Where Are America's Fittest Cities?

July 31, 2023

The fittest cities in the U.S. have been ranked in the American College of Sports Medicine's (ACSM) 16th annual ACSM American Fitness Index. No. 1? Arlington, Va., which had top scores in both the personal health and community/environment subscores. Arlington was followed by Washington, D.C.

The ACSM/Elevance Health Fitness Index evaluated America’s 100 largest cities using 34 evidence-based indicators. Rounding out the top 10 fittest cities are Seattle; Minneapolis; Irvine, Calif.; Madison, Wis.; San Francisco; St. Paul, Minn.; Denver; and Oakland, Calif. (the East Bay city’s first time in the top 10). Full rankings and scores, a summary report, a city comparison tool and other insights are accessible on the Fitness Index website.  

“No city is immune to chronic disease, but fortunately, every city and every person can take positive steps toward creating healthier lifestyles,” said Shantanu Agrawal, M.D., chief health officer of Elevance Health. “Physical activity has proven to be an effective tool in reducing the prevalence of many chronic diseases. Getting sufficient physical activity could prevent one in 12 cases of diabetes, one in 15 cases of heart disease and one in 10 premature deaths. We also know that food is medicine, and consistent access to nutritious food is an essential part of maintaining health. When we provide our bodies with nutritious foods, we are less affected by diet-sensitive chronic conditions. Proper nutrition, fitness and health are deeply connected, and when we prioritize all three, we can improve our quality of life.” 

The science-based Fitness Index offers city leaders valuable data annually to make potentially life-changing decisions in policy, systems and environmental-change strategies that drive fitness and health improvements in their communities. The Fitness Index research findings indicated the impacts of the COVID-19 pandemic are still being felt across the country, and the full impact may not be known for decades.  

“The importance of the Fitness Index has taken on new meaning for individuals and communities seeking to improve their health and well-being,” said Stella Volpe, Ph.D., RDN, FACSM, ACSM-CEP, chair of the American Fitness Index Advisory Board and ACSM president-elect. “Research suggests that to improve physical and mental health, prevent disease and disability, and enhance quality of life for all Americans, we must create a culture that integrates physical activity into our daily lives.” 

ACSM recommends at least 150 minutes per week of moderate-intensity aerobic activity -- about 22 minutes per day -- and muscle-strengthening activity twice a week. Volpe said 78% of adults in the Fitness Index cities reported exercising in the previous month, but only 51% met the aerobic activity guidelines, while an even smaller percentage (24%) met both aerobic and strength activity guidelines.  

“Unfortunately, Americans are still not moving enough,” said Volpe. “This underscores the need for local community leaders to step up and make bold spending choices, policy decisions and infrastructure changes to increase opportunities for residents to be physically active and healthy. Collective actions and resources at the community level greatly influence the health choices available to us, and the Fitness Index is a road map for where communities can improve.” 

Arlington, Va., ranked among the top 10 cities for 16 of 34 indicators, giving it a balance of healthy behaviors and community assets. Arlington had the highest percentage of residents exercising in the past 30 days, the lowest percentage of residents with diabetes, no pedestrian fatalities and tied for cities with the highest percentage of residents who live within a 10-minute walk to a park. All cities can be compared to Arlington or others ranked in the Fitness Index by accessing the online City Comparison Tool

Additional findings from the 2023 Fitness Index rankings include: 

  • Cities in the top 25 generally scored well in health outcomes. However, cities outside of the top 25 took honors for lowest rates of asthma and heart disease, with El Paso, Texas, and Bakersfield, Calif., leading the way, respectively. 
  • Riverside, Calif., improved the most, rising 18 spots (from No. 90 to No. 72) in the rankings, the largest shift being an improvement in personal health indicators—specifically, more people consuming fruits and vegetables and fewer days with poor mental health.
  • Santa Clarita, Calif., replaced Hialeah, Fla., in the top 100 cities based on the U.S. Census population data. Santa Clarita was No. 66 in the overall rankings.
  • Cities with the highest rates of one chronic disease tend to also have high rates of other chronic diseases and generally rank in the bottom 25 overall: diabetes and obesity (Laredo, Texas); high blood pressure (St. Petersburg, Fla.); heart disease (Louisville, Ky.); asthma (Fort Wayne, Ind.); and stroke (Winston-Salem, N.C.).