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The ACSM American Fitness Index: Using Data to

Identify Opportunities to Support Physical Activity
Terrell W. Zollinger,1 Barbara E. Ainsworth,2,3 Walter R. Thompson,4 Stella L. Volpe,5 NiCole R. Keith,6 Gretchen S. Patch,7
Jessica M. Coffing,8 and Lynette L. Craft7

INTRODUCTION
ABSTRACT The American College of Sports Medicine
Since 2008, the American College of Sports Medicine (ACSM) American Fitness In- (ACSM) launched the ACSM American
dex program has provided data, materials, resources, and connections to help city Fitness Index® (Fitness Index) program
officials, public health professionals, and community-based organizations assess in 2008 because a void existed among
the fitness of their residents, identify opportunities to improve health outcomes, other summary reports that did not take
and enable physically active lifestyles. The purpose of this article was to describe into consideration both personal health
the development and methods used to create the annual scores and rankings for behaviors and the environment in which
the Fitness Index. Fitness Index indicators were originally selected by ACSM con- people live to summarize the fitness of
tent experts and other nationally recognized fitness experts who understood the and resources for residents. Reported annu-
importance of community assets to improve health behaviors and outcomes. Indi- ally, the focus of the Fitness Index program
cator values for the 100 largest US cities were gathered from reputable, regularly is 1) to inform decision makers and the pub-
updated, publicly available data sources. Indicator values for the cities were lic of the health, social, and economic bene-
ranked, weighted, and combined into a personal health subscore, a community/ fits of physical activity, including policies
environment subscore, and a total score that were then ranked from the most fit and infrastructure that promote healthy be-
(rank 1) to least fit (rank 100) cities. Fitness Index indicators are reviewed by ACSM
haviors; 2) to engage city officials and resi-
content experts and updated annually to ensure the Fitness Index stays true to its
dents to recognize their city’s strengths and
goal. Strengths of the Fitness Index include the use of multiple indicators related to
the health and behaviors of residents as well as community assets and policies.
opportunities to better promote a healthful
Some data limitations for the Fitness Index include sample variability from year environment; and 3) build local capacity
to year, use of self-reported survey data with well-known biases and variability, and partnerships to implement policy and
and lack of availability of important data indicators. The annual summary report infrastructure changes to enable physically
suggests how these rankings and data can be translated into action within cities. active lifestyles for all residents (1). The Fit-
Additional resources for the American Fitness Index, including an interactive tool ness Index program provides data, mate-
that allows comparison of indicator values among cities, are available online. rials, resources, and connections to health
promotion partners on a Web site to help cit-
ies improve their indicators (2).
Since the mid-1980s, there has been considerable expansion
of efforts to conduct and report surveillance activities to assess
population health status and physical activity levels at the state
level. Components of national surveys, such as the Centers for
1
Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Disease Control and Prevention (CDC) Behavioral Risk Sur-
IN; 2College of Health Solutions, Arizona State University, Phoenix, AZ; 3School veillance System survey (BRFSS) and the US Census Bureau
of Exercise and Health, Shanghai University of Sport, Shanghai, CHINA; 4De- American Community Survey (3,4), are frequently used by re-
5
partment of Kinesiology and Health, Georgia State University, Atlanta, GA; De-
partment of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute
searchers who translate the findings and present them in the
6
and State University, Blacksburg, VA; School of Health and Human Sciences, popular press. In the last few decades, it became possible to
Indiana University, Indianapolis, IN; 7American College of Sports Medicine, generate substate-level and city-level health and physical activ-
Indianapolis, IN; and 8J. Coffing and Associates, Indianapolis, IN ity reports, as well as city-level infrastructure and other rele-
Address for correspondence: Terrell W. Zollinger, Dr.P.H., Richard M. Fairbanks vant measures. Population health measures have been aggre-
School of Public Health, Indiana University, 1050 Wishard Blvd, Suite 5100, gated at the state and substate levels for use by researchers
Indianapolis, IN 46202-2872 (E-mail: [email protected]). and public health professionals (e.g., Robert Wood Johnson
Foundation–supported County Health Rankings and more re-
2379-2868/0801/e000223
Translational Journal of the ACSM cently the CDC PLACES project (5,6)). Organizations also
Copyright © 2023 by the American College of Sports Medicine have evaluated and reported community assets that support

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Copyright © 2023 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 physical activity (e.g., Trust for Public Land (7), Walk Score addition, this article discusses how the Fitness Index evolved
(8)). A few organizations have aggregated groups of health during the past 15 yr to remain current and relevant for stake-
measures on focused topics; however, none were identified holders. Finally, suggestions are presented for how these rank-
that aggregated both population health indicators and com- ings and data can be translated into action within cities.
munity assets into a single index to specifically measure cities’
overall fitness (9,10). To fill this void and in response to the METHODS
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goal of improving the nation’s health and promoting physi- The first step in creating the Fitness Index involved iden-
cally active lifestyles, the Fitness Index was developed. tifying available population health and community measures
Most city officials recognize that higher levels of physical fit- related to physical fitness and mental health. A national panel
ness, healthier population attributes, and access to resources to of 26 content experts, using a modified Delphi method to reach
promote physical activity can be major attractions for busi- consensus, assessed and weighted possible measures on a scale
nesses, their employees, and future residents (11). Consequently, from 0 to 3. The panelists were asked to rate the importance
city officials, public health professionals, and community-based of each measure based on their expert opinion if the measure
organizations interested in improving health measures benefit was not relevant (and thus, not included), had lower importance
from understanding how residents’ health and community as- or impact on fitness (weight = 1), had moderate importance or
sets (e.g., walkability, parks, recreation centers) in their cities impact on fitness (weight = 2), or had high importance or im-
compare with those in other cities and how these influence fo- pact on fitness (weight = 3). From this process, 31 indicators
cused interventions and policy efforts (12). were originally identified for inclusion in the Fitness Index cal-
The central component of the Fitness Index program is a culations and then separated into two indicator subgroups: per-
data report that includes individual city rankings and scores sonal health and community/environment.
based on indicators of personal health behaviors and out- Indicator values were gathered from the publicly available
comes as well as community assets and policies that support data sources shown in Table 1 and entered into a spreadsheet
physical activity. The 2022 Fitness Index included 34 indica- for analysis. Two indicators were coded before being entered
tors consisting of 9 health behaviors, 10 health outcomes, 6 in the spreadsheet: Complete Streets Policies and Physical Ed-
built environment measures, 6 types of recreational facilities, ucation Requirement (shown in Table 2). Complete Streets
and 3 policy measures as shown in Fig. 1. These indicators Policies were graded on a scale from 0 to 2 by type of policy
were used to create scores and ranks for two subscales and a at the city or county level with those including enforcement
total score for each city evaluated. mechanisms receiving the highest grade. State-level education
This article describes the Fitness Index methods and data policies were used for the Physical Education Requirement in-
sources, along with its strengths and limitations. The rationale dicator. Local school district policies may be stronger, but not
and background that led to the development of the Fitness In- weaker, than state policies. Because cities typically have multi-
dex and the steps involved in creating it are also included. In ple school districts, it was not feasible to create a single code

Figure 1: Fitness Index indicators and scores.

2 Volume 8 • Number 1 • Winter 2023 ACSM American Fitness Index

Copyright © 2023 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 TABLE 1.
Fitness Index Indicators Included from 2008 to 2022.

Source Fitness Index Report Years

Health behaviors

% exercising in the last 30 days CDC BRFSS—County Data 2008–2022

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% physically active at least moderately CDC BRFSS—County Data 2008–2013

% meeting aerobic activity guidelines CDC BRFSS—County Data 2014–2022

% meeting aerobic and strength activity CDC BRFSS—County Data 2014–2022

guidelines

% bicycling or walking to work US Census American Community Survey 2008–2022

% using public transportation to work US Census American Community Survey 2008–2022

% consuming 5+ fruits/vegetables per day CDC BRFSS—County Data 2008–2013

% consuming 2+ fruits per day CDC BRFSS—County Data 2014–2022

% consuming 3+ vegetables per day CDC BRFSS—County Data 2014–2022

% sleeping 7+ hours per day CDC BRFSS—County Data 2018, 2021–2022

% smoking CDC BRFSS—County Data 2008–2022

Health outcomes

% in excellent or very good health CDC BRFSS—County Data 2008–2022

% physical health not good during the CDC BRFSS—County Data 2008–2022
past 30 days

% mental health not good during the CDC BRFSS—County Data 2008–2022
past 30 days

% with obesity CDC BRFSS—County Data 2008–2022

% with asthma CDC BRFSS—County Data 2008–2022

% with high blood pressure CDC BRFSS—County Data 2017–2022

% with angina or coronary heart disease CDC BRFSS—County Data 2008–2022

% with stroke CDC BRFSS—County Data 2017–2022

% with diabetes CDC BRFSS—County Data 2008–2022

Cardiovascular disease deaths/100,000 residents CDC Wonder 2008–2017

Diabetes deaths/100,000 residents CDC Wonder 2008–2017

Pedestrian fatalities/100,000 residents National Highway Traffic Safety Administration 2019–2022

% with health insurance CDC BRFSS—County Data 2008–2013

Built environment

Air quality index Environmental Protection Agency 2019–2022

Bike Score® Bike Score® 2019–2022

Farmers markets/1,000,000 residents USDA Farmers Market 2008–2020

% with food insecurity Feeding America® Map the Meal Gap 2021–2022

Park land as a percent of MSA land area Trust for Public Land—City Park Facts 2008–2018

Parks/10,000 residents Trust for Public Land—City Park Facts 2008–2022

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 TABLE 1.
(Continued)

Source Fitness Index Report Years

Acres of parkland/1000 residents Trust for Public Land—City Park Facts 2008–2018

% within a 10-min walk to a park Trust for Public Land—City Park Facts 2015–2022
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Walk Score® Walk Score® 2014–2022

Primary health care providers/100,000 HRSA Area Health Resource File 2008–2013
residents

Recreational facilities

Ball diamonds/10,000 residents Trust for Public Land—City Park Facts 2008–2022

Dog parks/10,000 residents Trust for Public Land—City Park Facts 2008–2018

Basketball hoops/10,000 residents Trust for Public Land—City Park Facts 2017–2022

Park playgrounds/10,000 residents Trust for Public Land—City Park Facts 2008–2022

Golf courses/100,000 residents Trust for Public Land—City Park Facts 2008–2016

Recreational centers/20,000 residents Trust for Public Land—City Park Facts 2008–2022

Swimming pools/100,000 residents Trust for Public Land—City Park Facts 2008–2022

Tennis courts/10,000 residents Trust for Public Land—City Park Facts 2008–2022

Policy and funding

Complete Streets policy Smart Growth America/National Complete 2019–2022

Streets Coalition—City Policy

Park expenditure/resident (adjusted) Trust for Public Land—City Park Facts 2008–2022

Physical education requirement National Association of State Boards of 2008–2022

Education—State Policy
HRSA, US Health Resources and Services Administration; USDA, US Department of Agriculture.

for a city-level physical education requirement indicator. The community/environment indicators, k = the indicator group,
Physical Education Requirement indicator was coded from 1 r = the city rank on the indicator, w = the weight assigned to
to 3, based on the number of grade levels (elementary, middle, the indicator, and City Scorekmax = the hypothetical score if a city
high schools) for which the state required physical education. ranked best on each indicator in the group.
Indicators were then ranked (worse value = 1) and multi-
plied by the weight assigned by the expert panel. Unhealthy in- TABLE 2.
dicators, such as percentage of residents smoking, were reverse Policy Grading Rubric Used to Assign Values before Ranking.
ranked (worst value = 100). The weighted ranks were then
summed by indicator subgroup to create subscores. Overall Grade
scores were then standardized to a scale with an upper limit
of 100 by dividing the overall score by the maximum possible Complete streets policy type
value and multiplying by 100. The individual weighted scores Ordinance, law, tax levy 2
were also averaged for both indicator subgroups to create the
total score. Both the subscores and the total scores for the Policy, design manual/guide, plan, internal 1
100 cities were then ranked (best = 1). The following formula policy, executive order, resolution
summarizes the scoring process:
No policy type 0
n
Physical education requirement

Required at 3 grade levels (elementary, 3

City Scorek ¼ ðð∑rki wki Þ=City Scorekmax Þ  100
middle, and high schools)

i¼1 Required at 2 grade levels 2

Required at 1 grade level 1

where n = the number of personal health indicators or number of

4 Volume 8 • Number 1 • Winter 2023 ACSM American Fitness Index

Copyright © 2023 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 The Fitness Index included indicators for the most populated physically active lifestyles. Cities with the highest scores in
US communities designated by the US Office of Management the Fitness Index report have high community fitness, a con-
and Budget using US Census Bureau data. From 2008 to cept analogous to individuals having high personal fitness.
2017, metropolitan statistical areas (MSAs) were chosen as Results from the 2022 Fitness Index showed high rankings
the unit of measurement because they represent the group of for cities where residents had good health behaviors and suffi-
counties comprising the larger urban areas where residents live, cient community assets to support physical activity and health,
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work, and access community assets. Starting in 2018, the Fit- as is seen in Table 3 (15,16). The higher-ranking communities
ness Index shifted the unit of measurement to cities rather than also provided more financial support for parks with recrea-
MSAs. This approach acknowledges that the central city and tional features and enacted policies supporting school physical
surrounding suburbs are controlled by different government education and Complete Streets for safer walking, bicycling,
agencies and may have different health behaviors and and other forms of active living (17–19). Conversely, rankings
community-level infrastructure to support physically active life- were lower for cities where residents had less positive health
styles. Among the most populous cities, it should be noted that behaviors and a higher prevalence of chronic disease risk fac-
Arlington, VA, is sometimes referred to as Arlington County, tors and conditions, as well as fewer community assets and
whereas other times, just Arlington. The US Census Bureau re- policies to support physical activity (20).
fers to Arlington, VA, as a “Census Designated Place”—a city, Cities that ranked near the top had scores in the 70s and 80s
town, place equivalent, and township—and is included in the on a 100-point scale, indicating that all cities still had room for
Fitness Index list of the 100 most populated cities (13). improvement. Similarly, cities near the bottom of the rankings
generally had scores in the 20s, 30s, and 40s on a 100-point
DATA SOURCES scale, showing that residents in those cities had some good per-
The Fitness Index utilizes indicators that are generally sonal health indicators or outcomes, and there were commu-
available to the public and, to ensure validity and reliability, nity assets in place that could provide a foundation for focused
are from reputable, regularly updated sources as shown in initiatives and more supportive policies.
Table 1. Only modifiable measures are included to enable city The rankings of the personal health subscores are generally
officials to implement targeted programs, policies, and strate- correlated with the rankings of the community/environment
gies to improve fitness. Each year, the Fitness Index content ex- subscores. For example, in the 2022 Fitness Index, the top-
perts, ACSM staff, and technical consultants review potential ranked city overall, Arlington, VA, ranked first in both the
new measures, data sources, and current indicator weights to personal health subscores and the community/environment
determine if changes are necessary to ensure that the Fitness In- subscores. Minneapolis, MN, which ranked third overall,
dex data report is up-to-date and uses the best measures avail- ranked fourth in the personal health subscores and third in
able. Nineteen of the 34 indicators used in the 2022 report the community/environment subscores. Four of the top 10
have been used in the Fitness Index since 2008 as shown in cities ranked among the top for the personal health and
Table 1. Changes in the indicators used are the result of changes community/environment indicators. This implies that these
in the data collected by the sources or new measures that be- cities were supportive of walking and bicycling, provided access
came available and were judged to be important, whereas less to parks with various recreational facilities (ball diamonds, bas-
impactful or less reliable measures were removed. ketball hoops, playgrounds, recreational centers, swimming
Occasionally, missing data were encountered and addressed in pools, and tennis courts), had park funding, and had physical
various ways, depending on the indicator. The Fitness Index sum- education policies (17,21,22). Cities ranked in the bottom 10
mary report, an executive summary of the data report, includes a had fewer of these assets, with three cities ranked from 93 to
footnote to indicate where data were either missing or not re- 100 in the community/environment indicators.
ported in the same way across cities. When appropriate, alterna- When ACSM launched the Fitness Index in 2008, there
tive ways to obtain missing data are noted in the summary report. were very few city-level reports on the health and well-being
In addition to the indicators used to create the Fitness Index, of residents, and none were identified that provided a single
population characteristics were obtained (e.g., age, race/ combined measure of multiple indicators. Uniquely, the ACSM
ethnicity, disability, education, poverty levels) for each city combined personal health indicators with community assets in
from the most recent census reports. Population characteristics one index measure and at a metropolitan level. In the begin-
are not included in the Fitness Index scoring calculations or ning, MSAs were used because they included not only activities
rankings; however, they are made available to city officials to and other assets within the city limits, but also captured suburban
help identify other cities with comparable characteristics for areas where residents contribute to the personal and community
better interpretation of the scores and rankings. These data assets of the city. Later, with better city-level data available, an un-
values are made available on the Fitness Index Web site in a derstanding of the demographic differences of urban and subur-
city comparison tool (14). Because the data used for the Fitness ban residents, and recognizing the need for city-specific data for
Index were previously collected by other organizations and city policy makers, the Fitness Index report was narrowed to cit-
publicly available in a de-identified summary form, the Fitness ies in 2018 (23). Even today there seem to be no other reports that
Index program was judged to be exempt from institutional re- include personal health and community assets in a single focused
view board approval. city-level report. City officials have used the Fitness Index and the
rankings to make better judgments when reviewing the needs of
DISCUSSION their city and its citizens.
ACSM designed the Fitness Index to help city officials The 100 cities included in the Fitness Index are home to
identify opportunities to improve the health of residents and 64.8 million people, approximately 20% of the US population
expand community assets, including policies, to better enable (24). Consequently, as these cities’ officials continue their efforts

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 TABLE 3.
2022 Fitness Index Rankings and Scores (out of 100) for the 100 Largest Cities in the United States

Total Personal Health Community/Environment

Cities Rank Score Rank Score Rank Score

Arlington, VA 1 85.0 1 86.8 1 82.5

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Madison, WI 2 78.2 2 84.9 22 68.5

Minneapolis, MN 3 78.0 4 76.7 3 80.0

Washington, DC 4 77.9 5 75.7 2 81.1

Seattle, WA 5 77.8 3 79.5 12 75.2

Irvine, CA 6 72.0 6 75.6 25 66.9

Portland, OR 7 71.4 12 71.8 18 70.8

St. Paul, MN 8 71.4 19 65.5 4 79.9

Denver, CO 9 69.9 9 72.6 27 65.9

Chicago, IL 10 69.6 22 63.5 6 78.4

Oakland, CA 11 69.1 8 73.0 32 63.5

Boise, ID 12 66.5 18 66.1 24 67.0

Boston, MA 13 66.4 31 59.0 10 77.1

San Francisco, CA 14 65.8 27 62.1 17 71.1

Aurora, CO 15 63.8 17 66.5 37 60.0

Lincoln, NE 16 63.5 26 62.1 29 65.6

New York, NY 17 63.1 21 64.3 36 61.3

Atlanta, GA 18 62.0 36 57.7 23 68.2

Jersey City, NJ 19 62.0 15 67.9 45 53.4

San Jose, CA 20 62.0 11 72.3 57 47.1

Buffalo, NY 21 61.6 55 50.3 8 77.9

Honolulu, HI 22 61.3 25 62.3 38 59.9

San Diego, CA 23 61.2 20 64.6 42 56.3

Santa Ana, CA 24 61.0 7 74.5 75 41.6

Tampa, FL 25 60.3 33 58.8 34 62.6

Fremont, CA 26 60.3 13 69.8 58 46.5

Austin, TX 27 59.5 14 68.0 56 47.2

Sacramento, CA 28 58.4 49 53.4 31 65.5

Plano, TX 29 58.3 29 61.0 44 54.5

Spokane, WA 30 58.2 56 49.9 20 70.1

Anaheim, CA 31 57.8 10 72.5 88 36.7

Milwaukee, WI 32 57.8 67 45.0 11 76.4

Albuquerque, NM 33 57.8 50 52.3 28 65.8

Raleigh, NC 34 57.8 24 63.0 50 50.3

6 Volume 8 • Number 1 • Winter 2023 ACSM American Fitness Index

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 TABLE 3.
(Continued)

Total Personal Health Community/Environment

Cities Rank Score Rank Score Rank Score

Tucson, AZ 35 57.7 37 56.9 41 59.0

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Richmond, VA 36 57.7 57 49.7 21 69.2

Durham, NC 37 57.0 16 66.9 69 42.7

Pittsburgh, PA 38 56.7 72 41.3 5 78.9

St. Petersburg, FL 39 56.0 63 46.1 19 70.2

Miami, FL 40 55.0 58 49.6 33 62.9

Long Beach, CA 41 55.0 44 54.1 43 56.3

Glendale, AZ 42 54.8 41 55.9 46 53.2

Virginia Beach, VA 43 54.7 35 58.3 52 49.6

Omaha, NE 44 54.5 62 46.2 26 66.5

Newark, NJ 45 54.1 54 50.4 40 59.4

New Orleans, LA 46 53.7 65 45.4 30 65.6

Norfolk, VA 47 53.5 74 39.1 14 74.3

Chula Vista, CA 48 53.5 28 61.6 74 41.7

Colorado Springs, CO 49 52.9 30 60.7 72 41.8

Reno, NV 50 52.9 32 58.8 64 44.3

Orlando, FL 51 52.4 60 47.3 39 59.7

Los Angeles, CA 52 52.0 40 56.3 61 45.7

Winston-Salem, NC 53 51.7 34 58.6 73 41.8

Charlotte, NC 54 51.6 23 63.1 92 35.1

Cleveland, OH 55 51.1 81 33.0 9 77.3

Anchorage, AK 56 51.0 38 56.5 67 43.2

Dallas, TX 57 50.1 51 51.9 55 47.6

Chandler, AZ 58 49.3 47 53.8 68 42.8

Hialeah, FL 59 49.2 61 46.6 47 53.1

Scottsdale, AZ 60 49.2 42 55.9 81 39.6

Houston, TX 61 48.7 39 56.4 85 37.5

Philadelphia, PA 62 48.5 88 28.0 7 78.0

Nashville, TN 63 48.0 46 53.9 82 39.5

Stockton, CA 64 48.0 53 51.8 70 42.5

Mesa, AZ 65 47.9 43 55.2 86 37.2

Phoenix, AZ 66 47.4 45 54.1 84 37.7

Baltimore, MD 67 46.8 91 27.4 13 74.7

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 TABLE 3.
(Continued)

Total Personal Health Community/Environment

Cities Rank Score Rank Score Rank Score

Cincinnati, OH 68 45.7 90 27.6 16 71.8

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San Antonio, TX 69 45.1 52 51.9 91 35.2

St. Louis, MO 70 44.2 96 23.9 15 73.4

Jacksonville, FL 71 43.6 73 40.6 54 48.1

Greensboro, NC 72 43.2 71 41.8 62 45.1

Gilbert, AZ 73 42.5 48 53.5 98 26.7

Garland, TX 74 42.4 59 47.4 90 35.2

Fort Wayne, IN 75 42.1 64 45.5 87 37.2

Columbus, OH 76 41.3 80 33.7 48 52.1

El Paso, TX 77 41.1 75 38.7 63 44.5

Fresno, CA 78 39.9 66 45.2 94 32.2

Laredo, TX 79 39.1 79 34.4 60 45.8

Irving, TX 80 38.5 76 38.5 83 38.6

Corpus Christi, TX 81 38.3 85 30.3 51 49.7

Fort Worth, TX 82 38.0 68 44.2 96 29.0

Arlington, TX 83.5 37.8 69 44.2 97 28.7

Toledo, OH 83.5 37.8 98 21.3 35 61.6

Bakersfield, CA 85 37.3 70 42.7 95 29.5

Lubbock, TX 86 37.1 78 34.6 77 40.8

Chesapeake, VA 87 37.0 77 34.6 79 40.6

Kansas City, MO 88 36.4 87 28.1 53 48.4

Wichita, KS 89 35.8 83 31.5 71 42.0

Riverside, CA 90 35.5 82 32.4 80 39.9

Detroit, MI 91 35.2 95 24.6 49 50.5

Lexington, KY 92 34.4 86 29.6 76 41.2

Henderson, NV 93 34.3 92 26.0 59 46.3

Memphis, TN 94 33.0 84 30.7 89 36.4

Las Vegas, NV 95 32.9 93 25.4 65 43.6

Louisville, KY 96 30.5 97 21.7 66 43.2

Indianapolis, IN 97 29.7 89 27.8 93 32.5

Tulsa, OK 98 26.9 100 17.4 78 40.7

North Las Vegas, NV 99 25.9 94 25.3 99 26.6

Oklahoma City, OK 100 20.1 99 19.8 100 20.5

8 Volume 8 • Number 1 • Winter 2023 ACSM American Fitness Index

Copyright © 2023 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 to improve the health and fitness of their residents, a large pro- Some data limitations for the Fitness Index include sample var-
portion of the US population could benefit. The data sources iability from year to year and could seem to be a slight change in a
used for the Fitness Index are publicly available from reliable city’s scores and ranking. Much of the data used in the Fitness In-
sources that have been updated regularly. As such, officials of dex are responses to surveys that have well-known biases and
cities not included in the Fitness Index are able to collect indica- variability. Also, the lack of important community asset data
tor data for their city using similar approaches to identify op- available for all 100 cities, such as the number of miles of multi-
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portunities to provide support for physical activity and health purpose trails per capita, is another limitation. Including these in-
among their residents. Furthermore, because the Fitness Index dicators would add value to the Fitness Index. Finally, using
report identifies cities with the best values for each indicator, city-level data limits inferences to subcity geographical areas, such
these cities can serve as models that other cities could emulate. as neighborhoods or townships, for comparisons.
A challenge for the selection of personal health and commu-
nity asset indicators for the Fitness Index was choosing indica- Dissemination and Use
tors that can reasonably be changed in a timely fashion through The Fitness Index project places pertinent and important in-
personal and city-level action. For example, including indicators formation at the fingertips of city officials to support policies
that may be difficult to change (e.g., availability of land space in that can directly impact the health and fitness of the residents.
a city to create new parks) may make it more difficult for a city As such, the Fitness Index uses a robust dissemination plan to
to improve that indicator from one year to the next. reach targeted audiences. Strategies were tailored to reach di-
A majority of personal health indicators and outcomes do verse audiences and to leverage multiple forms of communica-
not change rapidly, and there may be a significant time lag tion as shown in Table 4. The ultimate goal of the dissemination
for the impact of new initiatives to be seen in some of the health plan is to provide public health professionals, community-based
indicators (25). Improvements in community asset indicators organizations, and residents involved in local advocacy efforts
are important long-term investments; consequently, notable with the data needed to engage city officials in data-driven
improvements in the health of residents are expected to slowly policy decisions. For example, advocates can cite per-capita
but surely follow (26). funding of city parks and recreation departments for their cit-
Because private recreational spaces are not counted in the ies and how access to parks and similar assets directly affect
national database, the actual availability of community assets residents’ ability to be physically active and improve their
may be underestimated in the data report; only those managed mental health. Research shows that investment in public
by the city’s parks and recreation department are counted. For parks results in an increase in physical activity (22). In addi-
example, privately owned and commercial facilities, such as tion, it is important for cities to support the development of
health clubs, YMCAs, and gyms that require paid memberships, infrastructure that promotes walking and bicycling, in addi-
as well as recreational facilities integrated into neighborhoods tion to parks and recreational facilities (27,28). This includes
supported by homeowners’ association fees, are not included. having places to walk within a close proximity to home like

TABLE 4.
Dissemination Strategies for the Fitness Index.

Strategy Target Audience Media Type*

Direct email campaigns ACSM members and certified professionals, city officials (e.g., Owned, paid
mayors; councilors; departments of public health, transportation,
parks and recreation), newsletter subscribers

News releases and media advisories Journalists (broadcast, print, online, radio) Earned

Social media: ACSM members and certified professionals, city officials, Earned, owned, paid
community-based organizations, public

Facebook, Instagram, LinkedIn,

Pinterest, Twitter

Traditional media: City officials, public Earned

Broadcast (radio, television), print

(newspapers, magazines)

Web sites: ACSM members and certified professionals, city officials, Owned
community-based organizations, journalists, public

Blog, city comparison tool,

infographic, summary report
*Media types: owned, exposure achieved via platforms owned and controlled by an organization; paid, exposure achieved by purchasing access to target
audiences; earned, exposure achieved based solely on the merit of the content.

http://www.acsm-tj.org Translational Journal of the ACSM 9

Copyright © 2023 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 parks and recreational facilities, walking and bicycling trails, Services; 2022 [cited 2022 Sep 5]. Available from: https://www.cdc.gov/brfss/
index.html.
and other free and low-cost places for physical activity (18,
4. United States Census Bureau. American Community Survey [Internet].
29). Adoption and enforcement of Complete Streets policies Washington (DC): U.S. Department of Commerce; 2022 [cited 2022 Sep 5].
to provide connected sidewalks and protected bicycle lanes Available from: https://www.census.gov/programs-surveys/acs/.
in addition to driving lanes not only enables residents to com- 5. University of Wisconsin Population Health Institute. County Health Rankings &
mute or recreate safely on foot or nonmotorized devices, but Roadmap [Internet]. Madison (WI): University of Wisconsin Population Health
Institute; 2022 [cited 2022 Sep 5]. Available from: https://www.
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also results in more ecologically friendly transportation (30). countyhealthrankings.org/.

The Fitness Index is a significant resource for researchers 6. Greenlund KJ, Lu H, Wang Y, et al. PLACES: local data for better health. Prev
interested in studying associations between personal health Chronic Dis. 2022;19:E31.
indicators and community support for physical activity and 7. Trust for Public Land. Parkserve Data Downloads [Internet]. Los Angeles: Trust
policy decisions affecting overall population health. For ex- for Public Land; 2022 [cited 2022 Sept 5]. Available from: https://www.tpl.org/
parkserve/downloads.
ample, it may be used to answer the question, “Does a con-
nection exist between a city’s walkability, Complete Streets 8. Walk Score. Cities & Neighborhoods [Internet]. Seattle: Redfin; 2022 [cited
2022 Sep 5]. Available from: https://www.walkscore.com/cities-and-
policies, number of pedestrian fatalities per 100,000 resi- neighborhoods/.
dents, and other health outcomes?” Data are also available 9. Castrucci BC, Rhoades EK, Leider JP, et al. What gets measured gets done:
for multiple years, allowing for longitudinal analyses. Social an assessment of local data uses and needs in large urban health depart-
and behavioral scientists might use the Fitness Index to com- ments. J Public Health Manag Pract. 2015;21(Suppl 1):S38–48.

pare changing behaviors within the culture of a targeted city 10. National Committee on Vital and Health Statistics. Measuring Health at the
Community Level: Data Gaps and Opportunities. A Workshop Summary and
or make comparisons between geographically different cities Project Overview [Internet]. Washington (DC): U.S. Department of Health and
(e.g., northeast versus southwest or east coast versus west Human Services; 2017 [cited 2022 Sep 5]. Available from: https://www.
coast cities). Political scientists might also find it interesting ncvhs.hhs.gov/wp-content/uploads/2017/04/Measuring-Health-at-the-
Community-Level-Data-Gaps-and-Opportunities.pdf.
to determine if a certain political climate attracts more (or
11. Office of Sustainable Communities. Smart Growth and Economic Success:
less) fit people. Benefits for Real Estate Developers, Investors, Business, and Local Govern-
ments [Internet]. Washington (DC): U.S. Environmental Protection Agency;
2012 [cited 2022 Sep 5]. Available from: https://www.epa.gov/sites/default/
Conclusion files/documents/smart_growth_and_economic_success.pdf.
The Fitness Index provides a resource for city officials, pub- 12. Armstrong R, Waters E, Moore L, et al. Understanding evidence: a statewide
lic health professionals, and community-based organizations survey to explore evidence-informed public health decision-making in a local
to examine how their city can support physical activity and government setting. Implement Sci. 2014;9:188.
health for residents. The Fitness Index not only provides a 13. U.S. Census Bureau. Arlington CDP, Virginia [Internet]. Washington (DC): U.S.
Department of Commerce; 2020 [cited 2022 Sep 5]. Available from: https://
more comprehensive assessment of a city’s fitness but also data.census.gov/cedsci/profile?g=1600000US5103000.
helps identify a variety of opportunities for city officials to fo- 14. American College of Sports Medicine. ACSM American Fitness Index Rank-
cus efforts on improving specific indicators that are included in ings [Internet]. Indianapolis: American College of Sports Medicine; 2022 [cited
the Index. Individual behavior efforts to become more fit 2022 Sep 5]. Available from: https://americanfitnessindex.org/rankings/.
would be difficult if community support for physically active 15. Short SE, Mollborn S. Social determinants and health behaviors: conceptual
lifestyles was not in place. City officials can use the Fitness In- frames and empirical advances. Curr Opin Psychol. 2015;5:78–84.

dex rankings and data to identify areas of excellence of peer 16. Sallis JF, Spoon C, Cavill N, et al. Co-benefits of designing communities for
active living: an exploration of literature. Int J Behav Nutr Phys Act. 2015;12:30.
cities that can provide model programs and policies. The data
17. Institute of Medicine. Educating the Student Body: Taking Physical Activity
can also help prompt city officials to evaluate streets for safe and Physical Education to School. Kohl HW III, Cook HD, editors.
walking and bicycling, to identify opportunities for improving Washington (DC): The National Academies Press; 2013. 502 p.
access to parks and park amenities within neighborhoods, 18. Sallis JF, Cerin E, Conway TL, et al. Physical activity in relation to urban envi-
and to pass policies that ensure adequate funding for these ronments in 14 cities worldwide: a cross-sectional study. Lancet. 2016;387
(10034):2207–17.
community assets.
19. World Health Organization Regional Office for Europe. Toward More Physical
Activity in Cities: Transforming Public Spaces to Promote Physical Activity—A
The authors would like to acknowledge all the Advisory Board Key Contributor to Achieving the Sustainable Development Goals in Europe
members who have contributed to the ACSM American Fitness Index. [Internet]. Geneva: World Health Organization; 2017 [cited 2022 Dec 5]. Avail-
T.W.Z. and J.M.C. received payments to collect and analyze able from: https://www.euro.who.int/__data/assets/pdf_file/0018/353043/
2017_WHO_Report_FINAL_WEB.pdf.
data for the American Fitness Index under contract from ACSM.
G.S.P. and L.L.C. were full-time employees of ACSM during the pe- 20. Lopez RP, Hynes HP. Obesity, physical activity, and the urban environment:
public health research needs. Environ Health. 2006;5:25.
riod of this study. The other authors report no conflicts of interest.
Funding for the Fitness Index was provided by the Elevance Health 21. Cohen DA, Leuschner KJ. How can neighborhood parks be used to increase
physical activity? Rand Health Q. 2019;8(3):4.
Foundation and ACSM.
22. Cohen DA, McKenzie TL, Sehgal A, et al. Contribution of public parks to phys-
ical activity. Am J Public Health. 2007;97(3):509–14.
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10 Volume 8 • Number 1 • Winter 2023 ACSM American Fitness Index

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Copyright © 2023 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.