Children should engage in regular exercise from age 2, and children and teens should watch no more than two hours a day of television, according to new recommendations by a task force on preventive medicine.
The recommendations by the Israel Association of Family Physicians, which are based on those of the U.S. Preventive Services Task Force, also warn against unnecessary medical tests and urge doctors to be more alert for signs of domestic violence.
The document for the first time recommends regular exercise even for very young children. It says children age 2 to 5 need 180 minutes a day of physical activity, while those age 5 to 19 need an hour a day of physical activity.
For adults aged 20 to 64, the document recommends at least 150 minutes a week of moderate exercise or 75 minutes a week of intensive exercise, while noting that doubling the amount increases the health benefits. For people 65 and older, it recommends strength-building exercises at least twice a week and exercises to improve balance at least three times a week.
As for television, this should be limited to two hours a day at most until age 19, the document says.
The task force advises vaccinating girls against cervical cancer with the Gardasil vaccine rather than Cervarix, even though the latter was chosen was by the Health Ministry for inclusion in the "health basket" of medicines subsidized by the national health insurance plan. Gardasil is effective against four different strains of papillomavirus, it explains, while Cervarix is effective against only two.
The ministry "didn't accept our recommendation for commercial [i.e. budgetary] reasons," said Prof. Chava Tabenkin, who prepared the document together with Prof. Amnon Lahad. "But if you've already decided to vaccinate against the disease, it's preferable to vaccinate against four strains rather than two."
The document advises physicians to urge patients to quit smoking, especially those aged 20 to 39, saying that 5 to 10 percent of people who receive such advice from their doctors actually follow it.
The document also includes a list of unnecessary medical tests. For instance, it says, annual mammograms are not necessary for women under 50 unless they have a known risk factor (like a family history of breast cancer ). CT scans for the early detection of lung cancer in smokers are unjustified, since they haven't been proven to work, while PSA tests for prostate cancer are also unjustified, since they are inaccurate.
High cholesterol, especially in younger people, should initially be treated through diet and exercise rather than drugs such as statins, the document advises. It also recommends a blood cholesterol test at least once every five years for men from age 35 and women from age 45.
The document repeats its controversial recommendation from five years ago that hormone replacement therapy shouldn't be given to all menopausal women, but only to those who are suffering from the effects of menopause, and then for the shortest time and at the lowest dose possible. That advice was criticized by the Israel Society of Obstetrics and Gynecology, but Tabenkin insisted that HRT isn't right for everyone.
"When they examined differences among population groups, they found that menopausal ultra-Orthodox women said they were blossoming, since they no longer had to observe niddah," she said, referring to the religious prohibition on sleeping with a menstruating woman. "But women from north Tel Aviv have trouble dealing with their body's aging."
The document recommends a colonoscopy to detect colon cancer once every 10 years, or at least once between the ages of 55 and 65, for those who don't do fecal occult blood tests. The latter are included in the health basket, whereas colonoscopies aren't.
But it says there is no reason to test for chronic kidney disease starting from age 40, since the lab tests for early detection of the disease haven't proven effective.
Finally, the document says, the task force is currently debating a recommendation that babies continue to receive vitamin D3 even after turning 1 year old, especially in the winter, given research showing that Israelis tend to suffer from vitamin D deficiency.