American Fitness Index: 10+ Years of Improving Community Health

The American College of Sports Medicine launched the American Fitness Index (Fitness Index) in 2008. The Fitness Index ranks the 100 largest cities in the United States according to variables that reflect and affect physical activity, physical fitness, health and quality of life of community members. Public health databases serve to develop the Fitness Index and include such components as: percent of adults exercising in the last 30 days, percent with obesity, percent who live within 10 minutes of a park and percent walking or biking to work. The Fitness Index provides information to civic and public health leaders regarding the “health” of their city and citizens and serves as a baseline or benchmark for cities to aspire and measure progress.

When it comes to changing health behaviors and health outcomes, those efforts that influence policy and environment are the most important levers to pull (think Clean Indoor Air Act). Since implementation of tobacco legislation, we’ve seen the rate of tobacco use decrease by about half, from 30+ percent of adults, to 14 percent of adults. Not surprisingly, the decrease in tobacco use in the United States is paralleled by an observed decrease in cardiovascular disease 507 deaths/100,000 to 273 deaths/100,000 people.

Physical activity and resultant physical fitness have a profound influence on health. The recently released 2018 Physical Activity Guidelines for Americans highlight the importance and influence of regular physical activity on health. To have the greatest impact, efforts that aim to promote physical activity in communities should address policy and environment, for example: school physical education requirements, bicycle lanes, public transportation infrastructure and farmers’ markets.

As a result of the Fitness Index, several cities have undergone significant efforts to address community infrastructure and policy with remarkable results!

Let’s take Oklahoma City for example. Under the leadership of their mayor, Mick Cornett, the city collectively lost one million pounds! They made the following changes to achieve these phenomenal outcomes: installed 400 miles of new sidewalks, over 100 miles of new jogging and biking trails, built a downtown park, built all new gyms in all the inner-city grade schools and removed fried foods from the school lunchroom.

We’ve watched other cities make meaningful improvements in their communities and in the health of their populations. It is important to continue these gains in cities, towns and communities across the country. We spend nearly 18 percent of our GDP (gross domestic product) on healthcare. These costs are largely driven by chronic diseases such as type 2 diabetes, which is most often related to unhealthy diet, insufficient physical activity and subsequent obesity.

Now more than ever, we need the American Fitness Index to help raise awareness and motivate, nudge, maybe even jolt community leaders to address infrastructure, environment and policy that allow community members to live their healthiest lives possible.

Author: Elizabeth Joy, MD, MPH, FACSM

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