Category: In the News

three people riding bikes in a park

Addressing Fitness Index FOMO | Resources for Cities Not Included on the Rankings Report

The American Fitness Index assesses key indicators and ranks the largest 100 U.S. cities by population and names one as the fittest city annually. What do you do if your community wasn’t large enough to be included in the rankings? How can you evaluate your community’s health and fitness? We can help you with that too! The  Community Fitness Assessment  was designed to help stakeholders in communities that were not included in the Fitness Index rankings by applying a similar approach to assessing their city’s community fitness and build understanding of the individual and societal factors related to physical activity in their community.  

The  Community Fitness Assessment  will lead you through the steps to find data about your community, identify peer communities and then identify your community’s areas of excellence and opportunities for improvement. 

 Community Fitness Assessment Steps

  1. Describe your community 
  2. Identify the communities you want to compare with your own 
  3. Search for personal health indicator data 
  4. Search for community/environment indicator data 
  5. Consider the option of a Mini Community Fitness Assessment 
  6. Interpret the results 
  7. Use the Community Fitness Assessment  profile to advocate for improved health and fitness 

The  Community Fitness Assessment  is designed with collaboration in mind. That is, your community will likely need to build a team that represents multiple city departments and community organizations, including the health department, parks and recreation, transportation, planning and zoning, as well as other key community-based organizations and businesses. Members of this team can gather the most current local data needed to conduct the Community Fitness Assessment.  This team can also engage community members to share the results and collect feedback on their priorities for addressing areas needing improvement.  

Throughout the process of conducting the assessment, leadership and engagement from elected officials like mayors and city councilors will be vital to success. These elected officials play a key role in allocating funding and passing ordinances that can advance the community-identified priorities. For example, community members may need new streetlights installed in their neighborhood to make it safer and easier to walk or bike home from work in the evening. City officials can work with local utilities to develop a plan for funding and installing new streetlights starting in areas with the highest need.  

The results of your  Community Fitness Assessment  won’t be directly comparable to the scores and rankings for the 100 American Fitness Index cities due to proprietary weighting of the indicators in the national index, but you will have a better idea of where your community is doing well and where there’s room for improvement. Using the American Fitness Index rankings, you can also identify cities that perform well on specific indicators to contact for advice in addressing your community’s needs.  

If your community needs a little extra help getting  your team started, you can also use the  Community Action Guide  which outlines the  steps to build an effective team to advocate for healthy changes in your community. 

We’d love to hear your feedback. Let us know how you used the  Community Fitness Assessment  here 

fresh produce with the fitness index logo

Food Insecurity: Defining and Addressing a Community Health Challenge

Food insecurity is defined by the U.S. Department of Agriculture (USDA) as   “a household-level economic and social condition of limited or uncertain access to adequate food.”  Generally, this indicator refers to households who don’t have enough food, particularly healthy food, to eat due to a lack of money and other resources. There are slight variations in how different organizations define food insecurity, but all relate to households who lack healthy food.   

How big is the problem? 

During the  COVID-19 pandemic, a spotlight was focused on food insecurity as many individuals lost their jobs, schools closed resulting in children not getting meals there and other normal sources of food were curtailed, resulting in households being unable to obtain all of the food that they needed. The U.S. Census Pulse Survey results indicate that those who sometimes or often did not have enough to eat due to lack of resources increased from about 20% pre-pandemic to 28% by mid-2021.  

10 US cities with lowest rates of food insecurity in 2021

The Feeding America non-profit group produces annual “Map the Meal Gap” reports that include estimates of food insecurity at the city level.  Their most recent report (2020) was used as the measure of food insecurity in the 2021 American Fitness Index (Fitness Index). Feeding America uses U.S. Census Current Population Survey data to measure of food insecurity based on a well-established statistical model using unemployment rates, median incomes, racial demographics and other factors shown to be determinants of food insecurity. Across the 100 cities included in the 2021 Fitness Index, there was almost a three-fold difference in the percentage of households with food insecurity, from a low of 6.7% for Arlington, VA, to a high of 18.2% for St. Louis, MO.  

What is the impact of food insecurity? 

A considerable amount of research  has examined the physical and mental impact of food insecurity, including poor physical health outcomes, inadequate intake of key nutrients for optimum functioning and increased risk of chronic disease. Associations also exist between food insecurity and obesity along with poor glycemic control among those with diabetes. Of particular concern from a fitness perspective is that food insecure households may not consume an adequate amount of protein, a nutrient essential for a variety of bodily functions, including building and repairing muscles,  bone health and development and stabilizing blood sugar.  

Healthy cognitive,  psychological and emotional development among children is also dependent on them consuming sufficient amounts of nutritious food. America’s poor and near-poor children are at higher risk of lower academic achievement and behavioral problems. Food insecurity has been associated with poor psychological and cognitive functioning, higher probability of behavioral problems and higher levels of aggression and anxiety among children. Food insecure women are more likely to experience prenatal depressive symptoms than food secure women. Another consequence of food insecurity is poor sleep which can cloud thinking and lower energy, as well as decrease the ability to make good decisions. The profound impact of food insecurity on individuals’ physical and mental health made a clear case for adding this indicator to the Fitness Index.  

How is food insecurity addressed at a policy level? 

The federal government  recently expanded the Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children (WIC) and other safety net programs that support low-income children and mothers during the pandemic to help increase access to food among those in need. These programs provide more than half of all food support for households in need. The USDA has also funded innovative demonstration projects such as creating and distributing meal boxes that contain a week’s worth of groceries that can be delivered to those in need. 

What can city officials do to reduce food insecurity  locally?  

In addition to supporting existing food banks, pantries and other food providing programs, many city  officials have supported the development and maintenance of innovative and effective programs to improve access to healthy food. The following examples offer city officials, local businesses and residents an opportunity to get involved in reducing food insecurity in their communities. 

  • Organize food providing programs into a network that shares  information and resources as well as analyzes food need patterns to build capacity in advance of expected needs.  
  • Develop apps or websites  to make local food resource information readily available. Information about food access is a critical resource particularly for households newly in need. 
  • Establish mobile food pantries and farm produce trucks to carry needed food into the food deserts and to others in need of food.  
  • Partner with  farm-to-table and farm-to-school programs which are effective ways to ensure those in need have access to fresh produce while at the same time supporting local farmers.  
  • Start  community gardens, using city property when allowed, as public gardening spaces. Those interested are assigned an area in a shared garden where they can grow fresh fruits and vegetables. Seeds, water, tools and other resources are often provided or shared when available.  
  • Create a  food rescue program that gathers unused food from restaurants and similar food preparation organizations that might have otherwise been discarded, and distribute these food items to agencies that provide hot meals to those in need. Alternatively, food rescue programs can work with local farmers to glean what is left in farmers’ fields after their harvest. This rescues fresh fruits and vegetables that would otherwise go to waste in fields. 
  • Support organizations that help those in need understand their eligibility for benefits and help them navigate the application process. State agencies are responsible for distributing  SNAP and WIC benefits, but many eligible people are not enrolled because applying for these benefits can be cumbersome and confusing.  

While the problem is  large, there is much we can all do to reduce food insecurity across the country. Clearly, having access to healthy food is important in all cities, and innovative, effective programs can be used by city officials to improve the access.  

If you or someone you know is experiencing food insecurity, you can find help at  


Author: Terrell W. Zollinger, DrPH, Professor Emeritus, Indiana University 

man sleeping in blue blankets and a pillow

The Importance of Sleep for Health

When we think about the most important actions that we can take to protect our health, we usually consider behaviors such as partaking in regular physical activity or eating a nutritious diet. Yet, an often-overlooked aspect of maintaining a healthy lifestyle is sleep. Sleep has serious implications for your physical and mental health. Adequate sleep will help you recover from exercise, enable your immune system to fight off pathogens and increase cognitive performance. In fact, to highlight its importance to health, the number of hours that people sleep is included as an indicator in the annual ACSM American Fitness Index (Fitness Index).

Despite the proven benefits of sleep on overall health, many of us tend to view it as a luxury and fail to get enough sleep. In fact, the Fitness Index reports that less than 65% of those who live in America’s 100 biggest cities get enough sleep (this number improves only modestly to 70% when we look at the entire U.S. population). Chronic sleep deprivation can have serious consequences on your health. For example, data have shown that lack of sleep can impair your body’s insulin response1—which can potentially contribute to the onset of diabetes. Moreover, chronic sleep deprivation has been associated with an increased risk of obesity and cardiovascular disease2. Lack of sleep can also alter memory retention, cause a negative mood, and inhibit your capacity to operate a motor vehicle. Data show that sleep deprivation impairs your ability to function to a greater extent than if you were intoxicated3.

Considering the negative ramifications of sleep deprivation, it is important to develop good sleep hygiene that contributes to a healthy lifestyle. To accomplish this goal, we must first commit to making sleep a priority. This sounds pretty intuitive but can also be difficult to do if you are juggling several responsibilities. To find balance, try building your daily schedule around your sleep (in much the same way you schedule other important activities like doing regular exercise or eating). Remember, if you make something a priority, you will always find time for it! Another way of developing good sleep hygiene is to go to sleep and wake up at roughly the same time every day, regardless of whether it is a weekend or vacation day. Doing this will help you fall asleep faster and make sleep less stressful.

Another key trait in those who have great sleep hygiene is having a pre-sleep ritual. Developing a routine that you can implement at least thirty minutes before going to bed will help “tell” your body it is time to go to sleep. Adopt activities that will help you relax, such as, taking a hot shower, reading a book or reducing your screen time. The bright light emitted from screens can alter how our bodies release melatonin and adenosine, two key chemicals that initiate our sleep cycles. In turn, it is best to just avoid looking at screens altogether before you go to bed. Lastly, do your best to make your bed your sleep sanctuary. Obviously depending on your circumstances, this may not be possible, but definitely try to use your bed for nothing other than sleep. You can make your space more conducive to promoting sleep by limiting the amount of light that enters your room and setting the room to a cooler temperature. Making these adjustments will contribute to a more restful night of sleep and help you build a sustainable habit.



  1. Knutson, K. L., Ryden, A. M., Mander, B. A., & Van Cauter, E. (2006). Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Archives of internal medicine166(16), 1768–1774.
  2. Pacheco, D. (2021, June 24). Physical health and sleep: How are they connected? Sleep Foundation.
  3. Williamson, A. M., & Feyer, A. M. (2000). Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational and environmental medicine, 57(10), 649–655.


Authors: Rafael Alamilla, M.S. and NiCole Keith, Ph.D. Ph.D., FACSM, IUPUI, Indiana University, Regenstrief Institute, Inc.


Infographic Sources:

  1. Markwald, Rachel R. Ph.D.; Iftikhar, Imran M.D., FACP, FCCP; Youngstedt, Shawn D. Ph.D. BEHAVIORAL STRATEGIES, INCLUDING
    EXERCISE, FOR ADDRESSING INSOMNIA, ACSM’s Health & Fitness Journal: March/April 2018 – Volume 22 – Issue 2 – p 23-29
  2. Bushman, Barbara A. Ph.D., FACSM Exercise and Sleep, ACSM’s Health & Fitness Journal: September/October 2013 – Volume 17 – Issue 5
    – p 5-8
  3. Pujalte, George G.A. MD, FACSM1; Benjamin, Holly J. MD, FACSM2 Sleep and the Athlete, Current Sports Medicine Reports: April 2018 –
    Volume 17 – Issue 4 – p 109-110
  4. American Academy of Sleep Medicine Public Safety Committee. TIP SHEET FOR HEALTH CARE PROVIDERS:
    Prioritizing Sleep & Managing Fatigue, 2021.

Infographic Author: Laura Young, Ph.D.

woman doing squats in living room in front of an open laptop

Impact of the COVID-19 Pandemic on the Fitness Index Indicators

We can all agree that the COVID-19 pandemic had a major impact on our lives and lifestyle in 2020 and continues yet today. Millions were sickened by the virus and hundreds of thousands lost family members. However, not everyone’s lifestyle was affected the same way. Millions lost their jobs, while others saw reduction in their work hours that caused severe economic hardship. Still others started working or getting their education remotely. Most of these individuals spent much more time at home. On the other hand, the essential workers still needed to carry out their job functions and some occupations, such as health care workers and delivery staff, worked more hours at their job locations.

Solid research on the impact of the pandemic on the relative fitness of the cities and their residents is very limited at this time. Undoubtedly, more will be known as time goes by. For now, the American College of Sports Medicine is considering how the pandemic might have an impact on the Fitness Index indicators and the city rankings in future reports. Due to the nature of data collection and reporting cycles, surveillance data collected in 2020 will not be available for analysis until the 2022 Fitness Index report. It is anticipated that community and environmental assets will not be significantly impacted by the pandemic. However, reduced use of these resources is likely due to closures, restrictions and changing lifestyles in response to the pandemic. In addition, the individual health indicators collected during 2020 are expected to decline in general, reflecting the pandemic’s adverse impact on individuals, their activities, jobs and communities.

The Fitness Index indicators to watch in 2022 include:

Health Behaviors

  • % exercising in the previous month
  • % meeting aerobic activity guidelines
  • % meeting aerobic & strength activity guidelines
  • % bicycling or walking to work
  • % using public transportation to work
  • % consuming 2+ fruits/ day
  • % consuming 3+ vegetables/ day

Health Outcomes

  • % in excellent or very good health
  • % with poor physical health in the previous month
  • % with poor mental health in the previous month
  • % with obesity

What does the evidence suggest at this point?

A large proportion of the population’s lifestyle became more sedentary during the pandemic. Exercise habits changed as gyms closed and folks stopped using public transportation and walking or biking to work; however, some individuals did begin exercising at home and started walking more in their neighborhoods. Overall, early research shows that for most individuals, physical activity reduced substantially as a result of the pandemic. The decrease in physical activity is expected to result in fewer individuals reporting exercising in the previous month, meeting the recommendations for strength and aerobic activities, as well as indicating that they had more days of poor physical or mental health in the previous month. The Fitness Index measure of self-assessed health status is also expected to decline in 2020.

Many families struggled to obtain nutritious food due to being out of work, having restricted ability to visit grocery stores and large groups of food items not being in stock caused by the pandemic. In addition, children receiving free and reduced meals at school were now kept home and consequently didn’t have access to that needed nutrition. However, to help meet the food need, community food resources expanded, including food pantries, SNAP benefits and ad hoc community food distribution centers. In any case, normal patterns of food access and food intake were negatively affected likely resulting in fewer individuals reporting eating the recommended number of servings of fruit and vegetables.

Data also show that the stress due to the pandemic in the form of the fear of getting the COVID-19 infection along with limited travel, lockdowns and lack of physical contact with extended family and friends, caused an increase in reported depression and mental health issues. An evidence of the anxiety caused by the pandemic was the well documented instances of panic buying and stockpiling of essential household items. Closely related Fitness Index indicators that are likely to be negatively impacted by anxiety are the reported number of days with poor mental health in the previous month and the number of hours of sleep respondents report getting each night on average.

Less physical activity, poorer diets and increased stress are known risk factors for weight gain. Thus, it is expected that the percent of city residents with obesity is likely to be one of the major consequences of the pandemic. The increase in obesity is expected to be seen in children as well as adults since children stopped attending school in person, thus missing physical activity classes and after-school sports programs. Instead, they spent more sedentary hours looking at screens to study, play video games and for entertainment.

The impact of the COVID-19 pandemic on the rankings of the cities in the 2022 Fitness Index is hard to anticipate. While all cities and their residents experienced the COVID-19 pandemic during 2020, the impact on the fitness indicators of the residents may not be the same across all cities since the rates of infection varied and the cities’ leaderships promulgated different restrictions and safety practices at different times during the year.

Analyzing the Fitness Index data for 2020 for next year’s report will yield answers to many questions, and it will certainly be interesting to see the results, so stay tuned! In the meantime, the 2021 Fitness Index is available now with data that describes the conditions present just before the pandemic started.




Jessie Fudge, M.D., FACSM, Kaiser Permanente and Terrell W. Zollinger, DrPH, Professor Emeritus, Indiana University

group of people doing tai chi in the park

Active People, Healthy Nation℠: Creating an Active America Together

Regular physical activity is one of the most important things that people can do to support their  health.  Being active can immediately help people feel better after each session of activity, and regular physical activity can reduce the risk of many chronic diseases and premature death. 

Although the benefits  of physical activity are well known,  many people  do not engage in the recommended amount of physical activity.  Populations with low income compared with higher incomes,  people  who are Black or Hispanic compared to non-Hispanic White  people  and residents of rural  areas  compared to urban areas have lower rates of physical activity.  We know that systematic inequities exist in opportunities to be physically active  which contribute to these  disparities.   

In response to  the  low  levels of physical  activity in the United States and the numerous benefits of being physically active,  in January 2020,  the Centers for Disease Control and Prevention launched  Active People, Healthy Nation,  a nationwide effort that aims to help 27 million Americans become more physically active by 2027.  The initiative supports equitable and inclusive access to opportunities for physical activity for all people regardless of age, race, education, socioeconomic status, disability status, sexual orientation or geographic location. 

How  do we increase  levels of physical  activity in the United States? 

sign post with seven arrows alternating pointing left and rightActive People, Healthy Nation provides a comprehensive  evidence-based  approach to improving physical activity by  promoting   at  the local, tribal, state and national level s even strategies that work  in partnership with other federal agencies and national organizations  (see figure).  Every Active People, Healthy Nation strategy can be designed to support equitable and inclusive access to opportunities for physical activity.  Communities can select strategies to increase physical activity that fit with their local context, including the needs and preferences of community members and community assets. 

How do I get involved? 

Everyone has a role to play  to increase physical activity—individuals, organizations and community champions. By joining Active People, Healthy Nation, you  and/or your organization  become part of a nationwide initiative and can help increase physical activity in the United States, reduce healthcare costs, build walkable neighborhoods, support local economies,  address health equity  and improve health for individuals, families and your communities. 

Joining is easy!  Visit the Active People, Healthy Nation  join  webpage  and click on the appropriate category: Individual Influencers, Organizations, or Community Champions.  Enter your email address to become  a supporter. There are a number of benefits including: 

  • Receiving access to resources and information through a monthly Active People, Healthy Nation newsletter. 
  • Receiving  website badges, social media messages and other resources to help spread the word about your work and your support for the initiative. 
  • Connecting  to a network of individuals, organizations and champions supporting Active People, Healthy Nation at national, tribal, state, and local levels. 

What can I do? 

Supporters have been  taking action  to support Active People, Healthy Nation and you can too!  Here are a few examples  of what other supporters have done and ways you can get involved: 

  • Individual influencers, organizations and champions have been posting on social media using #ActivePepole. Learn more about ways you can spread the word  
  • The  Maricopa Association of Governments  passed the first Active People, Healthy Nation Proclamation, showing commitment to active transportation and increasing physical activity in their community.  You can download  the  proclamation template  and work with an elected official to pass one in your community!  
  • The Division of Nutrition, Physical Activity, and Obesity within CDC currently  funds 61 recipients  in states and communities across the country to  create activity-friendly routes to  everyday  destinations,  based on  an evidence-based  strategy to increase physical activity recommended by the U.S. Community Preventive Services Task Force.  Projects  vary across communities and can include connecting routes like  sidewalks, paths, bicycle routes  and  public transit with destinations, such as  homes, early care and education, schools, worksites, parks  or  recreation centers. See if there is a  funded community  where you live and get involved! 
  • The Physical Activity Policy Research and Evaluation Network (PAPREN) is a CDC-funded Network that brings diverse partners together to create environments that maximize physical activity. PAPREN is a key research partner of CDC’s Active People, Healthy Nation initiative, facilitating collaboration across sectors and providing evidence and tools that states and communities can use to implement policy approaches to promote physical activity. Learn more about PAPREN  at-a-glance  or visit the PAPREN website  to join this  network of researchers, planners, engineers, policy makers, green space managers, health professionals, physical activity and fitness professionals and others. 

How can the  American Fitness Index  be used in conjunction with Active People, Healthy Nation? 

Tools such as the American Fitness  Index  provide data that decision makers  and partners  can use when creating plans  to improve physical activity in their communitiesCommunities  can examine and share the data  and  go through a process of equitable community engagement to determine where to focus their efforts.  Once they understand and identify  where they want to  work, communities can use the Active People, Healthy Nation  strategies  that  work  to narrow their focus on actions they want to take to increase active lifestyles.  



  • Fulton JE, Buchner DM, Carlson SA, et al. CDC’s Active People, Healthy NationSM: Creating an Active America, Together. Journal of Physical Activity and Health. 2018;15(7):469-473. doi:10.1123/jpah.2018-0249 
  • Schmid TL, Fulton JE, McMahon JM, Devlin HM, Rose KM, Petersen R. Delivering Physical Activity Strategies That Work: Active People, Healthy NationSM. Journal of Physical Activity and Health. 2021;18(4):352-356. doi:10.1123/jpah.2020-0656 

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 


Ken Rose,  MPA,  Branch Chief, Physical Activity and Health Branch, Division of Nutrition, Physical Activity and ObesityCenters for Disease Control and Prevention 

Emily Ussery, PhD,  EpidemiologistPhysical Activity and Health BranchDivision of Nutrition, Physical Activity and ObesityCenters for Disease Control and PreventionLCDR, US Public Health Service 

Kaitlin Graff, MSW, MPH, Program Coordinator,  McKing Consulting/Physical Activity and Health BranchDivision of Nutrition, Physical Activity and ObesityCenters for Disease Control and Prevention 

Facebook: @CDCEatWellBeActive 

Twitter: @CDC_DNPAO 


arlington virginia at sunset

What Makes Arlington, Virginia the Fittest City in America?

The American Fitness Index scores the country’s 100 largest cities (based on population) on 34 indicators of health. These indicators are broken into two categories: personal health, which measures the health of residents in the community, and community/environment, which measures both efforts that are undertaken by local authorities to promote health and fitness and the scale to which the environment promotes healthy behaviors. Arlington, VA earned the #1 overall ranking in the 2021 ACSM American Fitness Index with a score of 86.1 out of a possible 100. This is the 4th consecutive year that Arlington has been named the “Fittest City in America.”


What makes Arlington so fit?

Arlington ranked first in both the personal health and community/environment sub-scores. At the individual indicator level, Arlington ranked among the top 10 cities for 18 of the 34 indicators in the Fitness Index, with eight indicators ranked #1.

Arlington was ranked #1 for the following indicators:

  • Lowest percentage of residents with angina or coronary heart disease (.3%)
  • Lowest percentage of residents who smoke (3.5%)
  • Lowest percentage of residents with high blood pressure (15.2%)
  • Lowest percentage of residents experiencing food insecurity (6.7%)
  • Lowest percentage of residents with diabetes (4.2%)
  • Lowest percentage of residents with poor physical health in the previous month (24.1%)
  • Highest percentage of residents in excellent or very good health (66.9%)
  • Highest percentage of residents exercising in the previous month (85.7%)

Arlington ranked in the top 10 for the following indicators:

  • Percentage of residents who use public transportation to go to work
  • Percentage of residents who consume 2+ fruits per day
  • Percentage of residents who sleep 7+ hours per day
  • Percentage of residents with poor metal health (lowest)
  • Percentage of residents with obesity (lowest)
  • Percentage of residents who have experienced a stroke (lowest)
  • Bike Score
  • Percentage of residents who live within a 10-minute walk to a park
  • Number of tennis courts per 10,000 residents

See how the 99 other ranked cities compare to Arlington using the City Comparison Tool.

city with safe bike lanes

How High Is Your Bike Score? Barriers to Bikeable Communities

Moving to a new city in the middle of the COVID-19 pandemic could have made for a difficult transition. Without the typical options of going out to restaurants, concerts or sporting events, getting to know our new home presented with some challenges. When my husband and I moved to Minneapolis in June of 2020, we were both sidelined from running by injuries. Fortunately, the vastly connected bike trails in the city gave us an excellent way to explore our new city and stay safely distanced. We quickly found ourselves riding our bikes for longer than we ever had before, and one of the key reasons we continued to cycle was that it was “easy.” We weren’t fighting car traffic in the bike-only lanes. We never ran into areas where the bike lanes abruptly ended, so thankfully, we never had to merge with vehicular traffic. I do not enjoy cycling while cars speed past with little concern for others on the road, but Twin Cities bike trails were relatively protected from this. My biggest complaint was that at times there were too many cyclists (how could I say such a thing)!

During medical school, I would cycle commute to class, but I only had to travel a mile on streets that were not busy (though there were no bike lanes). I’ve considered cycling to work at times since, but several barriers existed, including community factors such as lack of infrastructure connectivity (bike lanes that connect to one another and do not require you to abruptly merge with vehicular traffic), lack of protected bike lanes and sidewalks and poor lighting, as well as personal factors such as not having access to a shower when I get to work. In Minneapolis, so many residents cycle commute or just ride for exercise, and now I understand why: the city infrastructure makes it easy and enjoyable. This made me think more about what needs to be done for those in other cities to have the opportunity to reap the benefits of cycling carefree in their communities.

Cycling to work or school has many benefits, including:

    • Increased physical activity which may lead to decreased risk of chronic disease
    • Reduced carbon footprint
    • Avoidance of traffic jams
    • Decreased risk of contracting COVID-19 through public transportation
    • Improved mood and cognition
    • Help people achieve the American College of Sports Medicine recommendations of 150 minutes of physical activity per week
    • Save money, as cycling is less expensive than owing and driving a car

Despite the benefits, there are barriers to cycling in many communities, including infrastructure connectivity, lack of protected bike lanes or sidewalks and poor lighting. Infrastructure connectivity is one of the primary barriers to cycling in cities in the United States. Complete Streets policies can help create communities where the choice to be active every day is easier and safer. Complete streets are designed to prioritize safety, comfort and right of way to walkers and cyclists to help create livable communities by prioritizing safety and public health. Eliminating additional barriers to cycling, such as narrow bike lanes, lack of separation from motor vehicles, challenging intersection crossings and snow-and-ice-covered bike paths are ways to make people feel more comfortable cycling.

USA map bike score 2020Although the ultimate choice to be active or cycle to work lies with each individual, providing access to safe, interconnected and well-lit bikeways should be a community responsibility, and community policies can help prioritize cyclists when planning a city’s infrastructure. The ACSM American Fitness Index assesses infrastructure connectivity using four indicators, one of which is the Bike Score®. Minneapolis, MN ranks #1 in Bike Score®, followed by Portland, OR, Chicago, IL, Denver, CO, and San Francisco, CA. But what has allowed these cities to rise to the top of the list? They primarily have a well-connected infrastructure with well-marked bike lanes that are often separate from motor vehicle traffic. Minneapolis implemented a Complete Streets Policy in 2016 that prioritizes pedestrians first, followed by bicycling and transit use and lastly motor vehicle use. Minneapolis has a growing bikeway network that encourages people of all ages to cycle throughout the year, both for exercise and when commuting. Many other cities have adopted a similar bikeway infrastructure, but there are still many cities that lack safe and well-connected bike lanes.


Author: Allison Schroeder, MD is  a Sports Medicine Fellow at Mayo Clinic Square in Minneapolis, MN. She will be joining the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh Medical Center as faculty beginning in August of 2021.

man in red sweater riding a bike with a backpack

Overcoming Barriers to Active Transportation

Active transportation has important environmental, health and economic benefits. Promoting active modes of transportation including walking, cycling and wheelchair or stroller rolling, can increase physical activity, benefit both individuals and communities economically and play a role reducing air pollution.

In some areas, active transportation can replace motor vehicle use entirely. More commonly, though, physical activity can be combined with cars or public transportation to replace parts of trips. However, participation in active transportation varies widely among urban, suburban and rural communities. This disparity has much to do with personal, environmental and cultural barriers that interfere with the adoption of active transportation. Encouraging people to utilize active modes of transportation requires that we identify and address these barriers.

One barrier to active transportation is the availability of resources and infrastructure in the community to make it realistic. For example, the American Fitness Index includes Walk Score, which is based on how well errands and activities can be completed on foot as opposed to needing a car. Large cities tend to have a higher walk score than smaller cities that are less dense and not as likely to have access to sidewalks, bike lanes and public transportation.

Other factors that influence the decision to walk and bike include the accessibility and conditions of sidewalks, bike lanes, multi-use trails and forms of public transportation. Also, the availability of bicycle parking and storage and a place to change clothes and shower after commuting are important potential barriers. Having access to these resources can make the decision to walk or bicycle for transportation easier.

Another barrier to active transportation is safety, both real and perceived. The infrastructure and culture in some cities make it safer for pedestrians and cyclists, so pedestrian fatalities are lower, and individuals and families are more likely to be active. Communities that lack sidewalks, bike lanes, safe street crossings and adequate lighting would certainly have lower participation in active transportation. Additionally, since there is “safety in numbers,” places where walking and bicycling are more common tend to be safer because motorists are more aware of their presence. When cyclists and pedestrians are less visible, drivers may not be as cautious, making safety more of a concern.

The community culture can be a barrier to active transportation. In places where active transportation and using public transit are the norm, people are more likely to leave their car at home and walk or bicycle to work or for leisure trips. Unfortunately, many people find that their community does not support active transportation, either through a lack of infrastructure or through the attitudes of the citizens. Relatively few people would begin or maintain a habit of active transportation when it isn’t widely accepted and supported through community norms or policies.

Personal factors can also be a limit factor. An individual’s belief in the health, environmental and economic benefits can influence their decision to participate in active transportation. The perceived additional time to walk or bike rather than drive is also a barrier, but it is interesting to note that most people overestimate the time required for active travel. A person’s fitness and ability to travel longer distances on foot or on a bicycle can also be a concern, especially if the commute includes hills. Combining walking with public transit for longer trips or using an electric-assist bicycle can reduce the intensity and make it more enjoyable. While active transportation is almost always less expensive than driving a car, the cost of a bicycle and other equipment may limit some from getting started. Bike sharing and financial incentives for purchasing a bicycle may reduce this concern. Finally, the weather can be an important consideration. Hot, cold or rainy climates can reasonably limit active transportation, especially when considering professional attire.

Many of these barriers can be overcome through education about the benefits of active travel, the availability of infrastructure, resources to support walking and cycling and tips to make active transportation safer and more comfortable. Advocating for changes in policies and the built environment can be effective as a grass-roots effort. Educating drivers, pedestrians and cyclists about traffic rules and safety can help change the culture. And making public transit, walking and cycling more visible through community “open streets” events can raise awareness and normalize active transportation. Ultimately, expanding access to active transportation can make communities more equitable, healthy and economically sound.


Author: Brian B. Parr, Ph.D., FACSM, ACSM-CEP, University of South Carolina Aiken

healthy food options

Nutritional Strategies for Healthy Aging

Over the last century, the human lifespan has undergone dramatic changes. At the start of the 20th century, the average lifespan at birth for women and men in the United States was 50 years. In 2021, the average life expectancy is around 77 years (1). This increasing lifespan trend is expected to continue rising to an average of 85 years by 2125. It is important to note that this change is primarily driven by a reduction in early morbidity rates rather than an extension of maximum lifespan. Due to this, many more individuals live longer lives during a period where they can be classified as “older adults.” Presently, 13% of the United States population is comprised of individuals over 65 years of age, compared to 4% in 1900 (2). Therefore, it is important to discuss research related to the effects of aging on physiology and metabolism to promote public health policies and practices that benefit older individuals.

Good nutrition is essential regardless of an individual’s age because it may help prevent diseases such as osteoporosis, high blood pressure, heart diseases, type 2 diabetes and certain cancers. However, good nutrition may be even more important in older individuals due to changes in energy intake and energy expenditure with age. The impairments in energy balance can be mediated by several factors such as reduced hunger and increased satiety (3), changes in blood sugar concentrations (4), impairments in hormone production (5), changes in taste and smell (6), reduced dietary variety (7) and medical and social factors (8). Furthermore, with increasing age, researchers have also observed a decline in  the amount of energy used while the body is at rest(9) and the amount of energy used for digestion, absorption and storage of consumed foods(10). Taken together, these changes in metabolism that occur as we age call for effective nutritional strategies that help older individuals stay healthy with aging.

Nutritional strategies that help older individuals stay healthy with aging

  • Incorporate food groups that provide nutrients without extra calories, such as fruits and vegetables (of different types and colors), whole grains (like oatmeal, whole-grain bread and brown rice), fat-free or low-fat dairy products fortified with vitamin D and calcium (like milk, yogurt, nut milks), lean protein sources (e.g., seafood, lean meats, poultry and eggs) and healthy fats (e.g., walnuts, almonds, avocados) will translate to a healthier lifespan.
  • Minimize high-calorie, low nutrient-dense foods (e.g., foods with excess calories but few nutrients, such as chips, desserts, baked goods, soda and alcohol).
  • Reduce saturated and trans fats (e.g., animal products, margarine, fried and processed foods).
  • Drink enough liquids to ensure proper hydration and prevent dehydration. Aging and certain medications may impact sensations of thirst. Older adults should consume two to three liters of liquids per day in the form of water (ideally), herbal teas, broths or liquid-based foods like smoothies and soups.
  • Maintain physical activity according to the ACSM guidelines to promote beneficial effects on healthy aging by reducing the risk of falling, fractures, coronary heart disease, developing high blood pressure, certain cancers and diabetes(11).


Authors: Rohit Ramadoss, M.S.; Stella L. Volpe, Ph.D., RDN, FACSM, ACSM-CEP, Virginia Polytechnic Institute and State University


  1. NVSS – Life Expectancy. (2021, March 10).
  2. 2017 Profile of Older Americans |
  3. Evidence for the anorexia of aging: Gastrointestinal transit and hunger in healthy elderly vs. Young adults | American Journal of Physiology-Regulatory, Integrative and Comparative Physiology.
  4. Campfield, L. A., Smith, F. J., Rosenbaum, M., & Hirsch, J. (1996). Human eating: Evidence for a physiological basis using a modified paradigm. Neuroscience & Biobehavioral Reviews, 20(1), 133–137.
  5. Roth, G. S. (1979). Hormone action during aging: Alterations and mechanisms. Mechanisms of Ageing and Development, 9(5), 497–514.
  6. Doty, R. L., Shaman, P., Applebaum, S. L., Giberson, R., Siksorski, L., & Rosenberg, L. (1984). Smell identification ability: Changes with age. Science, 226(4681), 1441–1443.
  7. Mt, F., & Kj, S. (1985). Characterizing consumption patterns by food frequency methods: Core foods and variety of foods in diets of older Americans. Journal of the American Dietetic Association, 85(12), 1570–1576.
  8. De Castro, J. M., & de Castro, E. S. (1989). Spontaneous meal patterns of humans: Influence of the presence of other people. The American Journal of Clinical Nutrition, 50(2), 237–247.
  9. Fukagawa, N. K., Bandini, L. G., & Young, J. B. (1990). Effect of age on body composition and resting metabolic rate. American Journal of Physiology-Endocrinology and Metabolism, 259(2), E233–E238.
  10. Thermic Effect of Feeding in Relation to Energy Balance in Elderly Men—Abstract—Annals of Nutrition and Metabolism 1983, Vol. 27, No. 1—Karger Publishers.
  11. Scientific Report |
heart and EKG on orange background

Healthy Hearts Power Fit Cities

February is American Heart Month, and there is no better time to appreciate the benefits of cardiovascular fitness and a strong heart! Heart disease is the leading chronic disease cause of mortality in the U.S., accounting for one in every four deaths1. Cardiovascular fitness plays an important role in reducing not only deaths from heart disease, but also the risk of coronary heart disease, hypertension, diabetes and stroke2.

In thinking about cardiovascular fitness, I found a striking similarity with my recent experience of completing several home improvement projects. Within a few short months, my house required a new water heater, AC system and significant updates to insulation. Although these systems typically go unnoticed when functioning well, they are important to my daily living and quality of life. My focus can be on the joys of work and play within the walls of a comfortable, adaptable and efficient home.

Cardiovascular fitness is your heart and vasculature’s ability to deliver oxygen throughout the body to the working muscles. We can’t see it, and, like a water heater or AC system, we can take it for granted, but it affects how well we work and play. It can take some effort to improve or maintain your cardiovascular system, but it is absolutely worth it! If our heart is efficient and strong, our health and quality of life benefits. At a daily level, cardiovascular fitness can improve our productivity and focus at work, give us more energy to play a round of tag with our grandchildren or propel us to walk the extra half mile to reach the city pier.

top 10: % or residents meeting aerobic activity guidelines 2020The best way to improve and maintain cardiovascular fitness is through physical activity that elevates your heart rate to at least moderate intensity levels. Only 50% of U.S. adults report meeting the recommended amounts of 150 minutes per week. Madison, WI is the leading city in the 2020 American Fitness Index rankings with an estimated 65%, and Laredo, TX is ranked lowest with only 34% of people reporting the recommended levels of activity. Use this handy infographic to learn how to monitor your exercise intensity.

The ultimate choice to be physically active is with each individual. However, the community’s environmental resources and policies will help or hinder these individual levels of physical activity and ultimately, cardiovascular fitness. Providing access to recreational facilities and parks for all residents allows for enhanced opportunities to be physically active. According to data collected for the Fitness Index, 100% of Boston, MA and San Francisco, CA residents are within a 10-minute walk to a park. The Fitness Index also tracts specific recreational facilities ranging from park playgrounds (Madison leading with 6.9 per 10,000 residents) to public swimming pools (lead by Cleveland, OH with 11 per 100,000 residents). Larger scale Complete Street policies that provide safe and aesthetically pleasing infrastructures for active walking and cycling can be important ways to increase aerobic activity and improve fitness. Cities across the country are beginning to adopt and implement strong Complete Streets policies, such as New Orleans, LA, Seattle, WA, St. Louis, MO, and Buffalo, NY.

I ultimately made the decision to make home improvements, however, I received support from local and state government resources and incentives programs along the way that made my decision easier. Promoting good cardiovascular fitness of each community member should be considered an individual and community priority just like keeping our homes in shape. Under the surface of a fit city, lies the heart of every resident to drive its vibrancy.


To learn more about heart health and physical activity, explore ACSM’s heart health resources.


Author: Amanda Paluch, Ph.D., University of Massachusetts Amherst


  1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Associationexternal icon. Circulation. 2020;141(9):e139–e596.

2. Ozemek C, Laddu DR, Lavie CJ, Claeys H, Kaminsky LA, Ross R, Wisloff U, Arena R, Blair SN. An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk. Prog Cardiovasc Dis. 2018 Nov-Dec;61(5-6):484-490. doi: 10.1016/j.pcad.2018.11.005. Epub 2018 Nov 13. PMID: 30445160.