While Americans registered a significant increase in aerobic and strength activity, other external factors, including smoke-filled air and a lapse of a food program, may be leading to lower fitness scores overall. This according to the 18th annual ACSM American Fitness Index rankings published by the American College of Sports Medicine and Elevance Health Foundation, which tracks how well the 100 largest U.S. cities support healthy, active lifestyles.
Based on 35 evidence-based indicators, the Fitness Index showed three indicators changed in an unhealthy direction: air quality, food insecurity, and reports of excellent or very good health. Declines in air quality can be attributed to wildfires and droughts; in addition to U.S. wildfires, smoke from wildfires across several Canadian provinces traveled south, affecting millions of people in the Northeast and Great Lakes regions in 2024. Ninety-nine of 100 cities in the Fitness Index had an increase in their food insecurity percentage. Research shows this may be a result of the expiration of the expanded Child Tax Credit and the end of other COVID-era programs supporting access to food.
City and county officials can use the Fitness Index as a data-driven baseline to measure progress and make informed decisions to further improve residents’ health. Arlington, Virginia; Washington, D.C.; Seattle; San Francisco, and Denver are the top five cities in this year’s rankings. Rounding out the top 10 fittest cities are Minneapolis, Madison, Wis., Atlanta, Sacramento, and San Diego.
“The Fitness Index has become a trusted and powerful tool to help us better understand and address the physical, behavioral, and social drivers of health in communities, while providing the data and expertise that empower advocates and city officials to take action,” said Shantanu Agrawal, M.D., chief health officer at Elevance Health.
Agrawal emphasized the partnership’s mutual vision to improve lives. “Elevance Health Foundation is working with communities to address social drivers of health in our country, including physical activity and the critical issue of food insecurity,” he continued. “Since 2021, our foundation has awarded more than $30 million to nonprofit organizations addressing food insecurity while improving health outcomes, reaching more than 1.2 million Americans. Our efforts are well received and rewarding, and ACSM is working nationally to extend and enrich lives through the power of movement.”
While challenges still exist, the Fitness Index data show a 9% increase on average in residents meeting the aerobic activity guidelines: 59.9% in 2025 is up from 50.9% previously reported. More impressively, in 94 of the 100 largest U.S. cities, residents reported improved aerobic activity levels; the largest increases were reported in Plano, Texas, and Fort Wayne, Ind. Cities also reported a significant increase in residents meeting aerobic and strength activity guidelines. Of the 100 cities assessed, 89 averaged a 7.6% increase, with the largest increase observed in Richmond, Va. (18.8%).
This upward trend among the largest 100 cities shows a growing commitment from both cities and their residents to promote and maintain active lifestyles and improve overall health through increased aerobic and strength activities.
Other notable improvements were seen in decreased rates of smoking (73 cities had a 2.6% decrease, on average). In addition, there was an increase in funding for parks: 64 cities reported an average increase of $48 per capita. Among these cities, seven had a per capita increase of more than $100.
“We celebrate the best efforts of individuals and municipalities to improve overall health and fitness levels,” said ACSM Past-President and Chair of the Fitness Index Advisory Board Stella Volpe, Ph.D., FACSM, ACSM-CEP. “These efforts are always going to be affected—good or bad—by a broad variety of other factors. This year, pollution from wildfires and legislation addressing food insecurity that limited further progress. Regardless, such challenges should never deter us from supporting and expanding healthy lifestyles for all.”
Volpe said the Fitness Index offers three distinct ways community leaders and residents can make a difference:
- Fuel Your Knowledge: Armed with Fitness Index data on a composite of health behaviors, chronic diseases, and community assets based on the most recent data available, residents can advocate for local initiatives and policy changes in their own communities.
- Celebrate Success and Inspire Action: The Fitness Index celebrates strides that the ranked cities have made toward promoting a culture of health and fitness. It is a source of inspiration for city leaders and residents alike, motivating them to pursue even greater achievements.
- Join the Movement: Cities are offered essential tools and resources by the Fitness Index to help leaders and residents assess their communities’ health and fitness landscape and work together to advocate for positive changes.
“Healthy living starts where we live, learn, work, and play,” Volpe continued. “By getting involved in grassroots advocacy, you can help create a community that encourages and supports a healthy, active life.”
Volpe said there are two new indicators this year—trail miles and splash pads—and an update to measuring tennis courts to include pickleball and dual-use courts. She said the advisory board adjusts indicators annually, noting that the data provides a framework for ongoing evaluation, enabling cities to monitor their progress and celebrate their achievements in building healthier and more vibrant communities.
Volpe encouraged government leaders and citizens alike to review and find a way to benefit from the research findings of the Fitness Index. “More of us are finding meaningful ways to live healthier and embrace fitness opportunities,” she said. “All of us must maintain this momentum and encourage our leaders to make bold spending choices, policy decisions and infrastructure changes to increase opportunities for residents to be physically active and healthy—one city at a time.”