Author: afi

From 50 to 100: Lessons Learned from the Expansion of the American Fitness Index

Two criticisms of the first decade of the ACSM American Fitness Index®and its annual report were that it was limited to only the 50 most populated cities in the USA and that the entire metropolitan area was counted among the data. These two observations had some merit. Cities protested that a certain suburb was not really a suburb (but based on the federal government definition of Metropolitan Statistical Area it was) and smaller cities like Arlington, Virginia and Madison, Wisconsin said “what about me?” The original approach to the rankings provided important and valuable general messages but limited the ability to provide targeted assistance to city and community leaders.

That all changed when the 2018 Fitness Index was released. The number of cities reported on grew to the top 100 largest cities based on population, and the definition of “city” was limited to the city limits. The updated approach provides city leaders with the local data that they need to make changes. The data are more in line with governing structures within a city and acknowledge the differences in health behaviors and community-level infrastructure between the city and surrounding suburban areas. The expanded rankings also provide a more inclusive approach by adding cities in states that weren’t previously represented.

With this new definition of city and the inclusion of the top 100, there are still opportunities for the Fitness Index to consider with future updates. For example, in my own hometown of Atlanta (ranked #20 in 2018), the reported population is 473,000 although there are three times that number working within the city limits each day (don’t try driving a car during rush hour!).

Some people might say that the Fitness Index should include the “near” suburbs. This idea may have merit, but the Fitness Index faces challenges with every update. For example, there is not a standardized approach for defining “near” suburbs. Absent of any way to standardize that approach for all cities (and to make fair comparisons), the definition of city was established for the 2018 report. Additionally, changes made to the Fitness Index must have reliable, regularly updated data sources. Currently there are limited data sets that include “near” suburbs.

The methodology for the 2019 rankings remains the same as was used in 2018. There are still 33 indicators divided almost equally between personal health indicators (health behaviors and health outcomes) and community/environmental indicators (built environment, recreational facilities, policy and funding). The city definition has not changed since 2018.

Effect on the rankings

Interestingly, while direct comparisons cannot be made between rankings for MSAs and the city proper, the 2018 rankings found that most cities ranked similar to their MSA ranking from 2017. The 2018 rankings indicate that for MSAs ranked high in the 2017 Fitness Index, the central cities of those MSAs also ranked high in the 2018 rankings. The 2017 rankings for MSAs in #1 Minneapolis, #2 Washington, D.C. and #3 San Francisco remained highly ranked after the 2018 expansion.

A similar pattern appeared in low ranking MSAs and their central cities. The cities ranked toward the bottom of the 2017 Fitness Index when 50 MSAs were reported included #48 Indianapolis, #49 Oklahoma City and #50 Louisville. In 2018, these cities remained among the lowest ranked cities (#98 Louisville, #99 Indianapolis and #100 Oklahoma City). Although these cities continue to be ranked the lowest among the top 100 most populated cities in the USA, there are some grassroots programs starting to take hold and some success has been achieved.


Author: Walt Thompson, Ph.D., FACSM

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

2018 American Fitness Index Overview Infographic

According to the 2018 ACSM American Fitness Index, the top 10 fittest cities in the U.S. are:

  1. Arlington, VA
  2. Minneapolis, MN
  3. Washington, D.C.
  4. Madison, WI
  5. Portland, OR
  6. Seattle, WA
  7. Denver, CO
  8. St. Paul, MN
  9. San Jose, CA
  10. Boise, ID

Share this infographic and the Fitness Index with your city officials and local leaders to start a conversation on making your city a healthier place for all residents.

Download a PDF of the Infographic here.

10th Annual American Fitness Index Reveals Minneapolis-St. Paul as the Newest “Fit City”

Half of metro areas saw scores improve

Indianapolis (May 16) – The twin cities of Minneapolis-St. Paul edged Washington, D.C. in the 10th annual American Fitness Index (Fitness Index) rankings released by the American College of Sports Medicine (ACSM) and the Anthem Foundation, the philanthropic arm of Anthem, Inc.  The nation’s capital held the top spot for the past three years and improved its score in 2017, but Minneapolis-St. Paul still finished on top despite the challenges of being a northern state with hard winters. (Link – View the rankings and individual metro data here or at the chart below.)

San Francisco-Oakland finished third this year, Seattle-Tacoma fourth, San Jose fifth, Boston sixth and Denver seventh. The top seven cities in the 2017 Fitness Index are between 4-13 percentage points ahead of the rest of the pack, principally related to lower rates of smoking and cardiovascular disease deaths and higher reported physical activity, consumption of fruits and vegetables, and per capita park expenditures in their communities.

Nationally, there were some remarkable positive shifts during the last year:

  • 16.0% increase in the percent who met the recommendations for aerobic and strength in the last 30 days
  • 10.5% drop in the percent with diagnosed angina or coronary heart disease
  • 3.9% increase in walkability scores
  • 3.9% increase in the percent who live within a 10-minute walk to a park
  • 3.7% increase in the total park expenditures per capita
  • 4.0% increase in the number of recreation centers per 20,000 residents

Metropolitan Statistical Areas (MSA) with the greatest improvement in their rankings since last year included San Jose, Los Angeles, Miami, Buffalo, Orlando and Las Vegas.

The 2017 Fitness Index rankings also revealed some shortcomings over the past year:

  • 11.7% increase in the rate of diabetes deaths
  • 6.3% reduction in the percent of residents biking or walking to work
  • 6.2% decrease in the percent of individuals eating the recommended number of servings of fruit
  • 4.6% reduction in the number of tennis courts per 10,000 residents

MSAs experiencing the largest drop in their rankings this year included Virginia Beach, Richmond, Providence, Philadelphia, Kansas City, New Orleans and Charlotte.

Against the backdrop of its 10th anniversary,  the Fitness Index offers some insightful long-term trends:

    • Smoking rates have declined (18.7% to 16.7%)
    • Drops in the death rates for diabetes (24.0/100,000 to 18.7/100,000) and cardiovascular diseases (223.0/100,000 to 174.6/100,000)
    • The number of farmers’ markets have increased (11.0/1,000,000 to 19.8/1,000,000)
    • Increases in the percent of residents using public transportation to work doubled (2.1% to 4.4%)
    • Residents biking or walking to work doubled (1.3% to 2.9%)
    • Total park expenditures per capita increased ($100 to $106)

Conversely, the 10-year comparison of Fitness Index indicators uncovered some challenges:

    • The percent categorized as obese increased (25.4% to 28.7%)
    • The percent self-reporting as having excellent or very good health declined (55.6% to 52.1%)
    • The percent diagnosed with asthma increased (8.2% to 9.0%), as did the percent with diabetes (8.0% to 10.7%)

The ACSM American Fitness Index provides evidence-based data and a number of valuable resources that help cities promote healthy lifestyles.  To aid communities in promoting physical activity and enhancing quality of life, ACSM and Anthem Foundation developed and released  the Community Action Guide offering an overview of the critical decisions and factors related to effective community action:

“Our ultimate goal is to offer individuals, families and communities trusted resources that can help them assess, plan and implement policies that promote positive health outcomes,” said Walter R. Thompson, Ph.D., FASCM, who chairs the Fitness Index Advisory Board and is president-elect of ACSM. “Ten years of evidence-based data offers these cities and their citizens valuable insights into how to substantively improve elements leading to healthier lives and reduced health care costs.”

“As the American Fit Index celebrates its 10th year, it’s a great opportunity to celebrate the efforts of communities and their leaders who have effectively used the data to make measurable changes that are helping improve the health and wellness of their residents,” said Craig Samitt, MD, chief clinical officer, Anthem, Inc. “While the improvements we are seeing are worth celebrating, we know there is still more that can be done. We are proud of our foundation’s work and collaboration with ACSM to offer science and evidence for communities to create a culture of healthy lifestyles.”

At the community level, the Fitness Index has been used as an assessment and evaluation tool to educate community leaders on the importance of key indicators of physical activity. Leaders can then focus on policy, systems and environmental change strategies that are evidence-based and create sustainability for the community.

The 2017 ACSM American Fitness Index rankings are as follows:

2017 Rank2016 RankMetropolitan Area2017 Score
12Minneapolis-St. Paul-Bloomington, MN-WI80.2
21Washington-Arlington-Alexandria, DC-VA-MD-WV79.2
35San Francisco-Oakland-Hayward, CA73.3
46Seattle-Tacoma-Bellevue, WA72.2
511San Jose-Sunnyvale-Santa Clara, CA71.6
67Boston-Cambridge-Newton, MA-NH71.5*
73Denver-Aurora-Lakewood, CO71.5*
84Portland-Vancouver-Hillsboro, OR-WA67.7
98Salt Lake City, UT66.3
1010San Diego-Carlsbad, CA65.6
1113Sacramento–Roseville–Arden-Arcade, CA63.3
1215.5±Austin-Round Rock, TX61.2
139Hartford-West Hartford-East Hartford, CT60.5
1415.5±Raleigh, NC58.6
1512Chicago-Naperville-Elgin, IL-IN-WI58.4
1629Los Angeles-Long Beach-Anaheim, CA55.7
1714Atlanta-Sandy Springs-Roswell, GA55.0
1822New York-Newark-Jersey City, NY-NJ-PA54.5
1926Tampa-St. Petersburg-Clearwater, FL54.1
2017Baltimore-Columbia-Towson, MD54.0
2120Milwaukee-Waukesha-West Allis, WI53.9*
2223Cincinnati, OH-KY-IN53.9*
2332Miami-Fort Lauderdale-West Palm Beach, FL52.6
2435Buffalo-Cheektowaga-Niagara Falls, NY52.5
2543Orlando-Kissimmee-Sanford, FL52.3
2628Saint Louis, MO-IL51.6
2719Virginia Beach-Norfolk-Newport News, VA-NC50.7
2825Cleveland-Elyria, OH50.0
2927Pittsburgh, PA49.0
3018Richmond, VA48.9
3121Providence-Warwick, RI-MA48.4*
3224Philadelphia-Camden-Wilmington, PA-NJ-DE-MD48.4*
3334Phoenix-Mesa-Scottsdale, AZ47.3*
3441Las Vegas-Henderson-Paradise, NV47.3*
3531Jacksonville, FL46.0
3630Kansas City, MO-KS45.0
3736Riverside-San Bernardino-Ontario, CA44.5
3837Dallas-Fort Worth-Arlington, TX43.2
3933New Orleans-Metairie, LA41.7
4040Houston-The Woodlands-Sugar Land, TX39.0
4138Columbus, OH37.4
4246Nashville-Davidson–Murfreesboro–Franklin, TN36.8
4342Detroit-Warren-Dearborn, MI35.8
4445San Antonio-New Braunfels, TX34.7
4547Memphis, TN-MS-AR33.2
4644Birmingham-Hoover, AL31.2
4739Charlotte-Concord-Gastonia, NC-SC30.3
4850Indianapolis-Carmel-Anderson, IN29.9
4949Oklahoma City, OK29.4
5048Louisville/Jefferson County, KY-IN23.1

±There was a tie in the ranking between the MSAs.

*The scores shown have been rounded to the nearest tenth of a point resulting in some apparent ties; however, the rankings are based on the full calculated score values that were not equal in those cases.


ACSM, the Indiana University School of Family Medicine and a panel of 26 health and physical activity experts developed the methodology to analyze U.S. Census data; data from the U.S. Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS); The Trust for the Public Land City Park Facts; and other existing research data in order to give a scientific, accurate snapshot of the health and fitness status at a metropolitan level.

ACSM is a global leader in promoting the benefits of physical activity and advocates for legislation that helps government and the health community make it a priority. ACSM encourages Congress to support continued funding of parks, trails and safe routes to school, as well as the need for all Americans to meet the prescribed physical activity recommendations included in the National Physical Activity Guidelines, and the need for the guidelines to be regularly updated every 10 years.

The data is made up of personal health, community and environmental indicators. Visit the online newsroom at for a complete list of the data components.

About the American College of Sports Medicine

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 50,000 international, national and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.   More details can be found at

About Anthem Foundation

The Anthem Foundation is the philanthropic arm of Anthem, Inc. and through charitable contributions and programs, the Foundation promotes the inherent commitment of Anthem, Inc. to enhance the health and well-being of individuals and families in communities that Anthem, Inc. and its affiliated health plans serve. The Foundation focuses its funding on strategic initiatives that address and provide innovative solutions to health care challenges, as well as promoting the Healthy Generations Program, a multi-generational initiative that targets specific disease states and medical conditions. These disease states and medical conditions include: prenatal care in the first trimester, low birth weight babies, cardiac morbidity rates, long term activities that decrease obesity and increase physical activity, diabetes prevalence in adult populations, adult pneumococcal and influenza vaccinations and smoking cessation. The Foundation also coordinates the company’s year-round Associate Giving program which provides a 50 percent match of associates’ pledges, as well as its Volunteer Time Off and Dollars for Doers community service programs. To learn more about the Anthem Foundation, please visit and its blog at

Infographic: 2017 ACSM American Fitness Index

According to the 2017 ACSM American Fitness Index, the top 10 fittest cities in the U.S. are:

  1. Minneapolis, MN
  2. Washington, DC
  3. San Francisco, CA
  4. Seattle, WA
  5. San Jose, CA
  6. Boston, MA
  7. Denver, CO
  8. Portland, OR
  9. Salt Lake City, UT
  10. San Diego, CA

Share this infographic and the Fitness Index with your local leaders to start a conversation on making your city a healthier place for all residents.

ACSM American Fitness Index Through the Years

In 2017 the ACSM American Fitness Index celebrates it’s 10th anniversary. For the last decade, the Fitness Index has been recognized as an assessment and evaluation tool to educate community leaders on the importance of key indicators of physical activity. With the support of supplementary resources such as the Community Action Guide and My Community Application Toolkit, leaders can focus on policy, systems and environmental change strategies that are evidence-based and create sustainability for the community.

Nationally, there have been noticeable long-term trends in the rankings that are both positive and negative. The positive trends include: smoking rates have declined two percent since the first rankings, more residents are biking and walking to work, and the number of farmers’ markets have increased. A few negative long-term trends have also become noticeable: the percent categorized as obese increased, the percent self-reporting as having excellent or very good health declined, and the percent of people diagnosed with asthma increased.

The Fitness Index celebrates the efforts made to improve the health and wellness of residents and urges all communities to identify opportunities for improvement.  For more information on highlights over the last 10 years, download the infographic below or details specific to your city can be found at

Today Show Looks to ACSM for America’s Healthiest City

To help kick off 2014, The Today Show looked at where in America you should go if you want to be “healthy, wealthy and wise”.

In their search for evaluating America’s healthiest cities, the show’s producers examined a number sources and ultimately settled on the ACSM American Fitness Index®. For the past three years Minneapolis/St. Paul has earned the highest ranking.

ACSM and the Fitness Index Advisory Board are honored to be considered as the best measure of a “healthiest” city. It’s a testament to the research and planning that went into creating the Fitness Index and the work to update the rankings each year since 2008.

For the segment on The Today Show, journalist Craig Melvin spoke with runners and bikers using the city’s expansive trails and paths, highlighted Minneapolis’ robust park and recreation system, and featured a healthy food program called Urban Roots.

The segment also included a portion of an interview with Fitness Index Advisory Board Chair Dr. Walt Thompson.

Check out the segment and read the story on The Today Show website. The 2014 report will be released in May ahead of the ACSM Annual Meeting.

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