A two-year survey conducted by the Health Ministry's Israel Center for Disease Control (ICDC), the University of Haifa and Tel Aviv University has targeted women, the religiously observant, Arabs, smokers, the overweight, married people, the less educated and younger people as being more likely to live sedentary lifestyles. ICDC director Prof. Manfred Green and colleagues report in the just-published November issue of the Israel Medical Association Journal (IMAJ) that with this information, the authorities should aim intervention at these sub-populations to reduce their risk of suffering and dying from cardiovascular disease, stroke, diabetes and other "couch potato" disorders. The aim of the study, they said, was to identify a self-reported sedentary lifestyle in the Jewish and Arab communities and compare it to past and future levels of activity. If health promotion programs are to succeed, the authors stressed, more is needed to be known about these specific populations. Since it's impossible to know how much exercise people actually get, the researchers had to depend on answers by respondents to questionnaires in Hebrew, Russian and Arabic. They were asked if they were physically active for at least 20 consecutive minutes, whether walking, running, swimming, playing ball games or any other sports activities. Those who answered affirmatively were asked further about how often. About 50 percent answered yes to the first question, while 60% of these said they were active nearly every day or every other day, and 35% of them once or twice a week, and 5% once or twice a month. The authors conceded that their measurement of physical activity among Arabs was not clear, as they did not include physical exertion during work as exercise during leisure time. Because lower-income populations, including Arabs, often work in manual labor jobs, during which they expend a lot of energy, their answers could not be easily compared with higher-income people, mostly Jews, who exercise during their leisure time. They concluded that "more research is needed" to ascertain the levels of physical activity and energy expenditure, especially in the Arab community, as well as levels of leisure time activity in both populations. Among Jews, the less educated, smokers and others with risk behaviors need to be targeted, they said, and the Arab sector needs "all-round intervention to increase awareness of a healthy lifestyle." Dr. Naama Constantini, a leading sports medicine specialist from the orthopedic surgery department of the Hadassah-University Hospital in Jerusalem, who was asked to comment, said there is a vicious circle among people who smoke, are overweight and too tired to exercise, who then gain weight and are even less active. "Sub-populations who are not exercising should be targeted, each according to their needs. Public health nurses, who can educate children about the need to exercise, are being cut; physical education classes in schools have been reduced," she said. "The government must invest resources in programs if it is serious about encouraging active lifestyles. The Education Ministry can withhold funding from independent haredi schools that do not offer physical education, and rabbis can speak about the importance given in the Torah to promoting good health." Many schools, especially in the Arab sector, have inadequate or nonexistent facilities for physical education. There is no place to play in many schools, Constantini added.