Sosyal Bilimler ve Sağlık Bülteni

Özgün Makale

No. 19 (2026)

Current Evidence on Work Ability in the Aviation Sector: A Narrative Review from an Occupational Health Perspective

Submitted
June 10, 2026
Published
2026-09-02

Abstract

Work ability is a multidimensional construct reflecting the balance between workers’ health, functional capacity, professional competence, and personal resources and the demands of their work. Aviation personnel may be particularly vulnerable to impaired work ability because of irregular work–rest schedules, shift work, night and early-morning duties, time-zone transitions, insufficient recovery, noise, thermal conditions, ergonomic and psychosocial hazards, sustained attention demands, and safety-critical responsibilities. This narrative review aimed to examine the concept and assessment of work ability and to synthesize the available evidence on work ability among aviation workers from an occupational health perspective.

A literature search of PubMed/MEDLINE, Scopus, and Web of Science identified five eligible publications. As two publications were based on the same sample of pilots, the evidence represented four independent data sources. Lower work ability was associated with inadequate sleep, fatigue, insomnia, work-related burnout, longer monthly flight hours, insufficient time off and frequent operational delays. Among flight attendants, healthier eating habits and certain individual characteristics were associated with higher work ability, whereas insomnia and work-related burnout were associated with lower work ability. Among pilots, lower work ability was associated with unintentional sleep during flight. A small uncontrolled intervention study reported improvements in sleep duration, alertness, perceived stress and current work ability following a change in shift scheduling. In the sample included in the psychometric study, better perceived health and age below 45 years were associated with higher work ability. Nevertheless, the small body of evidence, heterogeneity in study designs and assessment methods, and predominance of observational data limit causal interpretation and the generalizability of the findings across the aviation sector.

The Work Ability Index may provide complementary information for monitoring workers’ health and planning preventive occupational health interventions. However, it should not be considered a substitute for aeromedical fitness or fitness-for-duty assessment. Further research involving larger and more representative samples, diverse aviation occupational groups, standardized assessment methods, and stronger longitudinal or controlled designs is warranted.

References

  1. Adel, M., Akbar, R. & Ehsan, G. (2019). Validity and reliability of work ability index (WAI) questionnaire among Iranian workers; a study in petrochemical and car manufacturing industries. J Occup Health, 61(2), 165–174. https://doi.org/10.1002/1348-9585.12028
  2. Alexopoulos, E. C., Merekoulias, G., Gnardellis, C. & Jelastopulu, E. (2013). Work Ability Index: Validation of the Greek Version and Descriptive Data in Heavy Industry Employees. Journal of Advances in Medicine and Medical Research, 3(3), 608–621. https://doi.org/10.9734/BJMMR/2013/2552
  3. Baethge, C., Goldbeck-Wood, S. & Mertens, S. (2019). SANRA–a scale for the quality assessment of narrative review articles. Res Integr Peer Rev, 4, Article 5. https://doi.org/10.1186/s41073-019-0064-8
  4. Bergsten, E. L., Mathiassen, S. E. & Vingård, E. (2015). Psychosocial work factors and musculoskeletal pain: A cross-sectional study among Swedish flight baggage handlers. BioMed Research International, 2015, Article 798042. https://doi.org/10.1155/2015/798042
  5. Bern, S. H., Brauer, C., Møller, K. L., Koblauch, H., Thygesen, L. C., Simonsen, E. B., Alkjær, T., Bonde, J. P. & Mikkelsen, S. (2013). Baggage handler seniority and musculoskeletal symptoms: Is heavy lifting in awkward positions associated with the risk of pain? BMJ Open, 3(11), Article e004055. https://doi.org/10.1136/bmjopen-2013-004055
  6. De Zwart, B., Frings-Dresen, M. & Van Duivenbooden, J. (2002). Test-retest reliability of the Work Ability Index questionnaire. Occup Med, 52(4), 177–181.
  7. Eskelinen, L., Toikkanen, J., Tuomi, K., Mauno, I., Nygård, C-H. & Ilmarinen, J. (1991). Symptoms of mental and physical stress in different categories of municipal work. Scand J Work Environ Health, 17, 132–136.
  8. Folke, F., Sorjonen, K. & Melin, M. (2026). Pilots’ and cabin crews’ psychosocial work environment in relation to mental health and fitness-to-fly safety behaviors: latent profile analyses. Front Psychol, 17, Article 1740908. https://doi.org/10.3389/fpsyg.2026.1740908
  9. Fredes-Collarte, D., Olivares-Faúndez, V., Sánchez-García, J. C., Ganga Contreras, F., Peralta Montecinos, J. & Herrera Parraguez, J. (2026). Job Satisfaction and Health Problems Among Cabin Crew: The Mediating Role of Burnout. Healthcare, 14(4), Article 473. https://doi.org/10.3390/healthcare14040473
  10. Freyer, M., Formazin, M. & Rose, U. (2019). Factorial Validity of the Work Ability Index Among Employees in Germany. J Occup Rehabil, 29(2), 433–442. https://doi.org/10.1007/s10926-018-9803-9
  11. Gharib, S., Martin, B. J. & Neitzel, R. L. (2021). Pilot assessment of occupational safety and health of workers in an aircraft maintenance facility. Safety Science, 141, Article 105299. https://doi.org/10.1016/j.ssci.2021.105299
  12. Gharibi, V., Mokarami, H., Taban, A., Aval, M. Y., Samimi, K. & Salesi, M. (2016). Effects of work-related stress on work ability index among Iranian workers. Safety and Health at Work, 7, 43–48.
  13. González-Domínguez, M. E., Fernández-García, E., Paloma-Castro, O., González-López, R. M., Rivas Pérez, M. P., López-Molina, L., García-Jiménez, J. & Romero-Sánchez, J. M. (2024). Work Ability Index: Psychometric Testing in Aeronautical Industry Workers. Safety and Health at Work, 15(1), 80–86.
  14. Gould, R., Ilmarinen, J., Järvisalo, J. & Koskinen, S. (2008). Dimensions of work ability: Results of the Health 2000 Survey. Finnish Centre of Pensions.
  15. Griffiths, R. F. & Powell, D. M. (2012). The occupational health and safety of flight attendants. Aviat Space Environ Med, 83(5), 514–521.
  16. Hakola, T., Niemelä, P., Rönnberg, S. & Ropponen, A. (2021). Longer Work Shifts, Faster Forward Rotation— More Sleep and More Alert in Aircraft Inspection. Int. J. Environ. Res. Public Health, 18, Article 8105. https://doi.org/10.3390/ijerph18158105
  17. Hu, C. J., Hong, R. M., Yeh, G. L. & Hsieh, I. C. (2019). Insomnia, work-related burnout, and eating habits affecting the work ability of flight attendants. Aerosp Med Hum Perform, 90(7), 601–605.
  18. Ilmarinen, J. & Tuomi, K. (1992). Work ability index for aging workers. Finnish Institute of Occupational Health.
  19. Ilmarinen, J. & Rantanen, J. (1999). Promotion of work ability during ageing. Am J Ind Med, 36(S1), 21–23.
  20. Ilmarinen, J. (2001). Ageing workers in Finland and in the European Union: Their situation and the promotion of their working ability, employability and employment. Geneva Papers Risk Insur, 26, 623–641.
  21. Ilmarinen, J. (2007). The work ability index (WAI). Occup Med, 57(2), 160.
  22. Ilmarinen, J., Tuomi, K. & Klockars, M. (1997). Changes in the work ability of active employees over an 11-year period. Scand J Work Environ Health, 23, 49–57.
  23. Ilmarinen, J. (2019). From work ability research to implementation. Int J Environ Res Public Health, 16(16), Article 2882.
  24. Karabel, M. P. (2019). Çalışabilirlik İndeksi’nin Türkçe uyarlaması geçerlilik ve güvenilirliği. [Uzmanlık tezi]. Sakarya Üniversitesi Tıp Fakültesi.
  25. Marqueze, E. C., Nicola, A. C. B., Diniz, D. H. M. D. & Fischer, F. M. (2017). Working hours associated with unintentional sleep at work among airline pilots. Rev Saúde Pública, 51, Article 61.
  26. Mélan, C. & Cascino, N. (2022). Effects of a modified shift work organization and traffic load on air traffic controllers’ sleep and alertness during work and non-work activities. Applied Ergonomics, 98, Article 103596. https://doi.org/10.1016/j.apergo.2021.103596
  27. Morschhäuser, M. & Sochert, R. (2006). Healthy Work in an Ageing Europe. Federal Association of Company Health Insurance Funds.
  28. Nadeau, S. & Morency, F. (2017). De-icing of aircraft: Incorporating business risks and occupational health and safety. Int. J. Saf. Secur. Eng, 7(2), 247–266. https://doi.org/10.2495/SAFE-V7-N2-247-266
  29. Nogueira, H. C., Diniz, A. C. P., Barbieri, D. F., Padula, R. S., Carregaro, R. L. & De Oliveira, A. B. (2012). Musculoskeletal disorders and psychosocial risk factors among workers of the aircraft maintenance industry. Work, 41(Suppl. 1), 4801–4807. https://doi.org/10.3233/WOR-2012-0767-4801
  30. Pellegrino, P. & Marqueze, E. C. (2019). Aspects of work and sleep associated with work ability in regular aviation pilots. Rev Saúde Pública, 53, Article 16. https://doi.org/10.11606/S1518-8787.2019053000345
  31. Peukert, M., Claus, L. & Meyer, L. (2025). Subjective and objective fatigue dynamics in air traffic control. Industrial Health, 63(5), 431–442. https://doi.org/10.2486/indhealth.2024-0206
  32. Rashid, H. S. J., Place, C. S. & Braithwaite, G. R. (2014). Eradicating root causes of aviation maintenance errors: Introducing the AMMP. Cogn. Technol. Work, 16(1), 71–90. https://doi.org/10.1007/s10111-012-0245-4
  33. Sallinen, M., Onninen, J., Ketola, K., Puttonen, S., Tuori, A., Virkkala, J. & Åkerstedt, T. (2021). Self-reported reasons for on-duty sleepiness among commercial airline pilots. Chronobiol Int, 38(9), 1308–1318. https://doi.org/10.1080/07420528.2021.1927071
  34. Sluiter, J. K. (2006). High-demand jobs: age-related diversity in work ability? Appl Ergon, 37(4), 429–440. https://doi.org/10.1016/j.apergo.2006.04.007
  35. Tengland, P. A. (2011). The concept of work ability. J Occup Rehabil, 21, 275–285.
  36. Tomaç, S., Saldırım, H. B., Eren, M., Şerbetçioğlu, M. B. & Yılmaz, O. (2023). Evaluation Of Noise Induced Hearing Loss In Airport Ground Handling Workers. KBB-Forum, 22(3), 198–205.
  37. Tuomi, K., Ilmarinen, J., Eskelinen, L., Järvinen, E., Toikkanen, J. & Klockars, M. (1991). Prevalence and incidence rates of diseases and work ability in different work categories of municipal occupations. Scand J Work Environ Health, 17(1), 67–74.
  38. Tuomi, K., Ilmarinen, J., Jahkola, A., Katajarinne, L. & Tulkki, A. (1998). Work Ability Index (2nd ed.). Finnish Institute of Occupational Health.
  39. Von Bonsdorff, M. B., Seitsamo, J., Ilmarinen, J., Nygård, C. H., von Bonsdorff, M. E. & Rantanen, T. (2011). Work ability as a determinant of old age disability severity: Evidence from the 28-year Finnish longitudinal study on municipal employees. Aging Clin Exp Res, 24, 354–360.