When measuring the nation’s collective fitness, the good news is Americans are more likely to take a brisk walk, play pickleball or lift weights.

But this year’s ACSM American Fitness Index ranking of the nation’s fittest cities, published July 22, also found some worrisome trends. Air quality deteriorated and more people struggled to afford healthy, nutritious food.

The annual report, published by the American College of Sports Medicine and Elevance Health Foundation, ranks the nation’s 100 most populous cities on personal and community health indicators. This year’s report evaluated 35 indicators, including new categories like measuring trail miles, splash pads and tennis and pickleball courts.

Arlington, Virginia, ranked as the nation’s fittest place for the eighth consecutive year. Washington, D.C., located across the Potomac River from Arlington, ranked second. Seattle, San Francisco and Denver rounded out the top five fittest cities.

The report ranked Oklahoma City at the bottom of the list. Lubbock, Texas; North Las Vegas; Memphis and Wichita were among the bottom five ranked cities.

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People can view the report to see how their community fared on indicators such as public green spaces, access to parks, recreational areas, basketball hoops and bike lanes. The report also grades personal health measures such as obesity rates, fruit and vegetable consumption, mental health, sleep and smoking rates.

American College of Sports Medicine President Stella Volpe said the report is an opportunity for cities that don’t rank well to study what higher-ranking peers do to give their residents a chance at improved health.

“We hope cities that don’t fare as well may still be able to make some changes that help their citizens,” Volpe said. “Let’s just try to make our citizens as healthy as they can possibly be.”

Americans improved aerobic and strength

The report said the nation overall did a better job of meeting aerobic thresholds.

The report cited Centers for Disease Control and Prevention guidance that recommends people get at least 150 minutes of moderate-intensity aerobic activity such as walking fast, riding a bike or mowing the lawn every week. People also should do muscle-strengthening exercises such as lifting weights or doing push-ups twice a week.

The 2025 report said 59.9% of Americans walked, biked, ran or otherwise met or exceeded the minimum aerobic activity recommendations − an increase of 9 percentage points from last year. Nationwide, 94 of the 100 largest U.S. cities had improved aerobic activity.

The report said 89 of 100 cities improved on a separate category that gauges both aerobic and strength activity.

The report also cited decreased smoking rates and more funding for parks as contributors to big cities’ overall health.

All but this remote city had rising food insecurity

The report highlighted the troubling trend of rising food insecurity as inflation sent grocery prices higher and COVID-19-era programs that helped financially strapped Americans ended.

The percentage of people who reported food insecurity in 2025 increased to 12.9%, up from 10.4% the year before. Food insecurity is when people don’t have or don’t think they can get nutritionally adequate and safe foods.

Anchorage, Alaska, was the only top-100 city that didn’t have a higher rate of food insecurity.

“That increase in food insecurity is something to be very concerned about,” Volpe said.

End of COVID-19 aid, GOP tax cut law could worsen food insecurity

The ACSM report said the rise of food insecurity might be due to the expiration of the expanded child tax credit and other food security programs during the COVID-19 pandemic.

Cindy Jordan, CEO and founder of Pyx Health, said many lower-income households have struggled to afford routine, healthy meals after they lost health insurance coverage.

Pyx Health contracts with health insurance companies to arrange food, transportation and other services mainly to people on Medicare and Medicaid, the government health programs for people who are older, low-income and disabled.

During the COVID-19 pandemic, states suspended routine eligibility checks for Medicaid to ensure low-income families access to health care wasn’t disrupted during the health crisis. The Biden administration resumed those eligibility checks nearly two years ago. As of 2024, nearly 1 in 4 Medicaid recipients who disenrolled when states resumed eligibility checks remained uninsured, according to a KFF survey.

More families could face food insecurity under President Donald Trump’s tax cut and spending law. As many as 22.2 million Americans could lose some or all of their Supplemental Nutrition Assistance Program benefits under the tax cut law, according to an Urban Institute analysis.

Jordan, who was not involved in the ACSM report, said eliminating food assistance could worsen the nation’s chronic heath epidemic. People will skip preventive care until they end up in a hospital emergency room.

“If you don’t eat healthy food, the cost to the health system is dramatic,” Jordan said. “That’s exactly what we want to avoid.”

Canadian wildfires, air quality and mental health

The nation’s air quality also worsened over the last year.

ACSM’s 2024 report said residents of the nation’s largest cities could count on good air quality nearly 2 out of every 3 days. Fewer than half of the days were clear over the past year, ACSM’s 2025 report said.

Smoke from wildfires across several Canadian provinces traveled south and worsened air quality for millions of people in the Northeast and Great Lakes regions over the past year, the report said.

Poor air quality can trigger coughing, wheezing and asthma and contribute to heart and lung disease, according to the Environmental Protection Agency.

The combination of poor air quality and rising food insecurity could have contributed to a 2% drop in the share of people who described themselves to be in excellent or very good health.

The report also tracked the percentage of people who described poor mental health in the past month. About 44.9% of people said they recently had poor mental health, barely changed from last year’s figure of 44.7%.

Volpe said poor mental health may slow physical activity, a risk factor for other chronic disease.

“We know that physical activity improves mental health,” Volpe said.