific reference ranges.
The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada.
Darryl P
DP
Leong
The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada.
Koon K
KK
Teo
The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada.
Sumathy
S
Rangarajan
Health Action by People, 'Chemmanam', Navarangam Lane Medical College Post Office Trivandrum India.
V Raman
VR
Kutty
Universidad de La Frontera Chile.
Fernando
F
Lanas
Medical Research & Biometrics Center National Center for Cardiovascular Diseases, FuWai Hospital Beijing China.
Chen
C
Hui
Jiangsu Provincial Center for Disease Control &12 Prevention Nanjing City China.
Xiang
X
Quanyong
Jiangxinzhou community health service center Nanjing City China.
Qian
Q
Zhenzhen
Xiaohang Hospital Nanjing City China.
Tang
T
Jinhua
Universiti Kebangsaan Malaysia Medical Center(UKMMC) Kuala Lumpur Malaysia.
Ismail
I
Noorhassim
Department of Cardiac Sciences, King Fahad Cardiac Center College of Medicine, King Saud University Riyadh Saudi Arabia.
Khalid F
KF
AlHabib
North-West University Physical activity, Sport and Recreation Research Focus Area, Faculty of Health Sciences Potchefstroom South Africa.
Sarah J
SJ
Moss
Sahlgrenska University Hospital/Östra Hospital Göteborg Sweden.
Annika
A
Rosengren
Department of Family Medicine and Department of Medical Education Yeditepe University Medical Faculty Atasehir, Istanbul Turkey.
Ayse Arzu
AA
Akalin
Independent University Bangladesh Bangladesh.
Omar
O
Rahman
University of Zimbabwe College of Health Sciences Department of Physiology Harare.
Jephat
J
Chifamba
Estudios Clínicos Latino America Rosario Argentina.
Andrés
A
Orlandini
PGIMER School of Public Health Chandigarh India.
Rajesh
R
Kumar
Department of Medicine Queen's University Kingston ON Canada.
Karen
K
Yeates
Fortis Escorts Hospital Jaipur India.
Rajeev
R
Gupta
Hatta Hospital, Dubai Health Authority Dubai.
Afzalhussein
A
Yusufali
College of Medicine University of the Philippines - Manila Malate Philippines.
Antonio
A
Dans
Dante Pazzanese Institute of Cardiology São Paulo Brazil.
Álvaro
Á
Avezum
Fundacion Oftalmologica de Santander (FOSCAL) Universidad de Santander (UDES) Bucaramanga Colombia.
Patricio
P
Lopez-Jaramillo
Institut universitaire de cardiologie et de pneumologie de Québec Québec Canada.
Paul
P
Poirier
Cardiac Rehabilitation Research Center Isfahan University of Medical Sciences Isfahan Iran.
Hosein
H
Heidari
Department of Social Medicine Medical University of Wroclaw Poland.
Katarzyna
K
Zatonska
Departments of Community Health Sciences and Medicine Aga Khan University Pakistan.
Romaina
R
Iqbal
Institute of Community and Public Health Birzeit University Ramallah Palestine.
Rasha
R
Khatib
The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada.
Salim
S
Yusuf
D000328:Adult; D000368:Aged; D005163:Factor Analysis, Statistical; D005260:Female; D018737:Hand Strength; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012016:Reference Values; D011795:Surveys and Questionnaires
handgrip strength; muscle strength; normative range; reference range; reference value