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Grip Strength as a Marker of Vitality in Mid-Life Women

April 20, 2022 by

Carla DiGirolamo, MD, NCMP, CF-L1

Loss of muscle mass and strength with age is related to many factors including the overall physiological changes with aging, reduced activity levels, and changing nutrition - among other factors. Excessive loss of muscle mass (sarcopenia) and strength (dynapenia) is a major cause of mortality and loss of independence and quality of life in the aging population.

Hand grip strength (HGS) is an accepted measure that reflects overall muscle strength and is widely used as a central marker for the onset of sarcopenia. Poor grip strength has been shown to correlate with low bone mineral density (BMD), depression, anxiety, sleep quality, fractures, diabetes, falls, and malnutrition. HGS is measured with a dynamometer and has come to be accepted as a simple, noninvasive, and inexpensive test to measure strength in older adults.

Greater attention is being paid to HGS as a predictor of decline in the female menopausal population with the goal of identifying risk factors early with the potential to intervene and mitigate the risk. Since December 2021 there have been 2 original articles and 2 editorials in the journal, Menopause speaking to this very issue. In one study, quality of life was measured over 5 parameters in 6000 menopausal Korean women. Greater HGS was associated with a greater quality of life score.  A second study of 249 menopausal women found that earlier age of menopause onset, greater adiposity (40% total body fat) adjusted by age, and osteopenia/osteoporosis were associated with low HGS.

A burning question that emerges from these studies is whether the onset of menopause itself causes a decline in muscle mass and strength that is independent of the expected decline that occurs due to age alone. Multiple studies have suggested that menopausal onset independently exacerbates age-related decline, however, the studies were small and should therefore be interpreted with caution.

However, it makes sense that the menopausal transition has an independent effect on muscle decline when we consider the physiologic relationship between estrogen decline and muscle function.

It is well-known that the number of estrogen “receptors” (cell surface proteins that receive estrogen signals) found on the surface of muscle cells decline as menopause approaches. This is likely related, in part, to the lower levels of estrogen circulating in the body. These circulating hormone and receptor changes are associated with:

  • A shift in the proportion of type 2 muscle fibers responsible for the short, powerful movement of heavy loads fueled by anaerobic metabolism toward the slow, sustained, more aerobic Type 1 muscle fibers.
  • Reduced speed and efficiency of signals from nerves to muscles.
  • A reduction of protein synthesis within the muscles that is necessary for muscle repair and adaptation.
  • Reduced overall muscle health, metabolism and ability to manage oxidative “stress” from cellular damage accumulated with age.
  • Insulin resistance: Reflected in a reduced ability of the muscle to utilize glucose from the bloodstream related to the changes noted above.

So how do we use this information as women and as wellness/health providers to help mitigate the risk of decline in our overall health and function? Does this mean that all we need to do is sit on the couch squeezing a hand stress ball while watching Netflix? Not quite.

The reason why grip strength is a good correlate of overall muscle strength is that the movements that require a strong grip are movements that involve a wide range of muscle groups.

A great everyday example is yard work - pruning bushes, mulching your flower beds, raking leaves, and moving heavy objects. These are functional movements that all require grip strength and overall muscle strength. In the CrossFit box, “pulling” movements such as farmer’s carries, pull-ups, dead-lifts, dumbbell or barbell rows, and curls - even jumping rope - all task grip strength in addition to upper and lower body strength and cardiovascular conditioning.

Below are two sample CrossFit-style workouts that, when combined with an appropriate warm-up and cool-down, can safely strengthen the upper and lower body as well as grip strength. Both workouts add a cardiovascular conditioning element which generates fatigue. Strengthening under conditions of fatigue is an effective way of building strength under resting conditions.

Workout 1

5 Rounds for time

  • 10 Pull-ups (modifications: barbell curls, assisted pull-ups, ring rows)
  • 10 Bent-over barbell/dumbbell rows
  • 10 Burpees (or other cardio activity for 45 sec - 1 min)

Workout 2

EMOM 10 minutes (every minute on the minute for 10 minutes)

  • Even minutes (0:00, 2:00, 4:00...etc) - 60 single under jump rope (or 30 double under jump rope)
  • (rest for any time remaining in the minute interval)
  • Odd minutes (1:00, 3:00, 5:00...etc) - 12 dead-lifts then stand and hold the weight for the remainder of the minute. If you are not proficient with deadlifts, then a 100 ft farmers’ carry is an option.

It is well-accepted that regular exercise is associated with improved conditioning, strength, flexibility, and overall physical fitness in older adults. Long-term (12 mo+) exercise programs in menopausal women have been associated with positive changes in basal metabolic rate, skeletal muscle mass, body fat percentage, and other functional and body composition variables.

The studies reviewed here underscore the need to integrate functional movement targeting strength and conditioning work into our training routines as mid-life women as well as those of our peri-menopausal and menopausal coaching clients. Because the health status and fitness/nutrition levels in this population are so diverse - from the sedentary to the Games-Level athlete - a “one-size-fits-all” approach is woefully insufficient. Each program should be individualized to her baseline level of health and fitness so she can live this next stage of life to her full potential.


About the Author: Dr. Carla DiGirolamo is a double Board-Certified Obstetrician Gynecologist and Reproductive Endocrinologist who has dedicated her career to caring for women through all stages of reproductive life. She is also a North American Menopause Society (NAMS) Certified Menopause Practitioner. Carla is a life-long athlete, CrossFit Level 1 Trainer, Certified Nutrition Coach, and member of CrossFit Health. She was also recently named to the MedFit Medical Advisory Board. For more articles about smashing the mid-life status quo, check out Athletic Aging on Substack!


  1. Menopause and exercise; Natalia M. Grindler, MD, and Nanette F. Santoro, MD; Menopause Vol. 22, No. 12, pp. 1351-1358
  2. Getting a grip on older women’s health; Nanette Santoro, MD; Menopause Vol. 28, No. 12, p. 1327
  3. Hand grip strength and health-related quality of life in postmenopausal women: a national population-based study; Yun Soo Hong, MD, MHS and Hoon Kim, MD, PhD, NCMP. Menopause Vol. 28, No. 12, pp. 1330-1339.
  4. A strong handshake! Do not forget to measure grip strength in menopause: a simple way to predict general frailty/impairment; Rafael Sa´nchez-Borrego, MD. Menopause Vol. 29, No. 1, pp. 3-5.
  5. Handgrip strength, dynapenia, and related factors in postmenopausal women; Pascual Garcı´a-Alfaro, MD, Sandra Garcı´a, BSc, Ignacio Rodrı´guez, MSc, and Faustino R. Pe´rez-Lo´pez, MD, PhD. Menopause Vol. 29, No. 1, pp. 16-22.
  6. The impact of ERa action on muscle metabolism and insulin sensitivity: Strong enough for a man, made for a woman Andrea L. Hevener, Zhenqi Zhou, Timothy M. Moore, Brian G. Drew, Vicent Ribas MOLECULAR METABOLISM 15 (2018) 20e34.

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