People in the nation's fittest cities are more likely to take brisk walks or routinely hit the gym. They also have lower rates of obesity and chronic disease.
People exercise on a bridge in Arlington, Va., with a view of Washington, D.C. skyline. Arlington and Washington are No. 1 and No. 2 in a new ranking of the nation's fittest cities.
But cities that cultivate a healthy community play an equally important role. Cities that consistently rank among the nation's fittest on the ACSM American Fitness Index promote physical activity with parks, trails, access to public transportation and strong environmental marks.
But even among the healthiest cities, food insecurity is a growing concern, according to the report.
The annual fitness index, published July 14 by American College of Sports Medicine and Elevance Health Foundation, ranks the nation's 100 most populous cities on personal health and community/environmental health indicators.
Arlington, Virginia, ranked as the nation's fittest city for the ninth year in a row. Washington, D.C., checked in at No. 2, followed by Minneapolis, Seattle and Denver.
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Oklahoma City ranked at the bottom of the list. Memphis, Tennessee, Port St. Lucie, Florida, Indianapolis, and Lubbock, Texas, rounded out the bottom five on the ranking.
Stella Volpe, who chairs the ACSM fitness index advisory board, said the report revealed a growing gap between the healthiest and least healthy cities.
Residents of high-scoring cities had lower obesity and chronic disease rates, higher physical activity and better access to walking and biking trails, public parks and public transportation. The opposite is true in communities that score poorly, Volpe said.
"If we have greater access to parks and playgrounds, where we can maybe do pull-ups outside, or greater walkability in our cities, those things will resonate," Volpe said. "But if your city is one where there are barriers to get to those places, it's not going to resonate."
Food insecurity worsens in all but one city
Every major city except Santa Ana, California, reported worsening rates of food insecurity. On average, food insecurity rates climbed 1.5 percentage points, increasing from 12.9% in 2025 to 14.4% in 2026.
Rising grocery prices make it difficult for a larger share of Americans to pay for healthy food. And changes under President Donald Trump's signature 2025 tax cut and spending bill also changed food assistance eligibility for low-income families.
The 2025 bill reduced funding for the Supplemental Nutrition Assistance Program, formerly known as Food Stamps, which provides food aid for millions of families. The federally funded, state-administered program also has imposed stricter work requirements for recipients.
"Households who qualify for SNAP have very little income that is stretched to pay rent and childcare and to put gas in the car," said Stacy Dean, executive director of the Global Food Institute at George Washington University. "SNAP was bringing groceries through the door. I'm deeply concerned about what's happening to families as they juggle one more very difficult challenge in their lives."
Air quality vs. outdoor activity
The index also ranked cities by percentage of good air quality days and asthma rates. While about 1 in 10 adults in the 100 largest cities had asthma, rates varied threefold in communities. Greensboro, North Carolina, has the highest asthma rate at 15.4%, according to the index.
People with asthma and other respiratory conditions might struggle to stay fit in cities with poorer air quality. Air pollutants can disrupt breathing and trigger asthma symptoms when people try to exercise outdoors.
Older adults with asthma often are less active than their peers, but the report noted the importance of being active to improve overall health and quality of life. People with asthma who stay active are less likely to be hospitalized, miss school or need a medical visit to manage symptoms, the index said.
The report suggested everyone, including those with asthma, might consider checking air quality index to adjust exercise or other activity schedules. Some people might want to exercise early in the morning or in the evening when pollution levels are lower. Others might find it safer to walk or work out indoors.
Cities with the biggest gains
Richmond, Virginia, made the biggest gain in the ranking, moving up 20 spots to rank as the nation's 20th-fittest city. Other cities that made large gains included Charlotte, North Carolina, up 19 spots to No. 42; Virginia Beach, up 18 spots to No. 61; and Durham, North Carolina, up 17 spots to No. 49.
Volpe said the annual ranking is meant to celebrate cities that score well — but also encourage lower-ranking cities to make small changes to improve community activity levels.
"Exercise is medicine," Volpe said. "Physical activity really can decrease our risk of chronic disease, and any movement is better than none."
