Category: Program Briefs

Using the American Fitness Index in the Classroom: Strategies and Lessons Learned

The American Fitness Index is a valuable tool and resource to researchers and practitioners alike. As an educator, I believe it has a place in the classroom as well. I teach an undergraduate upper-level, small class titled Physical Activity and Public Health. Throughout the semester we cover many topics including physical activity epidemiology, measurement, public health approaches and the role of community, environment and policy in promoting physical activity and health. The students are well versed in how the health and behaviors of a community can be influenced by the resources and supports available.

Typically, I have used the  Fitness Index as a part of the capstone activity in the class for group project (four to five students per group). I provide a general overview of the Fitness Index framework, discuss the types of data (e.g. health, behavioral, environmental variables) and what the communities may do with the information. Since the two largest cities in our state are covered within the Fitness Index, I have a list of the eight next largest cities in our state (to ensure that there is adequate data available) for the students to pick from for their community of focus. Once their community is selected, the fun can begin.

Using spreadsheet templates I created, the students explore their community and document all the variables included in the Fitness Index summary reports (Personal Health Indicators, Community/Environment Indicators) using the same data sources as the Fitness Index. Once the students completed their spreadsheets we were able to compare the communities in class to get an idea of how the communities measured up against each other, as well as the communities included in the Fitness Index.

While the groups completed their spreadsheets, I recruited a community stakeholder from each of the communities. These individuals were typically people who were well connected in the community for health-related issues (e.g. health department official, health-related non-profit worker, community hospital representative). As a class we discussed some general questions they would ask their stakeholder and then they built an interview guide and a few members of the group interviewed the individual.

To complete the project the groups compiled all of their findings in a report in the style of the Fitness Index summary using a template I provided. Then they wrote a letter to their stakeholder outlining the results, summarizing strengths and areas of opportunity for the community and listing possible resources for making improvements. The report and the letter were shared with their stakeholder. The project finished off with a class presentation where they shared all of their findings.

Student feedback from the project was overwhelmingly positive; most reported that they appreciated having real data to learn from, that their community stakeholder provided valuable insight to how to interpret and apply their findings, and they were excited to learn about how the communities would use their data. Some quotes from students about this project can be found here.

Lessons Learned

The most challenging part of the project was the recruitment of community stakeholders. Some communities had an abundance of possibilities, with several potential eager partners, while other communities had lackluster interest from possible partners and even once recruited didn’t follow up with the students in a timely manner to meet deadlines. Having some pre-arranged community contacts from other research activities and previous class projects was helpful and I would highly recommend it. Another challenging aspect of the project was teaching students to use publicly available datasets and resources to complete their spreadsheets. We used some class time to walk through this, and I would suggest planning for some class time to allow for overcoming some of these challenges. Lastly, I can’t stress enough the importance of providing templates to be able to have organized and useable data and reports that cover all of the aspects of the Fitness Index. Additional information on my experience in using the Fitness Index in the classroom can be found here.

The Fitness Index is a valuable teaching tool and I encourage you to be creative in designing assignments to use this framework. There are many valuable student learning outcomes from participating in a Fitness Index project that I hope you can explore.

Author: Melissa Bopp, Ph.D., FACSM is an associate professor and director of the undergraduate program in Kinesiology at Pennsylvania State University. She is a fellow of ACSM, co-chair of the Built Environment and Active Transportation Special Interest Group and member of the Health Science Policy committee. Her research is focused on the role of community, environment and policy in promoting physical activity for all populations. Twitter: @MelissaBopp_PhD

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.

 

Resources:

Authors:

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

Spotlight on Phoenix: Health and Fitness in the Valley of the Sun

Today’s post takes a look at the metropolitan statistical area of Phoenix, Arizona; also known as the “Valley of the Sun”. Phoenix is the largest state capital in the country and the metropolitan area is the 14th largest by population. The city is divided into 15 urban villages each with their own unique character.

Phoenix ranked 32nd in the most recent ACSM American Fitness Index® () data report, which evaluates the 50 most populous city areas and identifies the healthiest and fittest places in the United States. The metro area earned a score of 45.3 (out of 100 possible points) in 2011, moving slightly down from a score of 47.4 in 2010, however the rank remains the same.

The study reports 82.6% of the population participated in physical activity or exercise in the last 30 days; 8% above the U.S. average. Accordingly, the city has a lower percent with angina or coronary heart disease and lower death rates for cardiovascular disease and diabetes. Among the 50 largest metro areas, Phoenix has the highest percentage of residents with asthma (11.9%). Overall, the Valley of the Sun ranked 19th in personal health indicators.

However, the metro area ranked 44th in community/environmental indicators. The city boasts a decent amount of parkland as percent of city area, but falls behind in number of recreational facilities such as ball diamonds, playgrounds, golf courses, tennis courts, etc. In Arizona, the state only requires physical education classes at one level (among elementary, middle and high school). There are only 71.0 primary health care providers per 100,000 residents, way below the MSA average of 93.2.

The city struggles with poverty and unemployment, but has made strides since 2010. Due in part to high heat conditions, the city reports a lower percent using public transportation and biking to work.

For a complete list of Phoenix’s strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the Phoenix report at www.americanfitnessindex.org/report.htm.

Phoenix skyline

Spotlight on Kansas City: Health and Fitness in the City of Fountains

Today’s post takes a look at the metropolitan statistical area of Kansas City, Mo. Notably, the city has more parks, golf courses, famer’s markets and ball diamonds per capita than any other state. To be exact, there are 214 urban parks, 152 ball diamonds, 10 community centers, 105 tennis courts, five golf courses, and 30 pools occupying the city’s 318 square miles.

Kansas City ranked 22nd in the most recent ACSM American Fitness Index® () data report, which evaluates the 50 most populous city areas and identifies the healthiest and fittest places in the United States. The metro area earned a score of 51.5 (out of 100 possible points) in 2011, moving up from a rank of 29th and a score of 47.9 in 2010.

The area ranked 25th on community/environmental indicators related to the built environment, recreational facilities, physical education requirements and primary health care providers. The study reports 59.3% of the population is in excellent or good health. However, Kansas City continues to struggle with the number of smokers as nearly 20% are currently smoking, down just 1% from 2010 and still above the country’s average.

Despite the larger number of farmer’s markets per capita and City Market, one of the largest and most stable public farmers’ markets in the Midwest, only 18.7% of residents report eating 5+ servings of fruits and vegetables per day.

The percentage of residents with chronic health concerns is relatively low and the community still places a strong commitment to physical education classes for the city’s youth. With an abundance of fitness facilities in the Kansas City area, it is only a matter of time before the city can improve it’s ranking.

For a complete list of the Kansas City’s strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the Kansas City report at www.americanfitnessindex.org/report.htm.

Kansas City Skyline

Spotlight on Richmond, Va: Health and Fitness in One of America’s Oldest Cities

Today’s post takes a look at Richmond, the third largest metropolitan statistical area (MSA) in Virginia. The city of Richmond and its surrounding areas include a population of 1.2 million residents, six Fortune 500 companies, and countless historical monuments and museums.

Richmond took the number 12 spot in the 2011 data report with a total of 64.2 points (out of a possible 100). This ranking was down one spot from 2010. With an above average number of residents getting exercise in the last 30 days, a 5% increase in the number of residents eating five or more servings of vegetables and fruits each day, and a strong percentage (66%) reporting to be in excellent or very good health, it would appear that Richmond is making the right moves towards a healthier community.

On the other hand, Richmond experienced a nearly 4% increase in the number of reported smokers, an increase in residents categorized as obese, and an increase in the deaths per 100,000 from cardiovascular disease. Even with all that, the increase in healthy habits mentioned above, and the 6% increase in residents who are getting moderate physical activity, Richmond moved up a spot to 8th in personal health indicators related to chronic health problems and health care.

While Richmond scores in the top 10 on personal health indicators, it is in the top 20 according to the community and environment indicators. Almost every indicator used in this category stayed the same from the 2010 to 2011 data report with the exception of the number of farmer’s markets. This number nearly doubled from 4.9 per 100,000 residents in 2010 to 9.7 in this year’s report, indicating an increased propensity towards healthier eating. Richmond has the most tennis courts per 10,000 residents (6.9) among the 50 city areas measured in the data report.

For a complete list of Richmond’s strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the Richmond report at www.americanfitnessindex.org/report.htm.

Richmond Skyline

Spotlight on Los Angeles: Health and Fitness in The City of Angels

Today’s post looks at Los Angeles and its surrounding areas including Long Beach and Santa Ana. It is a city that promises new life, hope, fame and fortune to many looking to move west.

Los Angeles ranked 41st in the most recent ACSM American Fitness Index® () data report, which evaluates the 50 most populous city areas and identifies the healthiest and fittest places in the United States. L.A. earned a score of 39.1 (out of 100 possible points) in 2011, moving down from a rank of 38th and a score of 40.5 in 2010.

Los Angeles ranked 30th with a score of 44.8 on personal health indicators related to health behaviors, chronic health problems and health care. The City of Angels has a fairly low percentage of smokers (11.2%) compared to the national average of 17.9%. The percent of people getting exercise or doing physical activities within the last 30 days (77.8%) is only 1.6% higher than the national average, however, this is a 3.2% increase from the previous report in 2010. Los Angelinos fall at the low end of communities in which residents report being in excellent or very good health (48.8%, just a few points above the MSA low of 46.4%.

The city ranked 45th on community/environmental indicators related to the built environment, recreational facilities, park-related expenditures, physical education requirements and primary health care providers with a score of 33.9 out of 100 possible points. The metro area scored poorly in the number of recreational facilities per capita.

Despite its average scores on built environment indicators, the city has witnessed a propensity toward Smart Growth planning principles. Walk Score recently gave Los Angeles a score of 95 out of 100 and called it a “Walkers Paradise”. This is important because it lends to the physical and financial health of the residents and businesses in the community.

For a complete list of the L.A.’s strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the Los Angeles report at www.americanfitnessindex.org/report.htm.

Spotlight on Jacksonville: Health and Fitness in Florida’s Largest Metro Area

Today’s post takes a look at the metropolitan statistical area of Jacksonville, Fla., inclusive of Baker, Clay, Duval, Nassau, and St. Johns counties. Jacksonville is the largest city by land area in the contiguous United States and boasts one of the largest urban park systems in the country.

Jacksonville ranked 31st in the most recent ACSM American Fitness Index® () data report, which evaluates the 50 most populous city areas and identifies the healthiest and fittest places in the United States. The metro area earned a score of 46.7 (out of 100 possible points) in 2011, dropping it into the lower half of ranked areas, from a rank of 24th and a score of 51.2 in 2010.

Florida’s largest metro area ranked 36th on personal health indicators related to health behaviors, chronic health problems and health care.

While Jacksonville fell near average in categories related to physical activity, it combined a much higher than average percentage of smokers (21.3%) with a lower than average percentage of people eating 5+ servings of fruits and vegetables per day (20.5%), indicating fair health behaviors for the area.

Additionally, Jacksonville residents ranked average in most areas related to chronic health problems, had higher percentages of diabetics and deaths related to diabetes.

The area ranked 28th on community/environmental indicators related to the built environment, recreational facilities, park-related expenditures, physical education requirements and primary health care providers.

Jacksonville’s greatest asset to its built environment is its parkland acreage at 57.2 acres per capita, it ranks much higher than the MSA average of 18.9 acres per capita. Furthermore, the metro area’s recreational facilities ranked higher than the MSA average in categories including ball diamonds, park playgrounds, park units, recreation centers and swimming pools.

Moreover, Jacksonville residents have the advantage of a number of natural resources including miles of beaches, waterways, and preservation lands.

For a complete list of the Jacksonville’s strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the Jacksonville report at https://americanfitnessindex.org/report2.htm.

Spotlight on Milwaukee: Health and Fitness in Wisconsin’s Largest City

Today’s post takes a look at the metropolitan statistical area of Milwaukee-Waukesha-West Allis in Wisconsin. The fictional home of The Fonz, Richie Cunningham, Laverne and Shirley, is more accurately famous for its tradition as a brewing and manufacturing town.

Milwaukee ranked 21st in the most recent ACSM American Fitness Index® () data report, which evaluates the 50 most populous city areas and identifies the healthiest and fittest places in the United States. The metro area earned a score of 51.8 (out of 100 possible points) in 2011, moving up from a rank of 27th and a score of 49.2 in 2010.

Wisconsin’s largest metro area ranked 17th on personal health indicators related to health behaviors, chronic health problems and health care.

Milwaukee has an above-average percentage of smokers (18.9%) among the 50 metro areas included in the data report. And residents of this region are above average at getting physical activity. Seventy-nine percent of residents report getting physical activity in the last 30 days and 53% report being physically active at least moderately.

The percentage of residents with chronic health concerns is typically just below average. Nine in 10 residents have health insurance.

The area ranked 34th on community/environmental indicators related to the built environment, recreational facilities, park-related expenditures, physical education requirements and primary health care providers. The area has an above average number of farmers’ markets (22.4/1,000,000). Milwaukee scored very low on the number of recreation centers and tennis courts and spends only $59 per capita on park-related expenditures (the MSA average is $101.5).

Walk Score recently ranked Milwaukee as the 15th most walkable of the 50 largest U.S. cities. Milwaukee also lies on Lake Michigan, making it a popular venue for water activities such as sailing and windsurfing.

For a complete list of the Milwaukee’s strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the Milwaukee report at www.americanfitnessindex.org/report.htm.

Milwaukee

Spotlight on San Jose: Health and Fitness in Silicon Valley

Today’s post takes a look at the metropolitan statistical area of San Jose-Sunnyvale-Santa Clara in California. The area is often called Silicon Valley thanks to being the headquarters of tech giants such as Apple, Cisco Systems, eBay, Facebook, Hewlett-Packard, Intel, Google, Sun Microsystems and Yahoo!.

Silicon Valley ranked 11th in the most recent ACSM American Fitness Index® () data report, which evaluates the 50 most populous city areas and identifies the healthiest and fittest places in the United States. The metro area earned a score of 65.2 (out of 100 possible points) in 2011, moving up from a rank of 14th and a score of 61.0 in 2010.

People take their personal health seriously in the booming metro areas south of San Francisco. The area ranked 3rd on personal health indicators related to health behaviors, chronic health problems and health care.

Silicon Valley has the lowest percentage of smokers (8.8%) among the 50 metro areas included in the data report. And residents of this region are good at getting their fruits and veggies – 29.3% reported eating 5+ servings of fruits/vegetables per day. The percentage of residents with chronic health concerns is relatively low, including a metro-area low of only 4.5% residents having asthma. Almost 92% of residents have health insurance.

The area ranked 24th on community/environmental indicators related to the built environment, recreational facilities, park-related expenditures, physical education requirements and primary health care providers.

Despite its average scores on built environment indicators, the area has witnessed a propensity toward Smart Growth planning principles. Walk Score recently ranked San Jose as the 19th most walkable of the 50 largest U.S. cities.

For a complete list of the Silicon Valley’s strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the San Jose report at www.americanfitnessindex.org/report.htm.

San Jose Skyline

Spotlight on Minneapolis/St. Paul

Earlier this year, the American College of Sports Medicine (ACSM) released the annual ACSM American Fitness Index® () data report. This report evaluates the 50 most populous city areas and identifies the healthiest and fittest places in the United States.

For the first time, the metropolitan statistical area of Minneapolis-St. Paul-Bloomington edged out previous leader Washington, D.C. for the top spot with a score of 77.2 (out of 100 possible points). The metro area ranked 3rd with a score of 71.7 in 2010.

Minneapolis-St. Paul took the lead thanks to greater improvements in healthy behavior measures and a reduction in the percentage of smokers. The Twin Cities ranked 2nd on personal health indicators related to health behaviors, chronic health problems and health care. The area ranked 2nd on community/environmental indicators related to the built environment, recreational facilities, park-related expenditures, physical education requirements and primary health care providers.

Several factors contributed to the Twin Cities’ top ranking. The area has the highest percentage of residents who report getting physical activity or exercise in the last 30 days (85.9%) and relatively low smoking rate (15.3%). In the Twin Cities, the percentage of residents with chronic health concerns such as obesity, asthma, cardiovascular disease and diabetes is moderate-to-low. Another factor is that 92.9% of residents have health insurance.

While the area reduced park-related expenditures this year ($203 per capita), its percentage of parkland is still above average (16.7%), as is the percentage of recreational facilities (other than swimming pools). Farmers markets in the area also increased this year, indicating a trend in healthier eating.

In a future blog post, we’ll look at some of the programs, attractions and projects that are working to keep the Twin Cities in the top spot. For a complete list of the Twin Cities’ strengths and challenges, plus a breakdown of the components that helped make up its score, please visit the website and download the Minneapolis/St. Paul metro area report.