Interventions to improve work ability and reduce early exit from the labor market: a systematic review and meta-analysis among midlife and older workers

Abstract

Aim: To identify effective interventions designed to improve work ability and reduce early exit from the labor market of midlife and older workers. Method: Searches were conducted in PubMed, Cochrane Library, Scopus, Web of Science, and PsycInfo up to February 17, 2025, focusing on studies aimed at improving work ability and associated conditions (work productivity, work engagement, job performance, and work capacity) and reducing early exit from the labor market among participants aged ⩾40 years. Two reviewers evaluated the quality of studies. The effectiveness of interventions was evaluated using meta-analysis and, when not feasible, qualitative synthesis. Results: Of 17,505 publications, 41 studies were included, comprising 14 randomized controlled trials (RCTs, n = 4123) and 27 non-randomized studies (n = 4,616,452). Meta-analysis of RCTs showed that aerobic or strengthening exercises modestly improved work ability (pooled standardized mean difference 0.26, 95% CI 0.08–0.44). Qualitative synthesis indicated cognitive behavioral therapy (CBT) reduced productivity loss in workers with chronic health conditions. A meta-analysis of non-randomized studies showed policy reforms raising the eligible retirement age increased employment by 12 percentage points (pps) (95% CI 7–17) and decreased retirement by 29 pps (95% CI 8−50), but increased disability benefits by 6 pps (95% CI 1–11), unemployment by 7 pps (95% CI 2–12), and economic inactivity by 6 pps (95% CI 5–8). Policy reforms tightening unemployment benefit requirements increased employment and reduced unemployment, but increased disability benefits. Conclusions: Exercise improved work ability and CBT reduced productivity loss. Regulatory actions on retirement age and unemployment benefits were associated with higher work participation.