Adsense Scorecard ?

I have this Scorecard in my AdSense account it says:
Revenue optimization
Site health
Google+

My question is do I have to follow the advise it's giving me or it doesn't actually works?

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Yes, of-course it works why do you think its there? As you have already said its only recommendations that Adsense thinks may help you to increase your earnings you are not obligated in any way to follow them!

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They are recommendations only. Not requirements. And they are very generalized, not tailored to you and your site.

Especially the Google+ section. Just because they say size X would work better for you does not mean your size Y ad is not the more ideal one.

The best way to test anything like this is setting up an A/B test of your site and let it run for at least a week and then review your data to see which actually performs better for you.

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That's what I said however it looks like if you add Google+ button it makes Google happy so I recommend to add it

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