Author(s): MARQUES, A., BLANCHET, C., RIBEIRO, T., HENRIQUES-NETO, D., PERALTA, M., Institution: FACULDADE DE MOTRICIDADE HUMANA, UNIVERSIDADE DE LISBOA, Country: PORTUGAL, Abstract-ID: 2424

INTRODUCTION:
Muscular strength is increasingly recognised as a key biomarker of healthy ageing and a strong predictor of mortality in middle-aged and older adults. Handgrip strength provides a simple, reliable and clinically informative indicator of overall muscular fitness, while health behaviours such as smoking, alcohol consumption, physical activity and sleep are well-established determinants of longevity. Although both muscular strength and lifestyle behaviours independently influence mortality risk, their combined associations remain insufficiently understood. Therefore, this study aimed to examine the joint associations of grip strength and selected health behaviours with all-cause mortality in European middle-aged and older adults.
METHODS:
This prospective cohort study used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 12,693 adults aged ≥50 years, followed for up to 16 years. Health behaviours (smoking status, alcohol consumption, moderate and vigorous physical activity, and sleep disturbances) were self-reported. Grip strength was measured using a handheld dynamometer and standardised by age and sex, with participants classified into low, moderate, and high categories. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals for all-cause mortality across combined categories of grip strength and each health behaviour. Analyses were adjusted for sociodemographic and health-related confounders.
RESULTS:
Higher grip strength was associated with a lower risk of all-cause mortality across all health behaviour strata. Compared with individuals with low grip strength and unfavourable behaviours, those with high grip strength showed reduced mortality risk across smoking (HR≈0.70), alcohol consumption (HR≈0.60), physical activity (HR≈0.51–0.55), and sleep disturbance categories (HR≈0.60). The lowest mortality risk was observed among individuals combining high grip strength with favourable behaviours, with risk reductions ranging from 43% to 64%. No significant interaction effects were identified between grip strength and health behaviours, indicating predominantly additive associations.
CONCLUSION:
Grip strength is independently associated with all-cause mortality, irrespective of health behaviours. Individuals with higher grip strength consistently exhibited lower mortality risk across behavioural strata, and the combination of greater muscular strength and favourable health behaviours was associated with the lowest risk. These findings highlight the complementary roles of muscular fitness and lifestyle behaviours in shaping survival outcomes and support the routine assessment and promotion of muscular strength as part of integrated public health strategies targeting ageing populations.