The American Fitness Index is more than an annual ranking: it’s a tool communities can use to understand their strengths and identify opportunities to improve health.
Over the past 18 years, ACSM has worked closely with the Elevance Health Foundation to establish the American Fitness Index. The Fitness Index is a yearly composite score ranking of the largest 100 cities in the United States on their health behaviors, health outcomes, community infrastructure, and local policies that support engagement in physically active lifestyles. Additionally, the Fitness Index provides a plethora of resources that can be used by local officials, community groups, health organizations, and individual residents on ways to improve their community’s health, reduce chronic disease risk, and improve engagement in physical activity.
The true value of the Fitness Index is not found in the rankings alone, but rather its ability to provide communities with a roadmap for continuous improvement. Improving the health and wellness of communities doesn’t happen overnight, it requires strategic planning and informed decision-making over time. The Fitness Index can help guide this process.
Start with an Assessment
Every community health improvement process should start with an assessment of your current strengths and areas of improvement. The Fitness Index provides data across various health behaviors, chronic disease outcomes, built environment infrastructure, and policy/funding measures. Lower scores do not indicate failures; they can identify areas that have the greatest impact on change in the local community.
Make a Plan for Change
After opportunities for improvement have been identified from your community assessment, begin to formulate a plan for change. Examples may include expanding access to parks and local trails, enhancing access to healthy foods, or adopting policies that support active transportation and joint use of recreational facilities. Effective plans for change incorporate SMART goals- they are specific, measurable, achievable, realistic, and time-bound. Initial smaller and targeted actions can often lead to larger coordinated efforts for community change.
Invest in the Community
In order to consistently improve health outcomes, communities need to make informed decisions about where to spend funding, spearheading policy change, directing more staffing time, and expanding partnerships. Local governments may choose to invest more funding in building safer sidewalks and biking infrastructure, public transportation, community recreation/fitness programming, or supporting local farmers markets as a means of improving quality of life. Investing in people is equally important as tangible investments. Supporting local organizations and engaging community members in the decision-making process, while also building partnerships across various sectors, creates the greatest capacity for change.
Measure Impact
Continuous improvement requires measuring progress along the way. The Fitness Index allows communities to track health trends over time, while evaluating whether programs and initiatives are making a positive impact. Community health improvements may not necessarily translate to immediate ranking changes in the Fitness Index; however, they can often be highlighted across individual indicators (e.g., % meeting aerobic activity guidelines, % with obesity).
Putting Fitness Index Data into Action
The examples below illustrate how communities can use Fitness Index indicators to identify potential strategies for improvement.
| Constructs | Indicators | Examples of improvement strategies |
|---|---|---|
| Health Behaviors | Physical Activity Indicator: Meeting physical activity guidelines Healthy Eating Indicator: Consuming 2+ fruits per day | – Adding free permanent community gym equipment in public parks – Hosting free community workouts at local gyms or parks – Adding free food pantries with fresh produce – Facilitating local farmers markets |
| Health Outcomes | Physical Health Indicator: Percent of population with diabetes Mental Health Indicator: Percent of population with poor mental health in the previous month | – Free and conveniently located health screenings – Free resources on mindfulness and techniques to improve mental health – Mental health hotlines posted throughout common community facilities |
| Built Environment | Air Quality Index (AQI) Food Access Indicator: Percent of population with food insecurity Local Park Indicator: Parks as a percent of city area and percent of residents within a 10-minute walk to a park | – Expanding infrastructure to support biking and walking – Safe, reliable, and convenient public transportation and/or ride share options – Reduced vehicle emissions – Continued education on the impact of smoking – Adding free food pantries with fresh produce – Hosting farmers markets in different locations throughout the city to increase accessibility – Providing public transportation stops to public parks and recreation facilities – Acquire or repurpose land that can be transformed into parks – Consider walk or bikeability of the city’s population to a public park |
| Recreational Facilities | Recreational Facility Indicator: Playgrounds/10,000 residents and recreation centers/20,000 residents | – Expanding green space for parks and greenway paths – Building additional outdoor athletic fields (e.g. baseball/softball fields, basketball courts, pickleball/tennis courts, etc.) |
| Policy & Funding | Policy & Funding Indicator: Park expenditures per resident | – Apply for grants to support the expansion of healthy lifestyle initiatives – Incorporate strategies for improving community health and wellness in future policy and decision making |
Summary
Whether or not your city is included among the 100 cities ranked in the Fitness Index, every community has opportunities to improve health and wellness. The Fitness Index provides key metrics needed to guide the improvement process. When communities welcome continuous improvement (through assessing, planning, investing, and evaluating), they build capacity for lasting change.
For cities not included in the Fitness Index rankings, ACSM’s Community Fitness Assessment provides a way to put this approach into action. The toolkit walks communities through a similar assessment process, without rankings or weighted scores, to identify local strengths and opportunities for improvement and help inform future priorities. Cities can use the Community Fitness Assessment to start their own assessment and begin building a roadmap for a healthier community.
Community Fitness Assessment
The Community Fitness Assessment from the American Fitness Index helps stakeholders in communities that were not included in the annual Fitness Index rankings apply a similar approach to assessing their community fitness, a concept analogous to individuals having strong personal fitness. Explore the guide here: Community Fitness Assessment.
Learn more about how small changes can have big impacts on keeping communities active and healthy with this infographic: Small Changes Make a Big Difference.
