Category: In the News

city with safe bike lanes

How High Is Your Bike Score? Barriers to Bikable 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 the 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

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


  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.

woman standing and stretching at her desk

Staying Active During the COVID-19 Pandemic: Meeting Physical Activity Guidelines

The coronavirus pandemic has had a large impact on our daily life activities including our work, how we move from point A to point B, the time we spend in our homes and what we do recreationally. Physical activity is classified into four major domains: occupation, transportation, household and leisure-time; and all of these domains have also been directly impacted by COVID-19. Considering that exercise improves our mood and sleep, optimizes our immune system and can reduce stress and anxiety, it is now more important than ever to adhere to a physically active lifestyle. The most recent public health guidelines to control the spread of COVID-19 do not interfere with our ability to meet the ACSM-CDC physical activity guidelines.

To reduce the spread (or “flatten the curve”) of COVID-19 the federal government recommends the following:

The Physical Activity Guidelines for Americans provide a variety of recommendations for people of different ages and conditions. Briefly, children aged three to five years need physical activity throughout the day, every day, for growth and development. Children and adolescents aged six to 17 years need at least 60 minutes of moderate-to-vigorous intensity physical activity daily. Adults need 150 minutes a week of moderate-to-vigorous-intensity activity. Lastly, regardless of your age, some physical activity is better than none.

Is it possible to maintain a physically active lifestyle during the pandemic?

How can I incorporate enough physical activity to remain in optimal physical and mental health? How can I stay active if I am asked to work from home or remain socially distanced from others? These are very good questions, and the answers show that the sets of recommendations for physical activity and flattening the curve are not mutually exclusive. We can act consciously to reduce the spread of the virus that causes COVID-19, and we can maintain physical activity levels.

According to the CDC, “parks, trails and open spaces can provide opportunities for physical activity while also providing opportunities for a break, health and wellness.” Just because we are primarily working from home and limiting gatherings with other people does not mean we cannot visit parks and open spaces to engage in physical activity. Cities that have devoted funding to parks and outdoor recreation spaces can now reap the community health benefits of their investments.

Suggestions on how to incorporate physical activity while simultaneously controlling the spread of COVID-19:

  1. Socially distance. Vigorous exercise will most likely require that you keep more than six feet of distance from another person. Consider an exercise routine that you can do at home e.g., treadmill, strength training, calisthenics, yoga, etc. that does not require exposing others to respiratory droplets or particles.
  2. Wear a mask. Sometimes it is uncomfortable to exercise while wearing a mask, but the key is to provide a physical barrier to prevent the spread of air droplets while exercising. Fortunately, the sports industry has created a variety of masks that have been produced exclusively for exercise that are comfortable, breathable and minimize the spread of the respiratory droplets. There are also other alternatives to masks such as running buffs/ gaiters. These garments are worn around the neck and can easily be pulled up and down. Whenever possible wear a mask or any barrier, especially when you are around other individuals.
  3. Outdoors is better than indoors. Parks, trails, lakes, or any open space is preferable over indoor settings. Walking and gardening continue to be the two most popular modes of physical activity among adults and do not require major planning or financial investments.
  4. Proper ventilation and adequate air filtration are key. According to the CDC, facilities should adjust the ventilation so that the maximum amount of fresh air is delivered to occupied spaces while maintaining the humidity at 40-60%. If possible, increase filter efficiency of heating, ventilation, and air conditioning (HVAC) units to highest functional level.
  5. Be a team of one. Choose activities that you can do on your own rather than team sports, especially with activities or sports that require close contact.
  6. Engage in active family play time. Any game that gets everyone up and moving counts.
  7. Move around your home. Catch up on current or outstanding household chores such as cleaning out the closet, organizing the garage or rearranging furniture, and remember, vacuuming is also a physical activity!
  8. Break up TV time. Make television watching more active by doing jumping jacks or push-ups during the commercials.
  9. Work (out) from home. Even though some jobs require spending hours in video conferences or writing, we can still incorporate some physical activity while being productive. First, use a stand-up desk – sitting too much was never a good idea. Second, have several small weights (5, 10 lbs. dumbbells) readily available – no one will see you lifting some light weights – just remember to place the camera above your shoulders. Third, consider adding an under-desk bike pedal exerciser and ride the wave to a healthy 2021!

There are more ways to add physical activity to your daily life.  For additional information consider checking out  ACSM’s free workouts  or their COVID-19 resource page.

Author: Carlos J. Crespo, Dr.PH, FACSM, Portland State University

woman running and using a fitness tracker

Virtual Run, Walk and Roll Events, A Great Way to Stay Active and Connected!

The year 2020 has been a challenge for all of us. Schools, colleges, universities and businesses went virtual due to the COVID-19 pandemic. Commercial health clubs, corporate wellness programs, community-based fitness programs and medical fitness centers have closed their doors in an attempt to stop the spread of the coronavirus. But those dedicated to fitness have found ways to stay healthy and continue their exercise programs. Now that the winter holidays are upon us, let’s be creative to stay active together! Challenging your friends and family to participate in virtual fitness events is a great way to stay in shape and encourage some healthy competitive spirit!

Bill Thorn holds 2020 Peachtree Road Race shirtEvery year since 1970, a small gathering of 60,000+ runners (the + is because registration is limited but there always were runners without numbers) would gather in Atlanta on July 4th for a 10K run and wheelchair race called the Peachtree Road Race. There is no hotter or more humid place on the planet Earth than Atlanta on Independence Day, but we gathered there anyway all bunched up together and ready to do our best (or just run for the fun of it). We would run, walk and roll shoulder-to-shoulder, hot, sweaty and most of us breathing very heavily. Exactly the right environment for the viral spread of the coronavirus! This year the Atlanta Track Club, in their wisdom (and probably because they wanted to give away all those 2020 race T-shirts), created a completely virtual event allowing for participation from around the world.

Peachtree Road Race cancelled? NEVER! Just different this year.

How do virtual races or fitness events work? If you are in an organized virtual race or event, you pay an entry fee, use an app or fitness tracker to clock your distance and time and submit your results to the organizers. Easy as that!  Most of the time the entry fee often includes a finisher’s t-shirt, a race number and “other swag.” Many of these events also benefit local or national charities.

We understand that paying for a virtual race may not be in your budget or your immediate interest. How about a virtual race with family and friends? These are not difficult to organize and are lots of fun. Using the iPhone feature “Facetime” during the run is a fun way to stay connected and get the whole family involved. If you are like our families, we are all over the place including multiple states and hundreds of miles apart. Staying connected and providing support really helps. We also have a wide range of ages and levels of fitness so for more competitive of us, a full out 10K (or similar distance) is fun or for the less fit and younger kids a walk of a designated distance might work. In case a time and place cannot be arranged, but you are still competitive, any of the fitness trackers will work. Keep up with your time (or distance or whatever you agree on to be measured) and compare later. The family member with the best time wins (or at least has family bragging rights until the next competition).

Want a little assistance with virtual fitness events? Check out the following resources:

This holiday season make time for family, friends, and fitness even if it’s just playing outside, walking the dog together, or a virtual fitness event. For those of you participating in the virtual Peachtree Road Race or any other virtual fitness event, good luck out there!

Authors: Walter Thompson, Ph.D., FACSM, Georgia State University and Jammie Hopkins, DrPH, Morehouse School of Medicine

woman walking black and white dog in fall leaves

Holiday Stress Buster | Physically Distanced Physical Activity

Feeling overwhelmed at the thought of the holiday season? You are not alone. This winter will layer pandemic anxiety on top of holiday tension and cold weather challenges, all of which can lead to negative physical and mental health outcomes. Unchecked stress can contribute to high blood pressure and heart disease as well as increased anxiety and depression. In fact, in the 2020 Fitness Index, 30% of residents in the largest 100 U.S. cities have high blood pressure and 38% reported poor mental health. Adding seasonal stress to that mix is not a winning recipe.

A key (and free) way to reduce stress and anxiety is to be physically active. Research tells us even small amounts of activity can help reduce stress, enhance your mood, improve sleep and even strengthen your immune system – something we can all use during this pandemic. Even a 30-minute brisk walk provides immediate immune benefits that can last for several hours afterwards. Every active minute counts and can add up to better health.

What counts as physical activity? A lot actually! You do not have to prove you are an Ironman champion and go all out over the holidays. Moderate-intensity activities that allow you to talk, but not sing, during the activity are an ideal place to start. Walk the dog. Dance with your partner. Play catch with your kids. Ride your bike to the store. Even household chores like raking leaves, vacuuming and lifting laundry baskets will rack up activity minutes. Looking for a structured workout option? Check out this video playlist of free workouts from ACSM’s International Health & Fitness Summit.

Want more out of your activity? Take it outside. Being active in nature amplifies the reduction in stress and anxiety and reduces blood pressure. Walk down a tree-lined street, be active in your backyard or find a local park or green space. Be sure to treat nature gently – stay on designated trails, take your trash home with you and leave plants and animals exactly where you see them.

Looking to give back while being active this holiday season? There are many Virtual Walk/Run/Roll options that benefit charitable organizations across the country.

It would not be 2020 if we did not talk about COVID-19. Be safe when you are active away from your home. Keep your distance (at least six feet) from people outside of your household and wear a face covering over your nose and mouth if others are too close.

From all of us at the American Fitness Index, we wish you happy and healthy holidays!

hand crushing cigarettes

Quit Smoking to Improve Your Health | Smoking Cessation Resources

Only 20  minutes after your last cigarette, your heart rate and blood pressure begin to drop. Within a few  days, the carbon monoxide level in your blood drops to a normal rate. After a few weeks your circulation and lung function improve, and after a year your risk of heart attack drops significantly. These are only some of the drastic changes your body undergoes when you quit smoking, as identified by the American Cancer Society.

Despite the benefits of a smoke-free lifestyle, 15% of residents in America’s 100 largest cities are smokers. Across these cities, nearly 9.7 million people are at a heightened risk of certain cancers and coronary heart disease because of this habit. The Great American Smokeout, presented by the American Cancer Society, is Thursday, November 19, 2020. On this date, Americans are encouraged to make a plan to quit smoking. We have gathered a number of resources here to help you or others in your life make a plan to quit smoking.

graphic of US cities with highest smoking rates
This graphic shows the 10 cities ranked by the American Fitness Index to have the HIGHEST rates of adult residents who smoke.


Help Someone Else Quit Smoking

Help Employees Stop Smoking | American Lung Association

Smoking-Cessation: Role of the Fitness Professional in Clearing the Air | ACSM’s Health & Fitness Journal®

Helping a Smoker Quit: Do’s and Don’ts | American Cancer Society 


Support  To Quit Smoking

Sign up for support via text message | NIH – National Cancer Institute

Download the quitSTART app | CDC

Call the State Quitline | 800-QUIT-NOW (800-784-8669, English) 855-DÉJELO-YA (855-335-3569, Español)

Call the National Quitline | 877-44U-QUIT (877-448-7848) (support in both English and Spanish)

Smoking Cessation Resources for Veterans  | NIH – National Cancer Institute

Freedom From Smoking, Smoking cessation support for public housing | American Lung Association and Anthem Foundation  | Resources from the  NIH – National Cancer Institute specifically supporting women, teens and seniors.

SmokefreeEspañol   | Recursos en español de NIH –   Transformación de Descubrimientos de la Salud®

Deciding to Quit Smoking and Making a Plan | American Cancer Society 

Other Ways to Quit Smoking | American Cancer Society

Getting Help with the Mental Part of Tobacco Addiction | American Cancer Society

You Can Quit Smoking: Here’s How | CDC

Quitting smoking is tough. But Dorise, a public housing resident in Milwaukee, not only quit with help from the Freedom From Smoking (FFS) program, but also became a champion for others who wish to follow in her footsteps. While the Anthem Foundation has partnered for years with the American Lung Association to help people quit, a smoke-free policy for all public housing locations that went into effect July 31, 2018, prompting the partners to expand the program to help people like Dorise quit smoking for good.


*The Anthem Foundation is the funding partner of the American Fitness Index.

pedestrians in cross walk

October is Pedestrian Safety Month

The release of the 2020 American Fitness Index saw the average  pedestrian fatality rate across  the U.S.’s 100 largest cities grow from 2.2 deaths per 100,000 residents to 2.6.  That represents   approximately 1,680 lives lost, an increase of   261 deaths from the previous report.

Neighborhoods connected by sidewalks, protected bike lanes, lighting and benches are essential for reducing pedestrian fatalities. Safety, both real and perceived, can impact how often residents walk or bike in their neighborhoods. The 10 deadliest cities for pedestrians averaged 5.5 pedestrian deaths per 100,000 residents while the 10 safest cities averaged 0.6 fatalities per 100,000 residents.

St. Paul, MN has the lowest pedestrian fatalities at .3 deaths per 100,000 residents









To raise awareness of this rising number, several states have launched October as Pedestrian Safety Month.

“Pedestrian deaths are unacceptably high so federal leadership to achieve zero deaths is absolutely critical. As motor vehicles have become increasingly safer for occupants due to design changes and the addition of supplemental safety features, the same can’t be said for pedestrians. More must be done to ensure people on foot can safely travel our roadways.” – Pam Shadel Fischer, GHSA Sr. Director of External Engagement and author of several national best practice reports on pedestrian,  bicyclist  and  micromobility  safety.

The most dangerous cities for pedestrians are (average deaths per 100,000 residents):

100.  Hialeah, FL (7.5)

99. Phoenix, AZ (6.6)

98. Albuquerque, MN (6.1)

97. Stockton, CA (5.5)

96.  (tie) Miami, FL (5.1)

96. (tie) Tampa, FL (5.1)

96. (tie) Detroit, MI (5.1)

93. (tie) St. Petersburg, FL (4.9)

93. (tie) New Orleans, LA (4.9)

91. El Paso, TX (4.7)

How does your city rank?

orange sky, poor city air quality

Unhealthy Air Quality in the U.S. Pacific Northwest

As fires plague the Pacific Northwest region of the United States, residents in the area must be particularly cautious when spending time outdoors due to poor air quality. As Dr. Liz Joy points out in a previous Fitness Index blog post:

There is incontrovertible evidence linking poor air quality to adverse health outcomes. This is especially true for people with pre-existing conditions such as heart disease, stroke, asthma and chronic obstructive pulmonary disease. However, healthy people are at risk too. Exposure to air pollution has been linked to a higher risk of developing asthma, and recent studies have identified links between air pollution and adverse pregnancy outcomes.

You have likely seen eerie images on social media and the news of orange skies, particularly in the Bay Area of California. A healthy air quality index (AQI) range for any given day is a score between 0-50. Today’s (Friday, September 11, 2020) score in San Francisco, CA, is in the 200 range, which is considered “Unhealthy” to “Very Unhealthy” by the U.S. Environmental Protection Agency (EPA). In this AQI range, everyone may experience mild to serious health effects, and members of sensitive groups (those with lung/heart disease, older adults, children and teens) are more likely to experience serious health effects. Download the app for your smart phone or visit, and review the AQI for your local area.

What is poor air quality?

The EPA measures the quality of ambient air for five major air pollutants that affect health and are regulated by the Clean Air Act. These are:

  1. Ground-level ozone
  2. Particle pollution (a.k.a. particulate matter)
  3. Carbon monoxide
  4. Sulfur dioxide
  5. Nitrogen dioxide

The current air quality dangers in the Pacific Northwest are fueled by wildfires. According to the EPA:

Smoke is made up of a complex mixture of gases and fine particles produced when wood and other organic materials burn. The biggest health threat from smoke is from fine particles. These microscopic particles can penetrate deep into your lungs. They can cause a range of health problems, from burning eyes and a runny nose to aggravated chronic heart and lung diseases. Exposure to particle pollution is even linked to premature death.

Learn more about how smoke from fires can affect your health in this post from the EPA.

Learn more and resources

Check out these ACSM and American Fitness Index original resources on air quality:

  • ACSM Viewpoint on climate change and active transportation – mentions air pollution and high ozone
  • blog on indoor air quality to promote PA in vulnerable populations
  • Fitness Index blog on outside air quality and PA

Learn more and stay active at home: