The link with Mortality

3 Dec 2017

Muscle Weakness and the link with Mortality

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60 Studies

These studies firmly establish the link between muscle weakness and early death.

Some measure handgrip strength, others use the large axial and limb muscles but all reach basically the same conclusion. The stronger you are, the longer you live and the less disability you suffer. This effect is independent of age, fitness, exercise and BMI (body weight).


Laukkanen, P., Heikkinen, E., & Kauppinen, M. (1995). Muscle strength and mobility as predictors of survival in 75-84-year- old people. Age and Ageing, 24(6), 468–473.

Blair, S. N. (1996). Influences of Cardiorespiratory Fitness and Other Precursors on Cardiovascular Disease and All-Cause Mortality in Men and Women. JAMA: The Journal of the American Medical Association, 276(3), 205.

Lee, C. D., Blair, S. N., & Jackson, a S. (1999). Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. The American Journal of Clinical Nutrition, 69(3), 373–80. Retrieved from

Rantanen, T., Harris, T., Leveille, S. G., Visser, M., Foley, D., Masaki, K., & Guralnik, J. M. (2000). Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 55(3), M168–M173.

Katzmarzyk, P. T., & Craig, C. L. (2002). Musculoskeletal fitness and risk of mortality. Medicine and Science in Sports and Exercise, 34(5), 740–744.

Rantanen, T., Volpato, S., Luigi Ferrucci, M., Eino Heikkinen, M., Fried, L. P., & Guralnik, J. M. (2003). Handgrip Strength and Cause-Specific and Total Mortality in Older Disabled Women: Exploring the Mechanism. Journal of the American Geriatrics Society, 51(5), 636–641.

FitzGerald, S. J., Barlow, C. E., Kampert, J. B., Morrow, J. R., Jackson, A. W., & Blair, S. N. (2004). Muscular Fitness and All-Cause Mortality: Prospective Observations. Journal of Physical Activity and Health, 1(1), 7–18.

Willardson, J. M., & Tudor-Locke, C. (2005). Survival of the Strongest: A Brief Review Examining the Association Between Muscular Fitness and Mortality. Strength and Conditioning Journal, 27(3), 80–85.[0080:SOTSAB]2.0.CO;2

Newman, A. B., Kupelian, V., Visser, M., Simonsick, E. M., Goodpaster, B. H., Kritchevsky, S. B., … Harris, T. B. (2006). Strength, but not muscle mass, is associated with mortality in the Health, Aging and Body Composition Study cohort. J Gerontol A Biol Sci Med Sci, 61(1), 72–77. [pii]

Sasaki, H., Kasagi, F., Yamada, M., & Fujita, S. (2007). Grip Strength Predicts Cause-Specific Mortality in Middle-Aged and Elderly Persons. The American Journal of Medicine, 120(4), 337–342.

Gale, C. R., Martyn, C. N., Cooper, C., & Sayer, A. A. (2007). Grip strength, body composition, and mortality. International Journal of Epidemiology, 36(1), 228–235.

Swallow, E. B., Reyes, D., Hopkinson, N. S., Man, W. D.-C., Porcher, R., Cetti, E. J., … Polkey, M. I. (2007). Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax, 62(2), 115–120.

Ali, N. A., O’Brien, J. M., Hoffmann, S. P., Phillips, G., Garland, A., Finley, J. C. W., … Marsh, C. B. (2008). Acquired weakness, handgrip strength, and mortality in critically III patients. American Journal of Respiratory and Critical Care Medicine, 178(3), 261–268.

Ruiz, J. R., Sui, X., Lobelo, F., Morrow, J. R., Jackson, A. W., Sjostrom, M., & Blair, S. N. (2008). Association between muscular strength and mortality in men: prospective cohort study. Bmj, 337(jul01 2), a439–a439.

Ruiz, J. R., Castro-Pinero, J., Artero, E. G., Ortega, F. B., Sjostrom, M., Suni, J., & Castillo, M. J. (2009). Predictive validity of health-related fitness in youth: a systematic review. British Journal of Sports Medicine, 43(12), 909–923.

Ruiz, J. R., Sui, X., Lobelo, F., Lee, D. C., Morrow, J. R., Jackson, A. W., … Blair, S. N. (2009). Muscular strength and adiposity as predictors of adulthood cancer mortality in men. Cancer Epidemiology Biomarkers and Prevention, 18(5), 1468–1476.

Xue, Q. L., Beamer, B. A., Chaves, P. H. M., Guralnik, J. M., & Fried, L. P. (2010). Heterogeneity in rate of decline in grip, hip, and knee strength and the risk of all-cause mortality: The women’s health and aging study II. Journal of the American Geriatrics Society, 58(11), 2076–2084.

Phillips, A. C., Der, G., & Carroll, D. (2010). Self-reported health, self-reported fitness, and all-cause mortality: Prospective cohort study. British Journal of Health Psychology, 15(2), 337–346.

Han, S. S., Kim, K. W., Kim, K.-I., Na, K. Y., Chae, D.-W., Kim, S., & Chin, H. J. (2010). Lean Mass Index: A Better Predictor of Mortality than Body Mass Index in Elderly Asians. Journal of the American Geriatrics Society, 58(2), 312–317.

Artero, E. G., Lee, D., Ruiz, J. R., Sui, X., Ortega, F. B., Church, T. S., … Blair, S. N. (2011). A Prospective Study of Muscular Strength and All-Cause Mortality in Men With Hypertension. Journal of the American College of Cardiology, 57(18), 1831–1837.

Sundermann, S., Dademasch, A., Rastan, A., Praetorius, J., Rodriguez, H., Walther, T., … Falk, V. (2011). One-year follow-up of patients undergoing elective cardiac surgery assessed with the Comprehensive Assessment of Frailty test and its simplified form. Interactive CardioVascular and Thoracic Surgery, 13(2), 119–123.

Norman, K., Stobäus, N., Gonzalez, M. C., Schulzke, J. D., & Pirlich, M. (2011). Hand grip strength: Outcome predictor and marker of nutritional status. Clinical Nutrition.

Artero, E. G., Lee, D., Lavie, C. J., España-Romero, V., Sui, X., Church, T. S., & Blair, S. N. (2012). Effects of Muscular Strength on Cardiovascular Risk Factors and Prognosis. Journal of Cardiopulmonary Rehabilitation and Prevention, 32(6), 351–358.

Masunari, N., Fujiwara, S., Kasagi, F., Takahashi, I., Yamada, M., & Nakamura, T. (2012). Height loss starting in middle age predicts increased mortality in the elderly. Journal of Bone and Mineral Research, 27(1), 138–145.

Garc??a-Pe??a, C., Garc??a-Fabela, L. C., Guti??rrez-Robledo, L. M., Garc??a-Gonz??lez, J. J., Arango-Lopera, V. E., & P??rez-Zepeda, M. U. (2013). Handgrip Strength Predicts Functional Decline at Discharge in Hospitalized Male Elderly: A Hospital Cohort Study. PLoS ONE, 8(7).

Schaap, L. A., Koster, A., & Visser, M. (2013). Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiologic Reviews, 35(1), 51–65.

Cheung, C. L., Nguyen, U. S. D. T., Au, E., Tan, K. C. B., & Kung, A. W. C. (2013). Association of handgrip strength with chronic diseases and multimorbidity: A cross-sectional study. Age, 35(3), 929–941.

Puhan, M. A., Siebeling, L., Zoller, M., Muggensturm, P., & Riet, G. Ter. (2013). Simple functional performance tests and mortality in COPD. European Respiratory Journal, 42(4), 956–963.

Isaia, G., Greppi, F., Pastorino, A., Bersano, E. M., Rrodhe, S., Ricauda, N. A., … Zanocchi, M. (2013). Predictive effects of muscle strength after hospitalization in old patients. Aging Clinical and Experimental Research, 25(6), 633–636.

Savino, E., Martini, E., Lauretani, F., Pioli, G., Zagatti, A. M., Frondini, C., … Volpato, S. (2013). Handgrip strength predicts persistent walking recovery after hip fracture surgery. American Journal of Medicine, 126(12).

Chuang, S. Y., Chang, H. Y., Lee, M. S., Chia-Yu Chen, R., & Pan, W. H. (2014). Skeletal muscle mass and risk of death in an elderly population. Nutrition, Metabolism and Cardiovascular Diseases, 24(7), 784–791.

de Brito, L. B. B., Ricardo, D. R., de Araújo, D. S. M. S., Ramos, P. S., Myers, J., & de Araújo, C. G. S. (2014). Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology, 21(7), 892–898.

Hermans, G., Van Mechelen, H., Clerckx, B., Vanhullebusch, T., Mesotten, D., Wilmer, A., … Van Den Berghe, G. (2014). Acute outcomes and 1-year mortality of intensive care unit-acquired weakness: A cohort study and propensity-matched analysis. American Journal of Respiratory and Critical Care Medicine, 190(4), 410–420.

Matos, C. M., Silva, L. F., Santana, L. D., Santos, L. S., Protásio, B. M., Rocha, M. T., … Lopes, A. A. (2014). Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis: A 4-year study. Journal of Renal Nutrition, 24(3), 157–162.

Timpka, S., Petersson, I. F., Zhou, C., & Englund, M. (2014). Muscle strength in adolescent men and risk of cardiovascular disease events and mortality in middle age: a prospective cohort study. BMC Medicine, 12(1), 62.

Rowe, R., Iqbal, J., Murali-Krishnan, R., Sultan, A., Orme, R., Briffa, N., … Gunn, J. (2014). Role of frailty assessment in patients undergoing cardiac interventions. Open Heart, 1(1), e000033.

Srikanthan, P., & Karlamangla, A. S. (2014). Muscle mass index as a predictor of longevity in older adults. American Journal of Medicine, 127(6), 547–553.

Legrand, D., Vaes, B., Matheï, C., Adriaensen, W., Van Pottelbergh, G., & Degryse, J. M. (2014). Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old. Journal of the American Geriatrics Society, 62(6), 1030–1038.

Donoghue, O. A., Savva, G. M., Cronin, H., Kenny, R. A., & Horgan, N. F. (2014). Using timed up and go and usual gait speed to predict incident disability in daily activities among community-dwelling adults aged 65 and older. Archives of Physical Medicine and Rehabilitation, 95(10), 1954–1961.

Bohannon, R. W., & Magasi, S. (2015). Identification of dynapenia in older adults through the use of grip strength t-scores. Muscle and Nerve, 51(1), 102–105.

Dodds, R., & Sayer, A. A. (2015). Sarcopenia and frailty: new challenges for clinical practice. Clinical Medicine, 15(Suppl_6), s88–s91.

Sayer, A. A., & Kirkwood, T. B. L. (2015). Grip strength and mortality: A biomarker of ageing? The Lancet, 386(9990), 226–227.

Guadalupe-Grau, A., Carnicero, J. A., Gómez-Cabello, A., Avila, G. G., Humanes, S., Alegre, L. M., … García-García, F. J. (2015). Association of regional muscle strength with mortality and hospitalisation in older people. Age and Ageing, 44(5), 790–795.

Rijk, J. M., Roos, P. R., Deckx, L., van den Akker, M., & Buntinx, F. (2015). Prognostic value of handgrip strength in people aged 60 years and older: A systematic review and meta-analysis. Geriatrics & Gerontology International, n/a-n/a.

Costa, T. M. da R. L., Costa, F. M., Moreira, C. A., Rabelo, L. M., Boguszewski, C. L., & Borba, V. Z. C. (2015). Sarcopenia in COPD: relationship with COPD severity and prognosis. Jornal Brasileiro de Pneumologia, 41(5), 415–421.

Leong, D. P., Teo, K. K., Rangarajan, S., Lopez-Jaramillo, P., Avezum, A., Orlandini, A., … Yusuf, S. (2015). Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet, 386(9990), 266–273.

Martien, S., Delecluse, C., Boen, F., Seghers, J., Pelssers, J., Van Hoecke, A. S., & Van Roie, E. (2015). Is knee extension strength a better predictor of functional performance than handgrip strength among older adults in three different settings? Archives of Gerontology and Geriatrics, 60(2), 252–258.

Volaklis, K. A., Halle, M., & Meisinger, C. (2015). Muscular strength as a strong predictor of mortality: A narrative review. European Journal of Internal Medicine.

Martín-Ponce, E., Hernández-Betancor, I., González-Reimers, E., Hernández-Luis, R., Martínez-Riera, A., & Santolaria, F. (2015). Prognostic value of physical function tests: hand grip strength and six-minute walking test in elderly hospitalized patients. Scientific Reports, 4(1), 7530.

Lino, V. T. S., Rodrigues, N. C. P., O’Dwyer, G., Andrade, M. K. D. N., Mattos, I. E., & Portela, M. C. (2016). Handgrip strength and factors associated in poor elderly assisted at a primary care unit in Rio de Janeiro, Brazil. PLoS ONE, 11(11).

Kraschnewski, J. L., Sciamanna, C. N., Poger, J. M., Rovniak, L. S., Lehman, E. B., Cooper, A. B., … Ciccolo, J. T. (2016). Is strength training associated with mortality benefits? A 15 year cohort study of US older adults. Preventive Medicine, 87, 121–127.

Ding, L., & Yang, F. (2016). Muscle weakness is related to slip-initiated falls among community-dwelling older adults. Journal of Biomechanics, 49(2), 238–243.

McLeod, M., Breen, L., Hamilton, D. L., & Philp, A. (2016). Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology, 17(3), 497–510.

Fragala, M. S., Alley, D. E., Shardell, M. D., Harris, T. B., McLean, R. R., Kiel, D. P., … Kenny, A. M. (2016). Comparison of Handgrip and Leg Extension Strength in Predicting Slow Gait Speed in Older Adults. Journal of the American Geriatrics Society, 64(1), 144–150.

Strand, B. H., Cooper, R., Bergland, A., Jørgensen, L., Schirmer, H., Skirbekk, V., & Emaus, N. (2016). The association of grip strength from midlife onwards with all-cause and cause-specific mortality over 17 years of follow-up in the Tromsø Study. Journal of Epidemiology and Community Health, 70(12), 1214–1221.

Rossi, A. P., Fantin, F., Caliari, C., Zoico, E., Mazzali, G., Zanardo, M., … Zamboni, M. (2016). Dynapenic abdominal obesity as predictor of mortality and disability worsening in older adults: A 10-year prospective study. Clinical Nutrition, 35(1), 199–204.

Leong, D. P., Teo, K. K., Rangarajan, S., Kutty, V. R., Lanas, F., Hui, C., … Yusuf, S. (2016). Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: a prospective urban rural epidemiologic (PURE) study. Journal of Cachexia, Sarcopenia and Muscle, 7(5), 535–546.

Gaikwad, N. R., Gupta, S. J., Samarth, A. R., & Sankalecha, T. H. (2016). Handgrip dynamometry: A surrogate marker of malnutrition to predict the prognosis in alcoholic liver disease. Annals of Gastroenterology, 29(4), 509–514.

Celis-Morales, C. A., Lyall, D. M., Anderson, J., Iliodromiti, S., Fan, Y., Ntuk, U. E., … Gill, J. M. R. (2017). The association between physical activity and risk of mortality is modulated by grip strength and cardiorespiratory fitness: Evidence from 498 135 UK-Biobank participants. European Heart Journal, 38(2), 116–122.

Menant, J. C., Weber, F., Lo, J., Sturnieks, D. L., Close, J. C., Sachdev, P. S., … Lord, S. R. (2017). Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia? Osteoporosis International, 28(1), 59–70.


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