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San Francisco Tops List of America's Fittest Cities

by User Not Found | Aug 01, 2011
New ACSM American Fitness Index™ city rankings will help improve U.S. health

INDIANAPOLIS – San Francisco bested Seattle as the fittest of America’s most populous cities, according to a new program and report released today from the American College of Sports Medicine (ACSM) in partnership with the WellPoint Foundation. The ACSM American Fitness Index™ (AFI) inaugural data report, “Health and Community Fitness Status of 16 Large Metropolitan Areas,” is a snapshot of the state of health and fitness in America’s 15 most populous metropolitan areas, plus Greater Indianapolis.*

The AFI data report breaks down several data components related to health and fitness, including a unique evaluation of community-level data, and offers strengths and weaknesses of each city. In addition to a data report, the AFI is a program designed to improve health, fitness and quality of life in the United States by promoting physical activity.

ACSM contends that researching and understanding the scope of the problem is the first step toward developing programs, initiatives and policies to increase physical activity. The data evaluated for this report will help identify each metropolitan area’s strengths and weaknesses. 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.

San Francisco and the surrounding Bay Area achieved the top ranking in the AFI data report with a score of 403, based on figures related to healthy lifestyles and physical activity. The Bay Area scored above average on personal health indicators, such as the percentage of citizens who exercise regularly at least at moderate intensity, consistent with ACSM physical activity recommendations.

Nearly 32 percent of its citizens eat five or more fruits and vegetables per day. San Franciscans and their neighbors are more likely to have health insurance, less likely to have chronic health problems, and are comprised of fewer smokers on average. The region also fared well for amenities, such as parks and athletic facilities, and an above-average number of commuters who bike, walk or use public transportation. The number of primary care health providers in the Bay Area was among the highest for the largest metropolitan areas.

An ACSM research team from the Indiana University School of Family Medicine collected and analyzed the data gleaned from U.S. Census data, the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), and other existing research data in order to give a scientific, accurate snapshot of the health and fitness status at a metropolitan level.

The metropolitan rankings included in the report are:

Rank, MSA Name, Score
1. San Francisco, Calif., 403
2. Seattle, Wa., 401
3. Boston, Mass., 370
4. Washington D.C., 369
5. Atlanta, Ga., 285
6. Philadelphia, Pa., 268
7. Chicago, Ill., 267
8. Dallas, Texas, 261 
9. New York City, 260
10. Miami/Ft. Lauderdale, Fla., 235
11. Phoenix, Ariz., 233
12. Indianapolis, Ind., 231
13. Houston, Texas, 209
14. Los Angeles, Calif., 208
15. Riverside, Calif.,  n/a
16. Detroit, Mich., 149

“The ACSM American Fitness Index™ is more than a list of cities and their rankings,” said AFI Advisory Board Chair Walt Thompson, Ph.D., FACSM, Georgia State University, during the program’s launch at the Indiana Convention Center. “This report issues a call to action to improve the overall health, fitness and quality of life in the United States.”

Thompson continued by outlining how the data was collected, analyzed, and how ACSM and its members can lend their expertise in sports medicine and exercise science to promote a more physically active society.

“Where the rubber meets the road is how AFI can assist people living in communities who want to improve their health and fitness,” Thompson said. “We have identified some best practices at the community level to improve fitness. These might include more park space, an environment conducive to physical activity, recreational facilities, programs and policies.Moreover, we are connecting scientific knowledge with partners, alliances and policies that work.”

One highlighted initiative is “Building a Healthier Chicago,” led by the U.S. Department of Health and Human Services (HHS), the American Medical Association (AMA) and the Chicago Department of Public Health (CDPH). James M. Galloway, M.D., FACP, FACC, FAHA, assistant surgeon general and HHS regional health administrator, discussed how the Chicago-based program and AFI partnership is helping Chicago, which finished seventh in the AFI rankings, to improve the level of fitness of its residents.

“The new initiative is designed to build a healthier Chicago by focusing on the reduction of obesity through physical activity and healthful eating, as well as high blood pressure prevention, detection and control,” Galloway said. “Our methods and strategies are designed to reach all of the city’s diverse populations through awareness, education and action.”

Six of the 10 leading causes of death in Chicago are attributable to a chronic disease, with heart disease, cancer, and stroke topping the list. Each of these can be mitigated by people’s daily choices. Poor nutrition and lack of exercise are two of the major three leading causes of these diseases (tobacco is the third) and both of these factors are very closely linked to the ever-increasing epidemic of obesity in the U.S.

“Last year, affiliated health plans of WellPoint, Inc., the parent company of the WellPoint Foundation, implemented a State Health Index as another way to help improve the health of our communities,” said Wesley Wong, M.D., M.M.M., medical director and member of the AFI Advisory Board. “Through such programs, we are able to identify risk areas based on U.S. Centers for Disease Control data and then develop partnerships with local organizations promoting local programs designed to reduce areas of concern. By supporting ACSM’s initiative, we will be able to further our efforts across the country and have a larger impact on the health of our communities.”

About the ACSM American Fitness Index Program and Report
Physical activity and obesity are at epidemic proportions in the U.S., resulting in an increased prevalence of many chronic diseases. Meanwhile, health care expenditures associated with physical inactivity and obesity continue to rise.

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. 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 three categories: 1) health status indicators; 2) community and environmental indicators; and 3) the number of health care providers. 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.

Sixteen large metropolitan areas were included in the pilot phase of the program. Visit the online newsroom at for a list of the MSAs included, counties represented and data. Future revision of the AFI data report will likely be expanded to the 50 largest metropolitan cities in the United States.

*As the headquarters of ACSM and host city for this year’s Annual Meeting, Indianapolis was included in the rankings. Greater Indianapolis is the 33rd largest MSA and also headquarters for WellPoint, Inc.


The ACSM American Fitness Index™ (AFI) is an evidence-based measurement of the state of health and fitness in America’s 15 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 2008 AFI data report ranks and assigns a score to each of the 16 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. With combined assets of $200 million, the Foundation focuses its funding on strategic initiatives that address and provide innovative solutions to reduce the number of uninsured as well as organizations that promote 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

The  American College of Sports Medicine is the largest sports medicine and exercise science organization in the world.  More than 20,000 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.

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