Performance Status Nutrition

Handgrip Strength

Measuring grip strength is a proactive method of assessing inflammation, strength and fatigue.

MONITORING METHODSBASELINE MEASURE

4/29/20265 min read

Handgrip assessment as a proactive method of assessing inflammation

Our goal at Performance Status Nutrition is to help you be proactive and determine what tools and interventions may help you perform the best that you can. Rather than be reactive and deal with a full-on flare for weeks or months, we want to provide information that allows you to be proactive and identify your baseline metrics and methods of monitoring your performance status ahead of any active flare or treatment that you have to face. Our maxim here is: BASELINE MEASURE-MONITOR-PREVENT or INTERVENE. Know your baseline values, monitor those values on the regular and then take action to prevent inflammation flares or start early interventions to shorten a flare or reaction to a treatment or training regimen. Today we want to teach you about Handgrip monitoring.


Skeletal muscle, when contracted, releases cytokines and myokines that can reduce inflammation. A common biomarker of general inflammation, known as C-reactive protein or CRP, increases after muscle building exercises. Usually elevations in CRP are not favorable in chronic diseases but as we now know, cytokines can be both pro-inflammatory and anti-inflammatory depending on the context. With muscle contraction (accompanied by the appropriate rest) this temporary elevation is a positive thing. Studies have proved that exercise at the appropriate level will exert an anti-inflammatory effect in the long run. Handgrip assessment is a method to not only assess overall muscle strength, it can also inform us what is happening at the cellular level and metabolic health as a result of balanced myokine production. Since inflammation can be fluctuating, grip strength can also fluctuate and is highly responsive to increased inflammation, increased nutrition and recovery time. As a nutrition monitoring tool, grip strength is one of the first measures to improve as nutrition status improves. If you are exercising and doing strength training, the cellular changes will show up in a grip test before we see increases in the size of the muscle. The opposite is also true, if nutrition declines again then grip strength will reduce quickly. For this reason, hand grip assessment is great for measuring the response to a treatment or intervention or predicting an outcome.

Below are a few examples of how handgrip assessment is used in various conditions or situations:

  • Grip strength values are predictive of morbidity and mortality. The higher the grip strength, the better our bodies fight chronic illness and weather the impacts of aging.

  • Grip strength values are related to insulin and glucose values. As insulin and glucose decrease, handgrip increases.

  • Grip strength values are related to nutritional status. In malnourished individuals, grip strength improvement accompanies improved nutritional status.

  • Grip strength is a measure of functional status. Many definitions of sarcopenia or frailty use grip strength as a clinical marker. Higher grip strength is related to more muscle mass, less falls and increased ability to do daily activities.

  • Grip strength is predictive of surgical outcomes. Measuring grip strength prior to elective surgery may help outcomes if there is time for pre-hab to improve strength.

  • Grip strength is associated with successful rehab and discharge to home after hospitalization.

  • Grip strength is associated with overall cancer survival, even in advanced or palliative cancer cases.

  • Although muscle and joint diseases such as Multiple Sclerosis or Rheumatoid Arthritis have lower grip strength, regular measures during treatment are helpful at determining responses to therapy or medications and can diagnose post exertional fatigue in those with Myalgic Encephalitis Chronic Fatigue Syndrome.

  • Grip strength decline in athletes, may indicate neuromuscular fatigue and an early sign of overtraining.

  • Grip strength below baseline in athletes may indicate inadequate recovery time. (5-10% below baseline may warrant training adjustments).

  • Post training or competition measures in athletes may help measure fatigue.


Measuring hand-grip strength


  1. Hand Dynamometer is used to measure grip strength

    • The most common tool used in research is called the Jamar hydraulic dynamometer yet this tool is bulky and may be less practical for home use.

    • Handheld dynamometers are more available in wellness centers, doctors offices or even affordable for home use.

  2. Body Position

    • Sitting in chair

    • Feet flat on floor

    • Arm supported with armrest with 90 degree at elbow

    • Wrist at 0 to 30 degrees while holding the dynamometer where 4 fingers of hand is comfortable and adjusted so that it is not too tight or too loose around grip with thumb at the side

  3. Handgrip Technique

    • Squeeze the grip as hard as possible for 3 to 5 seconds with dominate hand

    • Repeat 3 times with 1 minute rest between each measure

    • Take the highest maximal grip and use that as the measure result



Result Comparison

  • There are reference tables available to determine if your baseline measure is considered low or diagnostic for sarcopenia. These reference tables will be based on gender, age, and medical conditions. When purchasing a hand dynamometer, reference guides with manufacturer recommendations will often be included for use.

  • The best use of handgrip will be to obtain your baseline value and use that value to compare with subsequent values. The change in subsequent values to baseline is helpful in determining improved grip strength. It is best to get a baseline value when inflammatory illness is stable or in remission. Below are a few examples of what the results could indicate.

    • Stable handgrip compared to baseline may indicate good recovery

    • Decreased handgrip compared to baseline may indicate poor recovery, increased inflammation or fatigue, decreased muscle function and/or strength.

    • Increased handgrip compared to baseline may indicate less inflammation or fatigue, increased strength with adequate recovery.


Monitoring helpful tips

  • Measure grip strength consistently

    • For autoimmune illness, daily or weekly may help guide pacing and plan daily activities. Morning testing is especially helpful to quantify morning stiffness.

    • For athletes, pre and post training or competition may inform coaches of planned training activities.

    • For strength training, weekly or monthly assessments are adequate depending on when added resistance is used in the workouts.

    • During cancer treatments, weekly measures along with other performance status scales can inform your oncologists of your changes in performance status.

  • Monitor trends along with tracking other factors such as:

    • Medications

    • Physical activity

    • Treatment or surgery

    • Illness symptoms

    • Self assessment questions (fatigue scales, Performance scales etc).


Summary Key Points:

  • Inflammatory mediators affect grip strength

  • Increases in grip strength may indicate better inflammatory control in inflammatory diseases

  • Grip strength assessment is a good proxy for total body muscle strength and function

  • Grip strength is a value that should be checked in all people, just as other vital signs such as body temperature, heart rate or blood pressure.

  • Monitoring grip strength is another tool to inform you of changes in your performance and functional status.

  • Obtain your baseline measure and determine a monitoring schedule to fit your unique situation.


References


Kathelijn Sophie Versteeg, Susanne Blauwhoff‐Buskermolen, Laurien M. Buffart, Marian A.E. de van der Schueren, Jacqueline A.E. Langius, Henk M.W. Verheul, Andrea B. Maier, Inge R. Konings, Higher Muscle Strength Is Associated with Prolonged Survival in Older Patients with Advanced Cancer, The Oncologist, Volume 23, Issue 5, May 2018, Pages 580–585, https://doi.org/10.1634/theoncologist.2017-0193

Cavalheiro do Espirito Santo R, Peterson Dos Santos L, Melo G, Dubey V, Agostinis-Sobrinho C. Longitudinal monitoring of handgrip strength in rheumatoid arthritis: a window into for disease activity-a systematic review with meta-analysis. BMJ Open Sport Exerc Med. 2025 Nov 21;11(4):e002617. doi: https://doi.org/10.1136/bmjsem-2025-002617

Vaishya R, Misra A, Vaish A, Ursino N, D'Ambrosi R. Hand grip strength as a proposed new vital sign of health: a narrative review of evidences. J Health Popul Nutr. 2024 Jan 9;43(1):7. Doi: https://doi.org/10.1186/s41043-024-00500-y

A.Tur-Boned, L. L.Andersen, R.López-Bueno, et al., “Dose–Response Association Between Handgrip Strength and All-Cause Mortality Across Different Levels of Systemic Inflammation,” Journal of Cachexia, Sarcopenia and Muscle17, no. 2 (2026): e70272, https://doi.org/10.1002/jcsm.70272.

Cronin J, Lawton T, Harris N, Kilding A, McMaster DT. A Brief Review of Handgrip Strength and Sport Performance. J Strength Cond Res. 2017 Nov;31(11):3187-3217. Doi: https://doi.org/10.1519/jsc.0000000000002149