Why I believe that Grip Strength should be the fifth vital sign

For hundreds of years doctors have been using vital signs to help them better determine stability, risk, prediction of outcome in their patients. They are important markers of pathology providing doctors with essential, real-time information about a patient’s immediate health. I have used these signs every day of my professional life —body temperature, pulse, respiratory rate, and blood pressure to help me identify issues before they escalate, teaching my students the importance of rapid reaction to their changes. Thanks to the stethoscope, invented by René Laennec in 1816, the way physicians assess vital signs, especially for heart rate and blood pressure was revolutionized.

I believe it is time to introduce a fifth vital sign: grip strength, as it offers insights into physical resilience, frailty, and even mortality risk in ways that other measures can’t. Grip strength truly deserves to be considered the fifth vital sign.

This belief is personal for me as my mother, who had always been active, experienced a severe fall earlier this year. She has not recovered since, and her health has been a downward spiral, months later she no longer walks, lost her ability to be independent. I realized only later that her grip strength had been weakening for months, which should have signaled her increasing frailty. If we had recognized the signs earlier, we might have intervened and prevented the fall.

Falls cost the U.S. healthcare system $50 billion annually, and that figure is expected to rise to $100 billion by 2030 due to an aging population. What many don’t realize is that falls are often tied to frailty, and grip strength is one of the easiest ways to detect it. My mother’s fall was more than just a personal tragedy—it opened my eyes to the ways we can prevent these incidents through early detection.

When I came across a study by Leong et al. (2015) in The Lancet, it completely changed how I thought about grip strength. This large-scale study followed 140,000 participants across 17 countries and found that weak grip strength was a stronger predictor of mortality than even blood pressure. People with weaker grip strength had a 16% higher risk of death from all causes, including cardiovascular diseases and cancer. This insight blew my mind. Grip strength, something we barely think about, could be such a powerful marker of overall health.

Even better, grip strength is measured in just 5 to 10 seconds using a dynamometer, a simple and non-invasive tool. If this one quick test can provide such critical insights into a person’s health, why aren’t we using it more routinely? If my mother's GP had tested grip strength over her many visitis (she loved to see her doctors and would not miss a single appointment), he could have seen the signs of her frailty earlier and alerted us perhaps preventing her fall.

Japanese researchers showed how just 7 minutes of simple strength exercises daily could significantly improve grip strength. This intervention could have been life-changing for my mom. These exercises, such as squeezing a stress ball or using light resistance bands, improve grip strength in just six weeks. Imagine how much more we could be doing for older adults with just a few minutes a day.

Grip strength isn’t just a physical marker—it’s connected to mental well-being too. Strength training increases levels of brain-derived neurotrophic factor (BDNF), which plays a crucial role in memory and cognitive function. Research by Cassilhas et al. (2012) demonstrated that regular strength training improves BDNF levels, protecting against age-related cognitive decline. This means that grip strength can provide insight into both physical and cognitive health.

And there is more, Strength training boosts serotonin and dopamine, the neurotransmitters responsible for regulating mood and promoting positive behaviors. In fact, consistent resistance training has been shown to help alleviate symptoms of anxiety and depression, while also helping to establish healthy habits.

Another major benefit of strength training is its impact on immune function. A study by Nieman et al. (1990) found that strength training increased the activity of natural killer (NK) cells and T-cells, which are essential for fighting infections. Regular resistance training can bolster the immune system, reducing the likelihood of illness.

Moreover, strength training has been linked to better sleep quality. Dolezal et al. (2014) showed that older adults who engaged in regular strength exercises experienced improved sleep efficiency, shorter time to fall asleep, and longer periods of deep sleep. Improved sleep also helps regulate metabolism and reduces the risk of metabolic disorders such as type 2 diabetes.

The beauty of grip strength is that it’s modifiable. Simple exercises, such as squeezing a stress ball, doing wrist flexions with light weights, or performing towel twists, can improve grip strength significantly over time. Even bedridden patients can engage in these exercises from a seated or lying-down position.

Incorporating grip strength as the fifth vital sign would allow doctors to identify frailty sooner, potentially preventing falls and improving long-term health outcomes. It’s a quick, non-invasive test that can offer valuable insights into both physical and mental health. I believe that by embracing this measure, we could save lives, reduce healthcare costs, and improve quality of life for so many people.

A strong grip is the first sign of strong health.