Category: In the News

woman and child running through park

Parks, Trails and Greenways Plus Programming Can Increase Physical Activity

Parks, trails, and greenways are an important part of a community. They are places where people can move, relax, and enjoy time with others. A new Community Preventive Services Task Force (CPSTF) recommendation shows that science backs up the idea that these places can help people be physically active.  

But simply having these community spaces is not enough. Additional efforts are needed to help people use these spaces to increase their physical activity. 

What is the new recommendation? 

To increase physical activity, CPSTF recommends park, trail, and greenway infrastructure interventions when combined with additional interventions. Infrastructure interventions include improvements to built and natural environments. Additional interventions include structured programs, like walking groups, fitness classes, and organized sports, as well as efforts to improve community engagement, enhance access, or increase awareness. 

When these interventions are combined, the number of people who use parks, trails, and greenways—and use them specifically to get moderate-to-vigorous physical activity—increases. 

CPSTF also suggests that communities work with partners across sectors to identify barriers to access and use of green spaces and ensure equity, engagement, safety, and accessibility for all populations. 

What are the benefits of physical activity and green spaces? 

Physical activity is one of the best things people can do to improve their health. And being active in nature has physical, mental, and social benefits. For example, people who have more access to green environments tend to move more than people with limited access. Specifically, people who live close to a park and feel safe there are more likely to walk, roll, or bike to the park and use it for physical activity. 

Outdoor recreation areas also provide places where people can observe or interact with nature, reduce stress, and improve their mental health. They provide places where families can play and neighbors can meet, which can improve family and community connections. 

Parks can also provide environmental benefits by reducing air and water pollution, protecting areas from inappropriate development (for example, on flood plains or steep slopes), and mitigating urban heat islands. They help reduce the risk of illness and injury by providing safe spaces where people can play and be active away from busy streets and commercial zones.  

Although everyone should have access to these benefits, long-standing, systemic social inequities have led to some populations living in areas with limited park, trail, or greenway access. This inequity may increase their risk of being physically inactive and having associated chronic disease conditions. 

Cross-sector partnerships can help address inequities and barriers to physical activity through interventions that enhance community engagement, raise awareness of natural environments, and improve access to safe opportunities for outdoor activity in these environments. 

How is the CPSTF recommendation relevant to the American Fitness Index? 

Several indicators in the American Fitness Index address recreational and natural environments. By developing new, high-quality parks, trails, and greenways, especially in historically underserved areas, communities could improve their score in two areas: parks per 10,000 residents and the percentage of residents within a 10-minute walk to a park. Communities could also improve their community/environment score by enhancing their park-based recreational facilities. They could improve their personal health score by improving park access, which will help residents be more physically active and have strong personal fitness. 

How does the CPSTF recommendation support Active People, Healthy Nation? 

Active People, Healthy Nation SM is a national initiative led by CDC to help 27 million people become more physically active by 2027. Creating or enhancing access to places for physical activity—such as building walking trails or providing access to existing nearby facilities—and providing information to encourage their use is one of the initiative’s core strategies to increase physical activity. 

The new CPSTF recommendation reinforces this strategy by providing evidence of the relationship between parks, trails, and greenways and increased physical activity. 

Visit the Active People, Healthy Nation website to subscribe to the monthly newsletter, share success stories, and learn how to get involved.  

Additional Resources 


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



Kaitlin Graff, MSW, MPH, Program Coordinator, McKing Consulting Corporation/Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention 

Akimi Smith, MPH, Evaluation Fellow, Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention 

David Brown, PhD, FACSM, Senior Behavioral Scientist, Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention  

woman in a blue top with hands folded

Moving More to Improve Mental Health: What City Officials Need To Know

One of the personal health indicators selected for inclusion into ACSM’s American Fitness Index® is a measure of the mental health status of city residents. Mental health and physical health are both important components of overall health and are themselves closely connected. Mental health plays a major role in maintaining good physical health. Mental health issues, such as depression and anxiety, are known to reduce people’s ability and desire to participate in health-promoting behaviors. In addition, poor mental health increases the risk of developing a chronic physical health problem such as diabetes, heart disease and stroke. 

Given the importance of good mental health to overall health, investing in resources to increase physical activity would be one way community leaders could improve their residents’ overall health and fitness. There is a growing body of evidence that recognizes the positive effects of exercise on reducing anxiety, stress and depression. 

Current research shows why physical exercise is essential to mental health. In addition to other biochemical mechanisms, exercise is well known to stimulate the body to produce endorphins and enkephalins, the body’s natural “feel-good” hormones, which can improve an individual’s mood and make problems seem more manageable. Psychological mechanisms influence the effects of exercise on mood states, as suggested by both the distraction hypothesis and the self-efficacy hypothesis. The simple act of focusing on exercise can give us a break from current concerns and damaging self-talk. 

Other research has shown that physical activity may play an important role in the prevention, treatment and management of mild to moderate mental health illnesses, especially depression and anxiety. Although people with depression tend to be less physically active than non-depressed individuals, increasing their participation in aerobic exercise and/or strength training has been shown to reduce depressive symptoms significantly. Anxiety symptoms and panic disorder also improve with regular exercise, and beneficial effects appear to equal that found with meditation or relaxation. Data suggests that acute anxiety responds particularly well to physical activity. 

While participating in exercise generally is beneficial for both physical and mental health, it is important to note that people have widely varying preferences for the types of activity in which they may want to engage. Clearly, the mental health benefits are associated with physical activities that people want to do and enjoy doing. Consequently, cities should provide access to a variety of types of activity so that residents can choose those that are most attractive to them and that would be of greatest benefit to both their mental health and physical health. 

Increasing access to physical activity resources like parks, trails and community centers is particularly important now that the COVID-19 pandemic has increased the need for mental health care in an already strained mental health system. The most recent published literature has documented a notable increase in reported depression and anxiety as a result of the COVID-19 pandemic. At the same time, there has been increased demand for public spaces to be physically active. Being physically active outdoors is particularly beneficial for mental health. 

In addition to improving access to physical activity resources, city officials must partner together with business and community leaders to increase access to mental health services and reduce mental health stigma. Innovative initiatives are particularly important now to help those in need of mental health care access the care they need, including: 

  • Using public service announcements to decrease mental health stigma,  
  • Expanding access to community mental health centers,  
  • Co-locating mental health services with primary health care services, 
  • Supporting the use of telemedicine to increase the availability of mental health services,  
  • Improving health care providers’ and first responders’ awareness and use of mental health referral networks, and 
  • Expanding evidence-based training for mental health providers. 

Many cities have implemented initiatives like these to improve access to mental health care for their residents. ACSM applauds their efforts and encourages other cities to adopt programs that have been shown to be effective elsewhere.


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

outline of a head with colorful balls of paper

The Cost of Mental Health: Seeking Community Solutions

Good mental health is effective functioning in daily activities resulting in good productivity (e.g., work, school), healthy relationships and the ability to cope with adversity. A threat to good mental health is mental illnesses, which are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Those experiencing mental illness may have difficulties functioning in social, work or family activities. Millions of Americans are affected by mental illness each year. Approximately one in five (20%) U.S. adults experience mental illness each year, with one in 20 experiencing a severe mental illness yearly. The great news is that mental illness is treatable, with most people continuing to function in their daily lives despite their mental illness.  

Of the millions of U.S. adults experiencing mental illness in 2020, only 46% received treatment, leaving millions to deal with their mental diseases alone. Those dealing with depression have a 40% higher risk of developing cardiovascular and metabolic disease than the general population. People with serious mental health illnesses are twice as likely to develop these same health complications. On the community level, it is estimated that almost 21% of the people experiencing homelessness have at least one serious mental health condition. And of those incarcerated, approximately 37% have a diagnosed mental illness. Untreated mental illnesses have a devastating impact on a person’s physical health and economic health, as serious mental illness accounts for $193.2 billion in lost earnings every year. With so much at stake, the solution appears to be simple—increase the percentage of people receiving mental health treatment.  

Unfortunately, of the almost 330 million people living in the U.S., 148 million (45%) live in a designated Mental Health Professional Shortage Area, placing these individuals at considerably higher risk of experiencing the ripple effects of mental illness. With so many not having ready access to mental health services, community mental health centers are critical to meeting the demand for mental health treatment. Community mental health centers are community-based and provide mental services, often as an alternative to hospitals. These community centers are mainly funded by federal, state and county programs. Local governments, which allocate funds to various programs on their level, are often forced to decide where the limited funds are given. Community mental health centers need to be prioritized for funding, considering the effects of poor mental health on the individual and community.  

In addition to the mental health professional shortage areas, there is a shortage of providers. The lack of providers has caused many people not to be able to receive treatment, even when proactively seeking it out. Many adults will simultaneously experience a substance use disorder with mental illness, often as a coping mechanism. The shortages of mental health professionals have resulted in inadequate access to treatment, at an alarming rate of 11% of individuals in need of substance abuse treatment receiving treatment. Mental health professionals commonly found in community health centers include social workers, psychiatrists, counselors, psychologists and peer support specialists. With funding shortages, community centers cannot hire professionals that can be of service to the community member. Some community centers also serve as assertive community treatment centers, where they provide services for mental health and offer housing assistance, financial management and employment services for the community members.   

In 2014, the Protecting Access to Medicare Act of 2014 created the concept of certified community behavioral health clinics, which provide comprehensive mental health and substance use services to individuals, often at no cost. In 2021, new federal funding aimed to expand the number of certified community behavioral health clinics to 340. Local officials should encourage the community centers in their areas to adjust to meet the guidelines set forth to establish themselves as a certified community behavioral health clinic. With funding a constant issue for local municipalities, any investment in community mental health centers can also be cost-saving for other more expensive programs. 


Author:  Alvin L. Morton III, M.S., Doctoral Candidate, University of Tennessee at Knoxville

hands holding a nutrtion app scanning a bowl of salad

#EatingHealthy: Can Nutrition Apps Do the Job?

We’ve all seen the increase in the number of available apps to monitor lifestyle behaviors such as physical activity, sleep and stress. There is also clear interest in apps that monitor diet and nutrition. So, how do you know if a nutrition app will be helpful? In the last few years, millions of users have downloaded and installed nutrition-related apps. The latest research supports that “if the shoe fits” then maybe it is worth using! Mobile apps can provide an opportunity for assessing and improving nutrition by providing personalized information and instant feedback.  

What are the benefits? 

Apps can be an effective tool to evaluate and monitor eating behavior and diet-related health risk factors. Apps can provide autonomy and help people take charge of their nutrition choices. Monitoring food intake, setting goals, and viewing progress can all occur privately which may be appealing for those who desire less in-person contact with health care providers.  

What type of apps are available?  

The number and type of nutrition apps are only growing and with many being free, apps have the potential to reach large numbers of people world-wide. Here are some of the most common types of nutrition apps available.  

  • Calorie Trackers/Food Tracking/Food Diary Programs 
  • Macronutrient (carb, protein and fat) and Micronutrient (vitamins/minerals) tracking 
  • Recipe Builders or Meal Planning 
  • Restaurant and Grocery Finders  
  • Diet Specialty – Example: carb counting for people with Type 2 diabetes 
  • Food Allergy or Food Intolerances  
  • Hydration  
  • Grocery and Money Saving  
  • Prompts or Timing 
  • Nutrition Counseling and Education 
  • Mindfulness/Intuitive Eating 
  • Diet Specific – Example: Weight loss or Low sodium 
  • Condition specific – Example: Pregnancy nutrition  

Apps can offer a wide range of personalization and unique features that may help in managing conditions or reaching personal goals.  

What are the cons? 

It takes effort to enter in every bite of food. It can be hard to remember to enter your food intake and to remember what exactly you ate. In addition, some apps don’t contain all products in their database. Rather, they may include broad categories of foods. For instance, some apps are unable to distinguish between Kraft’s macaroni and cheese and Annie’s brand macaroni and cheese.  

Nutrition apps are also generally harder to use than physical activity monitors. Unlike the automatic activity tracking (passive data input) that comes with a Fitbit, Apple watch or a pedometer, entering food into an app requires time and energy.  

Another consideration is the cost. Some diet-tracking apps may not be transparent about extra fees and may not provide satisfactory customer support. Many are subscription based and require full price to unlock useful features. 

A major downside to using apps is that you miss out on professional insight/advice that comes from interacting with a well-trained health care provider. Depending on the app and your specific goals, communication with a professional may not be included. Further, some apps fail to providing long-term and in-depth support, which are key for sustaining behavior change. 

Finally, not all apps are evidence or science based. If an app promises to help you lose 20 pounds in one week, chances are the quality is poor. Apps tailored to specific needs are more promising for prolonged use and effectiveness. Lifestyle changes take time and while the short-term use of apps can be effective, the long term use is largely unstudied.   

The bottom line 

Apps can be a great tool to improve health through better eating and planning. Smartphones offer inexpensive options allowing for more engagement, empowerment, self-monitoring and communication with health care providers. Research has shown that apps can be superior to traditional methods at helping track food intake, making better food choices and losing weight 

So if you come across a helpful app, walk it around and it give it a try! Nutrition apps can help make life easier. A great place to start is with the MyPlate App that allows you to pick daily food goals, see real-time progress and earn fun badges through a simple program to start building healthy eating habits one goal at a time!  

Additional information on eating healthy, meal planning, tools and resources can be found at


Author:  Laura Young, Ph.D.

woman wearing headphones, walking and checking an activity tracker on her wrist

Knowledge is Power: Wearable Heart Health Monitoring

February is heart month, and wearable devices are becoming a larger part of heart health promotion and cardiovascular care. Wearable devices incorporated into clothing or an accessory allow for real-time data collection and monitoring. Data monitoring allows physicians to practice medicine in a post-COVID-19 world where remote, decentralized and personalized patient care are becoming commonplace. As Navy researcher Rachel Markwald said, “you can’t manage what you’re not monitoring.” It is important to monitor sleep, activity, heart rate, blood pressure, etc. if someone wants to make a change to benefit performance or health. 

Functions of Wearables:  

As technology evolves, the capability and accuracy of smart devices advances. Output from wearable technology is becoming integrated into daily life. The global Wearable Medical Devices Market was valued at $14.6 billion USD in 2019. The compound market growth rate of wearable devices is expected to grow by 24.8% per year. Having 24/7 available data are helping the sports and fitness industries push the boundaries of human performance.  

Wearable devices currently on the market perform the following functions: 

  • Activity tracking – duration, pace, type 
  • Calorie burning 
  • Sleep tracking 
  • Measure heart rate (HR) – resting HR and HR variability 
  • Measure blood pressure 
  • Electrocardiogram looking at heart rhythm 
  • Pulse oximeter 
  • Body temperature 
  • BMI 
  • Body posture 
  • Fall detection 

Wearables allow for direct access to strategies for: 

  • Mindfulness 
  • Meditation 
  • Cognitive strength 

Challenges of wearables for monitoring heart health in the medical setting: 

  • Data accuracy – Inaccurate data is more harmful than no data.  
  • Behavioral change – Can wearables actually guide behavior change? 
  • Cost – Those who may benefit the most from wearable technology and continuous data monitoring may not be able to afford the devices. 
  • Data security – Health-related data may not be able to be securely shared with physicians. 

What is the best wearable for you (or your patients)?

You should consider your health and fitness goals, your ability to sift through large amounts of data, the data you believe are most beneficial to you, and the ease of use of the device. As technology continues to advance, the accuracy and capabilities of wearable devices will continue to improve. Overall, wearable devices are good at tracking physical activity parameters, but the technology for monitoring some cardiovascular vital signs, such as blood pressure, is still in its infancy.   

A list of wearable devices, their biological measurements, and description of research studies and FDA approval status can be found here:


Authors: Allison N. Schroeder, MD and Chad A. Asplund, MD, MPH, FACSM  

fitness equipment including tennis shoes, a water bottle, fitness tracker, hand weights and headphones

New Year, New You? Resources to Support an Active Lifestyle

If you’re among  the millions of Americans who want to start moving more in the new year, finding resources to exercise safely can be challenging. Whether you’re just getting started or a gym pro, ACSM has resources to help you move more and sit less!  

Turn on the Tech 

ACSM’s Health & Fitness Journal®    has announced the top fitness trends for 2022: Wearable technology tops the list for the 3rd time in four years, followed by home exercise gyms and outdoor activities.  Learn about the top 10 trends and access free resources! 

Wearable technology like smart watches and heart rate monitors can measure your steps, calories, heart rate, respiration, oxygen saturation and much more. Regardless of device or brand, using fitness tracker technology can help motivate you and can keep you accountable to your goals.   

Home Sweet Home 

If you’re looking to stay active at home, ACSM offers free on-demand exercise classes, help selecting a virtual fitness class, as well as tips for equipping a home gym.  

ACSM Summit Workouts | YouTube Playlist    Need a full at-home workout? Check out these  workouts that were presented at previous ACSM Health & Fitness Summit events!  

Exercise at Home: Options for People with Disability or Chronic Health Conditions | Video from ACSM partner NCHPAD  

Virtual Fitness: Choosing A Program That Is Right for You | From ACSM’s Health & Fitness Journal® 

Home Weight Room Equipment  | Infographic 

3 Essentials for Building a Home Gym  | Blog 

Looking to outfit your home gym? Here are tips for optimizing your set up, regardless of your budget, and a  breakdown of the most common equipment that you can purchase so you can determine which items are best for you! 

Pandemic Safety 

The COVID-19 pandemic continues to challenge communities around the world. Getting and staying active is a great way to strengthen your immune system, reduce anxiety, and improve sleep quality. In fact,  adults that were inactive before diagnosis were 2.49 times more likely to die of COVID-19 than those that met the physical activity guidelines¹ 

Staying Physically Active During the COVID-19 Pandemic |  Explore ACSM’s curated resources to help you and your family stay physically active during the pandemic.  

Safe Return to Physical Activity After COVID-19  | Read Dr. Meredith Turner’s recommendations for returning to physical activity following a COVID-19 diagnosis based on the severity of infection and duration of symptoms.  

Tips to Get Moving Again After COVID-19  | Infographic from the EIM Clinical Practice Committee 


  1. Sallis R, Young DR, Tartof SY, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. British Journal of Sports Medicine  2021; 55: 1099-1105.  
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