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ACSM American Fitness Index Ranks 50 Largest Metro Areas on Health and Community Fitness

by User Not Found | Aug 01, 2011
Washington, D.C., tops list of America’s fittest cities

SEATTLE – The Washington, D.C., metro area is the fittest of America’s 50 most populous metropolitan areas according to the American College of Sports Medicine’s (ACSM) American Fitness Index™ (AFI). ACSM unveiled the 2009 rankings and released the AFI data report, “Health and Community Fitness Status of the 50 Largest Metropolitan Areas,“ during the organization’s Annual Meeting in Seattle. The report, produced in partnership with the WellPoint Foundation, is a snapshot of the state of health and fitness in America’s most populous metropolitan areas.

The AFI data report reflects a composite of preventive health behaviors, levels of chronic disease conditions, health care access, as well as community resources and policies that support physical activity. In addition to a data report, AFI is a program designed to help communities identify opportunities to improve the health of their residents and expand community assets to better support active, healthy lifestyles.

“ACSM believes that researching and understanding the scope of the problem is the first step toward developing programs, initiatives and policies to increase physical activity,” according to AFI Advisory Board Chair Walt Thompson, Ph.D., FACSM. “The data evaluated for this report will help identify each metropolitan area’s strengths and weaknesses.”

Based on figures related to healthy lifestyles and physical activity, the Metropolitan Statistical Areas (MSA) of Washington-Arlington-Alexandria scored 74.4 in the AFI data report to achieve the top ranking. Metro areas completing the top five were Minneapolis-St. Paul, Denver, Boston and San Francisco, which finished at the top of the inaugural rankings in 2008. Seattle, ACSM’s host city for its 2009 Annual Meeting, along with the surrounding MSA, finished sixth.

The western United States dominated the top 10, with only three cities lying east of the Mississippi River. The nation’s largest cities finished in the middle of the pack with New York at 22nd, Chicago at 25th and Los Angeles at 30th.

The Washington metro area scored above average on the percentage of its citizens who eat five or more fruits and vegetables per day and had a low percentage of smokers. The area also has lower percentages of those with chronic health problems such as obesity, diabetes, angina or coronary heart disease.

Washington also boasts a high percentage of city land area for parks; higher park-related expenditures per capita; more recreation centers, tennis courts, park units and swimming pools per capita; a high percentage of citizens using public transportation or bicycling/walking to work; a higher-level state requirement for physical education classes; and a higher-than-average number of primary health care providers.

“The WellPoint Foundation is honored to be the founding and ongoing sponsor of the AFI program, and we are committed to improving the health of our nation,” said Wesley Wong, M.D., M.M.M., Regional Vice President and National Medical Director for WellPoint’s affiliated health plans and member of the AFI Advisory Board. “By supporting AFI alongside programs like our Healthy Generations initiative, we are able to identify risk areas and develop partnerships with community organizations promoting local programs designed to reduce areas of concern.”

The metropolitan rankings included in the report are:

Rank, Metropolitan Area, Score
1. Washington, D.C., 74.4
2. Minneapolis-St. Paul, Minn., 72.1
3. Denver, Colo., 71.6
4. Boston, Mass., 71.4
5. San Francisco, Calif., 71.3
6. Seattle, Wash., 69.7
7. Portland, Ore., 68.1
8. San Diego, Calif., 66.8
9. Austin, Texas, 65.1
10. Virginia Beach, Va., 63.1
11. Hartford, Conn., 62.5
12. Sacramento, Calif., 62.2
13. San Jose, Calif.. 61.3
14. Cincinnati, Ohio, 60.8
15. Atlanta, Ga., 59.3
16. Pittsburgh, Pa., 54.3
17. Milwaukee, Wisc., 53.0* 
18. Buffalo, N.Y., 53.0*
19. Baltimore, Md., 52.5
20. Raleigh, N.C., 52.3
21. Kansas City, Mo./Kan., 50.3
22. New York, N.Y., 48.9
23. Tampa, Fla., 48.5
24. Cleveland, Ohio, 47.9
25. Chicago, Ill., 47.6
26. Nashville, Tenn., 46.8
27. Philadelphia, Pa., 45.9
28. Jacksonville, Fla., 45.2
29. Columbus, Ohio, 43.9
30. Los Angeles, Calif., 43.6
31. Miami, Fla., 42.7 
32. Phoenix, Ariz., 42.5*
33. St. Louis, Mo., 42.5*
34. Charlotte, N.C., 40.3
35. Dallas, Texas, 39.6
36. Indianapolis, Ind., 39.3 
37. Memphis, Tenn., 38.5
38. Louisville, Ky., 37.7
39. San Antonio, Texas, 35.5
40. Riverside, Calif., 35.1
41. Houston, Texas, 34.7
42. Las Vegas, Nev., 34.6
43. Birmingham, Ala., 32.2
44. Detroit, Mich., 30.5
45. Oklahoma City, Okla., 23.2
NR. Orlando, Fla., N/A
NR. Providence, R.I., N/A
NR. Richmond, Va., N/A
NR. Rochester, N.Y., N/A
NR. Salt Lake City, Utah, N/A

*Scores have been rounded to the nearest tenth of a point resulting in some apparent ties; however, the rankings are based on the full, calculated scores that were not equal in those cases.

**Editor’s note: NR = not ranked; N/A = not available – Most of the community/environmental data were not reported in these cities.

Physical activity and obesity are at epidemic proportions in the U.S., resulting in an increased prevalence of many chronic diseases, poor quality of life and premature deaths. Meanwhile, health care expenditures associated with physical inactivity and obesity continue to rise each year with increasingly catastrophic costs to society.

The results of a 2007 Omnibus survey commissioned by ACSM suggest the solution to this growing national health crisis may lie at the local level. ACSM believes the key fundamentals for improving physical activity behaviors involves setting policies and recommendations that better enable individuals and communities to engage in physical activity as a part of a healthier lifestyle.

With this background in mind, ACSM created the ACSM American Fitness Index™ (AFI) program to statistically measure the state of health and fitness at a city-level; provide valuable resources to help cities focus on their efforts; and assist communities in connecting with invaluable health promotion partners.

To assist with measurement and to provide a baseline measure of health and fitness status, ACSM worked with the Indiana University School of Family Medicine and a panel of 26 health and physical activity experts on the methodology of the AFI data report. Researchers analyzed the data gleaned from U.S. Census data, the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), The Trust for the Public Land City Park Facts, and other existing research data in order to give a scientific, accurate snapshot of the health and fitness status at a metropolitan level.

The team chose to examine Metropolitan Statistical Areas (MSA) rather than city limits. This approach would allow for an examination of the shared health-related resources of the city core, its sister cities and the surrounding suburban area.

The data examined fall into two categories: 1) Personal Health Indicators; and 2) Community and Environmental Indicators. Visit the online newsroom at for a complete list of the data components.

With this data, cities can compare their health status and fitness attributes to other cities. Additionally, the cities can use materials, resources and connections associated with the program to help their city improve its health, fitness and quality of life.

With AFI’s network of health promotions partners, community programs, allied associations and other organizations, each community will be able to tap into best practices and existing resources to address its unique makeup of opportunities and challenges. The ultimate result will be an improvement in community fitness and a reduction in the rates of obesity and other chronic diseases.

Sixteen large metropolitan areas were included in the pilot phase of the program in 2008. This year, ACSM expanded the AFI program to measure and rank the 50 largest metropolitan cities in the United States. Visit the online newsroom at for a complete list of the MSAs included, counties represented and data. Follow the AFI program on Twitter - @ACSM_AFI.


The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world.  More than 35,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

The ACSM American Fitness Index™ (AFI) is an evidence-based measurement of the state of health and fitness in America’s 50 most populous metropolitan areas, plus Greater Indianapolis. Created in partnership with the WellPoint Foundation, the AFI program is designed to improve health, fitness and quality of life by linking communities, government agencies, health promotion groups, healthcare providers, and others with best practice strategies and partner organizations. The 2009 AFI data report ranks and assigns a score to each of the 50 metropolitan areas, based on personal health indicators, community environmental indicators, and healthcare provider information.For more information about the ACSM American Fitness Index™, please visit

The WellPoint Foundation, Inc. is a private, non-profit organization wholly funded by WellPoint, Inc. Through charitable contributions and programs, the Foundation promotes WellPoint’s inherent commitment to enhance the health and well-being of individuals and families in communities that WellPoint’s affiliate health plans serve. The Foundation focuses its funding on strategic initiatives that address and provide innovative solutions to health care challenges, as well as promoting the Healthy Generations Program, a multi-generational initiative that targets specific disease states and medical conditions. These disease states and medical conditions include: prenatal care in the first trimester, low birth weight babies, cardiac morbidity rates, long term activities that decrease obesity and increase physical activity, diabetes prevalence in adult populations, adult pneumococcal and influenza vaccinations and smoking cessation. The Foundation also coordinates the company’s annual associate giving campaign and provides a 50 percent match of associates’ campaign pledges. To learn more about the WellPoint Foundation please visit

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