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

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