American Fitness Index ranks 100 largest cities based on 35 indicators
Despite a significant increase in Americans’ aerobic and strength activity, external factors like smoke-filled air and the lapse of a Covid-era food program may be making us less fit overall.
Those are the primary conclusions from the 18th annual ACSM American Fitness Index® (Fitness Index) rankings published by the American College of Sports Medicine® (ACSM) and the Elevance Health Foundation, the philanthropic arm of Elevance Health, which annually tracks how well the 100 largest U.S. cities support healthy, active lifestyles.
The Fitness Index results — based on 35 evidence-based indicators — showed three indicators changed in an unhealthy direction — air quality, food insecurity and reports of excellent or very good health — each getting slightly worse. 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 and impacted 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, Washington; San Francisco, California and Denver, Colorado are the top five cities in this year’s rankings. Rounding out the top 10 fittest cities are Minneapolis, Minnesota; Madison, Wisconsin; Atlanta, Georgia; Sacramento, California; and San Diego, California. Full rankings and scores, a call-to-action report, a city comparison tool and other insights are accessible on the Fitness Index website.
“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, MD, chief health officer at Elevance Health. “Elevance Health Foundation enjoys our partnership with ACSM and the opportunity to leverage these insights and tailor our efforts to address specific community needs.”
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 and their residents reported improved aerobic activity levels; the largest increases were reported in Plano, Texas, and Fort Wayne, Indiana. 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, Virginia (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, PhD, 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,” she 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 splashpads, 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.
There were some major changes in the city rankings this year:
- Sacramento, California, leaped from 32 in 2024 to enter the Fitness Index Top 10
- San Diego, California, moved up one slot to rejoin the Top 10 (three Golden State cities are in this year’s Top 10)
- All four Ohio cities gained this year – Cincinnati from 62 to 35; Cleveland from 48 to 36; Columbus from 66 to 51; and Toledo from 87 to 78
- Both Nebraska cities made major jumps forward. Lincoln moved from 23 to 16, and Omaha moved from 51 to 32 in the 2025 city rankings
- Likewise, both New Jersey cities advanced, with Jersey City from 42 to 28, and Newark from 47 to 29
- Buffalo New York (24) overtook New York City, New York (33).
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.”
Overall Rank
- Arlington, VA
- Washington, D.C.
- Seattle, WA
- San Francisco, CA
- Denver, CO
- Minneapolis, MN
- Madison, WI
- Atlanta, GA
- Sacramento, CA
- San Diego, CA
- Chicago, IL
- Irvine, CA
- Boston, MA
- Plano, TX
- San Jose, CA
- Lincoln, NE
- Boise, ID
- St. Paul, MN
- Oakland, CA
- Pittsburgh, PA
- Austin, TX
- Chula Vista, CA
- Portland, OR
- Buffalo, NY
- Albuquerque, NM
View the full list of 100 city rankings here.
Find more details here or follow us @ACSMNews on X, formally known as Twitter, #100FitCities.
About the American College of Sports Medicine®
The American College of Sports Medicine® (ACSM) is the largest sports medicine and exercise science organization in the world, with nearly 50,000 members and certified professionals in more than 100 countries. Together, ACSM is committed to the mission of educating and empowering professionals to advance the science and practice of health and human performance. ACSM advocates for legislation to help the government and health community make physical activity a priority.
About Elevance Health Foundation
Elevance Health Foundation is the philanthropic arm of Elevance Health Inc. The Foundation works to improve the health of the socially vulnerable through partnerships and programs in our communities with an emphasis on maternal-infant health; behavioral health; and food as medicine. Through its key areas of focus, the Foundation also strategically aligns with Elevance Health’s focus on community health and becoming a lifetime, trusted health partner that is fueled by its purpose to improve the health of humanity. To learn more about Elevance Health Foundation, please visit www.elevancehealth.foundation or follow us @ElevanceFND on X and Elevance Health Foundation on Facebook.
Media Contacts
Paul Branks at 317-352-3827 or pbranks@acsm.org (American College of Sports Medicine®)
Mike Fulton at 301-651-2508 or mikef@asheragency.com (Asher Agency)
