America’s 50 Largest Metro Areas Get Their Annual Physical

For the third straight year, the Washington, D.C., metro area claimed the highest ranking in the American College of Sports Medicine’s (ACSM) American Fitness Index(TM) (AFI). The AFI data report, “Health and Community Fitness Status of the 50 Largest Metropolitan Areas,” evaluates the most populous city areas to determine the healthiest and fittest metro areas in the United States.

The AFI data report reflects a composite of preventive health behaviors, levels of chronic disease conditions, health care access, and community resources and policies that support physical activity.

“The ACSM American Fitness Index not only measures the state of health and fitness in our nation’s largest communities, but evaluates the infrastructure, community assets, policies and opportunities which encourage residents to live a healthy and fit lifestyle,” said AFI Advisory Board Chair Walt Thompson, Ph.D., FACSM. “I liken the data report and rankings to the metro areas ‘getting a physical’ at the doctor’s office. The information learned from the physical will help each metro area identify areas of strength and weakness.”

ACSM received a grant from the WellPoint Foundation, based in Indianapolis, to present the 2010 data report.

“The WellPoint Foundation is pleased to be a continuing sponsor of the American College of Sports Medicine American Fitness Index(TM) (AFI) program,” said Wesley Wong, M.D., M.M.M. Regional Vice President and National Medical Director for WellPoint’s affiliated health plans and member of the AFI Advisory Board. “This initiative enhances our health improvement efforts across the country and allows us to be a stronger community partner in the states we serve.”

Digging into the Data

The Metropolitan Statistical Areas (MSA) of Washington-Arlington-Alexandria scored 73.5 (out of 100 possible points) in the AFI data report to achieve the top ranking, just as it did in 2008 and 2009.

Characteristics of the D.C. area that helped it achieve the top ranking are a relatively low smoking rate, a higher-than-average percentage of folks eating the recommended daily serving of fruits and vegetables, and lower-than-average rates of chronic health concerns such as obesity, asthma, cardiovascular disease and diabetes. D.C.-area residents also use public transportation regularly, meaning they are likely to walk to and from their places of work or transit stations. Also, the area of parkland as a percentage of the city’s land area is significant, providing residents with lots of space to run, bike, play sports or take a leisurely walk.

Metro areas completing the top five were Boston, Minneapolis-St. Paul, Seattle and Portland, Ore. The Baltimore, Md., area (ACSM’s host city for its 2010 Annual Meeting), ranked 20th.

The western United States dominated the top 10, with only three cities lying along the eastern seaboard. The nation’s three largest cities finished in the middle of the pack with New York at 21st, Chicago at 33rd and Los Angeles at 38th.

Education proved to be a valuable predictor of health and fitness; areas with a high percentage of residents with high school degrees or higher are more likely to be physically active and be in excellent or very good health. This group is also more likely to have health insurance.

Considering the challenging economic climate in recent years, the data suggests being unemployed may be a health concern. Metro areas with a higher unemployment rate are more likely to have a higher percentage of death related to cardiovascular disease.

Poverty levels, disability rates and the rate of violent crime correlated with other health concerns, suggesting that health officials and programs may need to put more emphasis on populations that may be underserved. For example, areas with a higher percentage of households below the poverty level are more likely to smoke, be obese, have diabetes, and have both cardiovascular disease and diabetes related deaths. They are less likely to be physically active, in excellent or very good health, or have health insurance.

The metropolitan rankings included in the report are:

Rank Metropolitan Area 2010 Score 2009 Rank 2009 Score
1. Washington, D.C. 73.5 1 74.4
2. Boston, Mass. 72.6 4 71.4
3. Paul, Minn. 71.7 2 72.1
4. Seattle, Wash. 70.5 6 69.7
5. Portland, Ore. 70.4 7 68.1
6. Denver, Colo. 69.9 3 71.6
7. Sacramento, Calif. 65.8 12 62.2
San Francisco,
8. Calif. 64.7 5 71.3
9. Hartford, Conn. 64.4 11 62.5
10. Austin, Texas 63.9 9 65.1
11. Richmond, Va. 62.7 NR N/A
12. Cincinnati, Ohio 62.5 14 60.8
13. San Diego, Calif. 62.0 8 66.8
14. San Jose, Calif. 61.0 13 61.3
15. Salt Lake City, Utah 60.6 NR N/A
16. Atlanta, Ga. 57.7 15 59.3
17. Virginia Beach, Va. 57.2* 10 63.1
18. Providence, R.I. 57.2* NR N/A
19. Orlando, Fla. 55.5 NR N/A
20. Baltimore, Md. 53.5 19 52.5
21. New York, N.Y. 52.9 22 48.9
22. Raleigh, N.C. 52.4 20 52.3
23. Pittsburgh, Pa. 52.0 16 54.3
24. Jacksonville, Fla. 51.2 28 45.2
25. Cleveland, Ohio 51.0 24 47.9
26. Philadelphia, Pa. 50.4 27 45.9
27. Milwaukee, Wisc. 49.2 17 53.0*
28. Buffalo, N.Y. 49.2 18 53.0*
29. Kansas City, Mo. 47.9 21 50.3
30. Tampa, Fla. 47.8 23 48.5
31. Nashville, Tenn. 47.8 26 46.8
32. Phoenix, Ariz. 47.4 32 42.5*
33. Chicago, Ill. 47.0 25 47.6
34. Charlotte, N.C. 44.0 34 40.3
35. Columbus, Ohio 42.8 29 43.9
36. Riverside, Calif. 42.8 40 35.1
37. St. Louis, Mo. 40.5 33 42.5*
38. Los Angeles, Calif. 40.5 30 43.6
39. Miami, Fla. 39.9 31 42.7
40. Dallas, Texas 39.5 35 39.6
41. New Orleans, La.(2) 37.7 NR N/A
42. Houston, Texas 37.6 41 34.7
43. San Antonio, Texas 36.9 39 35.5
44. Indianapolis, Ind. 35.9 36 39.3
45. Las Vegas, Nev. 35.3 42 34.6
46. Louisville, Ky. 32.5 38 37.7
47. Detroit, Mich. 31.9 44 30.5
48. Memphis, Tenn. 31.6 37 38.5
49. Birmingham, Ala. 31.2 43 32.2
50. Oklahoma City, Okla. 24.3 45 23.2

*Scores have been rounded to the nearest tenth of a point resulting in some apparent ties; however, the rankings are based on the full, calculated scores that were not equal in those cases.

**Editor’s note: NR = not ranked; N/A = not available – Most of the community/environmental data were not reported in these cities.

(2)New Orleans, La. replaced Rochester, N.Y. as the 50th largest metropolitan area in 2010.

Putting the ACSM American Fitness Index(TM) Report to Work

In addition to measuring the health and fitness of the 50 largest metro areas, the AFI data report aims to help communities develop and implement efforts to raise awareness of the issues and policies affecting health and fitness in their local area.

There are additional tools available on the AFI Web site ( to help kick-start action in the community, spread the message via local media and social networks, and guide local efforts that support health and fitness.

With AFI’s network of health promotion 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.

About the ACSM American Fitness Index(TM) Program and Report

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. Researchers analyzed the data gleaned from U.S. Census data, the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), The Trust for the Public Land City Park Facts, and other existing research data in order to give a scientific, accurate snapshot of the health and fitness status at a metropolitan level.

The data examined fall into two categories: 1) Personal Health Indicators; and 2) Community and Environmental Indicators. Visit the online newsroom at for a complete list of the data components.

About the American College of Sports Medicine

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 35,000 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.

About the WellPoint Foundation

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. The Foundation focuses its funding on strategic initiatives that address and provide innovative solutions to health care challenges, as well as promoting 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

Source: American College of Sports Medicine

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.