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Paul Franks

Paul Franks

Principal investigator

Paul Franks

Association of walking pace and handgrip strength with all-cause, cardiovascular, and cancer mortality : A UK Biobank observational study


  • Thomas Yates
  • Francesco Zaccardi
  • Nafeesa N. Dhalwani
  • Melanie J. Davies
  • Kishan Bakrania
  • Carlos A. Celis-Morales
  • Jason M.R. Gill
  • Paul W. Franks
  • Kamlesh Khunti

Summary, in English

Aims: To quantify the association of self-reported walking pace and handgrip strength with all-cause, cardiovascular, and cancer mortality. Methods and results: A total of 230 670 women and 190 057 men free from prevalent cancer and cardiovascular disease were included from UK Biobank. Usual walking pace was self-defined as slow, steady/average or brisk. Handgrip strength was assessed by dynamometer. Cox-proportional hazard models were adjusted for social deprivation, ethnicity, employment, medications, alcohol use, diet, physical activity, and television viewing time. Interaction terms investigated whether age, body mass index (BMI), and smoking status modified associations. Over 6.3 years, there were 8598 deaths, 1654 from cardiovascular disease and 4850 from cancer. Associations of walking pace with mortality were modified by BMI. In women, the hazard ratio (HR) for all-cause mortality in slow compared with fast walkers were 2.16 [95% confidence interval (CI): 1.68-2.77] and 1.31 (1.08-1.60) in the bottom and top BMI tertiles, respectively; corresponding HRs for men were 2.01 (1.68-2.41) and 1.41 (1.20-1.66). Hazard ratios for cardiovascular mortality remained above 1.7 across all categories of BMI in men and women, with modest heterogeneity in men. Handgrip strength was associated with cardiovascular mortality in men only (HR tertile 1 vs. tertile 3 = 1.38; 1.18-1.62), without differences across BMI categories, while associations with all-cause mortality were only seen in men with low BMI. Associations for walking pace and handgrip strength with cancer mortality were less consistent. Conclusion: A simple self-reported measure of slow walking pace could aid risk stratification for all-cause and cardiovascular mortality within the general population.


  • Genetic and Molecular Epidemiology
  • EXODIAB: Excellence in Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health

Publishing year







European Heart Journal





Document type

Journal article


Oxford University Press


  • Public Health, Global Health, Social Medicine and Epidemiology


  • Cardiorespiratory fitness
  • Handgrip strength
  • Mortality
  • Walking pace



Research group

  • Genetic and Molecular Epidemiology


  • ISSN: 0195-668X