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Handgrip Strength and Timed Up-And-Go (TUG) Test are Predictors of Short-Term Mortality Among Elderly in a Population-Based Cohort in Singapore

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Asian studies on how physical tests predict short-term mortality in elderly are scarce. We assessed handgrip strength and timed-up-and-go (TUG) as such predictors among elderly Chinese in Singapore.


Prospective cohort study.


Community-dwelling Chinese elderly in Singapore.


We used data from 13,789 subjects in the prospective, population-based Singapore Chinese Health Study, who had a mean age of 74 (range 63 to 97) years at time of measurements.


Subjects underwent assessment for handgrip strength and TUG. They were followed for mortality via linkage with nationwide death registry through 2018.


In multivariable analyses, handgrip strength was inversely associated with risk of mortality in a dose-dependent manner: the hazard ratio (HR) [95% confidence interval (CI)] comparing extreme quartiles was 2.05 (1.44–2.90) (Ptrend<0.001). TUG was positively associated with mortality in a stepwise manner: the HR (95% CI) comparing extreme quartiles was 3.08 (2.17–4.38) (Ptrend<0.001). Compared to those with stronger handgrip and faster TUG, participants who either had weaker handgrip or slower TUG had a significant 1.59 to 2.11 fold increase in risk of mortality; while the HR (95% CI) for those who had both weaker handgrip and slower TUG was 3.93 (3.06–5.05). In time-dependent receiver operating characteristic curves, adding handgrip strength and TUG time to a Cox model containing sociodemographic and lifestyle factors, comorbidities, and body measurements significantly improved the area under the curve for the prediction of mortality from 0.5 to 2 years (P≤0.001).


Among elderly in a Chinese population, handgrip strength and TUG test were strong and independent predictors of short-term mortality.

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  1. 1.

    Cooper R, Kuh D, Hardy R. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. Sep 2010;9;341:c4467.

  2. 2.

    Garcia-Hermoso A, Cavero-Redondo I, Ramirez-Velez R, et al. Muscular Strength as a Predictor of All-Cause Mortality in an Apparently Healthy Population: A Systematic Review and Meta-Analysis of Data From Approximately 2 Million Men and Women. Arch Phys Med Rehabil. 2018;Oct;99(10):2100–2113.e2105.

  3. 3.

    Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;Jul 18;386(9990):266–273.

  4. 4.

    Wu Y, Wang W, Liu T, Zhang D. Association of Grip Strength With Risk of All-Cause Mortality, Cardiovascular Diseases, and Cancer in Community-Dwelling Populations: A Meta-analysis of Prospective Cohort Studies. J Am Med Dir Assoc. 2017;Jun 1;18(6):551.e517–551.e535.

  5. 5.

    Balogun S, Winzenberg T, Wills K, et al. Prospective Associations of Low Muscle Mass and Function with 10-Year Falls Risk, Incident Fracture and Mortality in Community-Dwelling Older Adults. J Nutr Health Aging. 2017;21(7):843–848.

  6. 6.

    Bergland A, Jorgensen L, Emaus N, Strand BH. Mobility as a predictor of all-cause mortality in older men and women: 11.8 year follow-up in the Tromso study. BMC Health Serv Res. 2017;Jan 10;17(1):22.

  7. 7.

    De Buyser S, Petrovic M, Taes Y, et al. Three year functional changes and long-term mortality hazard in community-dwelling older men. Eur J Intern Med. 2016;Nov;35:66–72.

  8. 8.

    De Buyser SL, Petrovic M, Taes YE, Toye KR, Kaufman JM, Goemaere S. Physical function measurements predict mortality in ambulatory older men. Eur J Clin Invest. 2013;Apr;43(4):379–386.

  9. 9.

    Idland G, Engedal K, Bergland A. Physical performance and 13.5-year mortality in elderly women. Scand J Public Health. 2013;Feb;41(1):102–108.

  10. 10.

    Sim M, Prince RL, Scott D, et al (2019) Sarcopenia Definitions and Their Associations With Mortality in Older Australian Women. J Am Med Dir Assoc. 2019;Jan;20(1):76–82.e72.

  11. 11.

    Tice JA, Kanaya A, Hue T, et al. Risk factors for mortality in middle-aged women. Arch Intern Med. 2006;Dec 11–25;166(22):2469–2477.

  12. 12.

    Arvandi M, Strasser B, Meisinger C, et al. Gender differences in the association between grip strength and mortality in older adults: results from the KORA-age study. BMC Geriatr. 2016;Nov 30;16(1):201.

  13. 13.

    Chen PJ, Lin MH, Peng LN, et al. Predicting cause-specific mortality of older men living in the Veterans home by handgrip strength and walking speed: a 3-year, prospective cohort study in Taiwan. J Am Med Dir Assoc. 2012;Jul;13(6):517–521.

  14. 14.

    Stenholm S, Mehta NK, Elo IT, Heliovaara M, Koskinen S, Aromaa A. Obesity and muscle strength as long-term determinants of all-cause mortality—a 33-year follow-up of the Mini-Finland Health Examination Survey. Int J Obes (Lond). 2014;Aug;38(8):1126–1132.

  15. 15.

    Kang L, Jia L, Han P, et al. Combined Effect of Obesity and Mobility Limitation with Incidence of Type 2 Diabetes and Mortality in Chinese Elderly. Rejuvenation Res. 2017;Oct;20(5):375–382.

  16. 16.

    Ong HL, Abdin E, Chua BY, et al. Hand-grip strength among older adults in Singapore: a comparison with international norms and associative factors. BMC Geriatr. 2017;Aug 4;17(1):176.

  17. 17.

    Capistrant BD, Glymour MM, Berkman LF. Assessing mobility difficulties for cross-national comparisons: results from the world health organization study on global ageing and adult health. J Am Geriatr Soc. 2014;62(2):329–335.

  18. 18.

    Hankin JH, Stram DO, Arakawa K, et al. Singapore Chinese Health Study: development, validation, and calibration of the quantitative food frequency questionnaire. Nutr Cancer. 2001;39(2):187–195.

  19. 19.

    Podsiadlo D, Richardson S. The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons. J Am Geriatr Soc. 1991;39(2):142–148.

  20. 20.

    StataCorp. Stata Statistical Software: Release 14. [software]. College Station, TX: StataCorp LP. 2015. Available from:

  21. 21.

    R-Core-Team. R: A Language and Environment for Statistical Computing. [software]. R Foundation for Statistical Computing. Vienna, Austria. 2019. Available from:

  22. 22.

    Therneau TM. A Package for Survival Analysis in S. Version 2.38 [software]. 2015. Available from:

  23. 23.

    Blanche P, Dartigues JF, Jacqmin)Gadda H. Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks. Stat Med. 2013;32(30):5381–5397.

  24. 24.

    Nofuji Y, Shinkai S, Taniguchi Y, et al. Associations of Walking Speed, Grip Strength, and Standing Balance With Total and Cause-Specific Mortality in a General Population of Japanese Elders. J Am Med Dir Assoc. 2016;Feb;17(2):184.e181–187.

  25. 25.

    Karlsen T, Nauman J, Dalen H, Langhammer A, Wisloff U. The Combined Association of Skeletal Muscle Strength and Physical Activity on Mortality in Older Women: The HUNT2 Study. Mayo Clin Proc. 2017;May;92(5):710–718.

  26. 26.

    Cooper R, Strand BH, Hardy R, Patel KV, Kuh D. Physical capability in mid-life and survival over 13 years of follow-up: British birth cohort study. BMJ. Apr 2014;29;348:g2219.

  27. 27.

    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;Jul;39(4):412–423.

  28. 28.

    Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014Feb;15(2):95–101.

  29. 29.

    Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;May;12(4):249–256.

  30. 30.

    Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;Jun;14(6):392–397.

  31. 31.

    Arango-Lopera VE, Arroyo P, Gutierrez-Robledo LM, Perez-Zepeda MU, Cesari M. Mortality as an adverse outcome of sarcopenia. J Nutr Health Aging. 2013;Mar;17(3):259–262.

  32. 32.

    Hardy R, Cooper R, Aihie Sayer A, et al. Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme. PLoS One. 2013;8(2):e56483.

  33. 33.

    Roberts HC, Syddall HE, Sparkes J, et al. Grip strength and its determinants among older people in different healthcare settings. Age Ageing. 2014;Mar;43(2):241–246.

  34. 34.

    Choquette S, Bouchard DR, Doyon CY, Senechal M, Brochu M, Dionne IJ. Relative strength as a determinant of mobility in elders 67–84 years of age. a nuage study: nutrition as a determinant of successful aging. J Nutr Health Aging. 2010;Mar;14(3):190–195.

  35. 35.

    Stenholm S, Koster A, Rantanen T. Response to The Letter “Overadjustment in Regression Analyses: Considerations When Evaluating Relationships Between Body Mass Index, Muscle Strength, and Body Size”. The Journals of Gerontology: Series A. 2014;69(5):618–619.

  36. 36.

    Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;Jul;40(4):423–429.

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We thank Siew-Hong Low of the National University of Singapore for supervising the fieldwork in the Singapore Chinese Health Study.


Funding Sources: This work was supported by the Singapore National Medical Research Council (NMRC/CSA/0055/2013) and the United States National Cancer Institute, National Institutes of Health (UM1 CA182876 and R01 CA144034), and the Saw Swee Hock School of Public Health, National University of Singapore. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Author Contributions: W-P Koh designed and conducted the study, W-P Koh, X Lin and KY Chua analyzed data, W-S Lim and J-M Yuan assisted in interpreting the data, KY Chua wrote the first draft and all authors critically edited the manuscript; W-P Koh had primary responsibility for final content. All authors read and approved the final manuscript.

Correspondence to Woon-Puay Koh.

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Disclosure Statement: The authors declare no conflict of interest.

Statement of Ethics: The study was approved by the Institutional Review Board at the National University of Singapore and written informed consent was obtained from all study participants.

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Chua, K.Y., Lim, W.S., Lin, X. et al. Handgrip Strength and Timed Up-And-Go (TUG) Test are Predictors of Short-Term Mortality Among Elderly in a Population-Based Cohort in Singapore. J Nutr Health Aging (2020).

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Key words

  • Chinese
  • handgrip strength
  • mortality
  • sarcopenia
  • gait speed