Indianapolis — The gap between America’s healthiest and least healthy cities is growing wider, according to findings from the 2026 ACSM American Fitness Index® (Fitness Index), released today by the American College of Sports Medicine® (ACSM) and the Elevance Health Foundation
The 19th annual report reveals that the nation’s fittest cities consistently combine lower obesity and chronic disease rates with higher physical activity, stronger active transportation, and broad access to parks and recreation infrastructure. Lower-ranked cities continue to struggle with higher obesity, lower activity levels, food insecurity and fewer opportunities to integrate movement into daily life
The result is two types of cities — one where healthy choices are built into everyday life, and another where structural barriers continue to limit long-term health
“Where you live increasingly determines how healthy you are,” said Stella Volpe, PhD, FACSM, ACSM-CEP, past president of ACSM and chair of the Fitness Index Advisory Board. “The healthiest cities don’t just encourage exercise — they make movement part of daily life through infrastructure, transportation and community design.”
The Fitness Index evaluates the 100 largest U.S. cities using 35 evidence-based indicators across personal health, community infrastructure and environmental conditions.
Key Findings from the 2026 Fitness Index
Among the clearest divides identified in the data:
- Top-ranked cities report significantly lower obesity rates than lower-ranked cities — often by more than 10 percentage points.
- Residents in top-performing cities are substantially more likely to meet recommended physical activity guidelines.
- Cities ranking highest in the Fitness Index have significantly higher Bike and Walk Scores and more trail miles, as well as increasingly greater rates of biking, walking, and public transit use.
- While park access is now high across many cities, only higher-ranked cities appear to successfully convert access into healthier outcomes.
- Lower-ranked cities continue to show clustering of chronic disease indicators, including obesity, diabetes and cardiovascular disease.
“The Fitness Index provides us more than just a ranking of cities; it gives communities the data they need to identify where gaps exist and which indicators have the greatest impact on long-term health,” said Shantanu Agrawal, MD, Chief Health Officer at Elevance Health. “Our longstanding support of the Fitness Index and the insights it provides for communities reflects our commitment to bettering whole health nationwide.”
Arlington Remains No. 1 for Ninth Consecutive Year
For the ninth consecutive year, Arlington, Virginia ranked as America’s fittest city
The top 10 cities in the 2026 Fitness Index are:
- Arlington, VA
- Washington, D.C.
- Minneapolis, MN
- Seattle, WA
- Denver, CO
- San Francisco, CA
- Irvine, CA
- Atlanta, GA
- Madison, WI
- Boston, MA
These cities share common traits:
- strong active transportation systems
- high physical activity rates
- broad access to parks and recreation
- and policies that support active lifestyles.
“The cities that consistently rank at the top aren’t succeeding because of one program or one investment,” Volpe said. “They’ve built systems that support healthier living over time. They are the ones creating environments where physical activity can easily become a part of everyday routines.”
Food Insecurity and Air Quality Pose Key Health Concerns
The 2026 Fitness Index also identified worsening trends in food insecurity and continued disparities in environmental conditions
For the second consecutive year, food insecurity increased nationwide, with 99 of the 100 largest cities reporting higher rates than the previous year. The national average is now above 14% of residents living with food insecurity
Air quality also varied dramatically across communities. On average, cities experienced good air quality approximately 51% of days annually, with eight cities reporting 10% or fewer days with good air quality. Because nearly 28 million Americans live with asthma, air quality continues to play an increasingly important role in outdoor physical activity and o
Movers and New Cities
Largest gains in the Fitness Index rankings were:
- Richmond, VA – up 20 spots from #40 to #20
- Charlotte, NC – up 19 spots from #61 to #42
- Virginia Beach, VA – up 18 spots from #79 to #61
- Durham, NC – up 17spots from #66 to #49
Moving down in the rankings were:
- Orlando, FL – down 19 spots from #45 to #65
- Laredo, TX – down 18 spots from #70 to #88
- Jacksonville, FL – down 16 spots from #68 to #84
Based on updated annual census data, three cities – Cape Coral, FL (#62), Hialeah, FL (#67) and Frisco, TX (#32) – were added to the 2026 Fitness Index, replacing Fremont, CA; Norfolk, VA; and Spokane, WA
Full rankings, city comparison tools and additional reowing us on X: @ACSMNews #100FitCities
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, 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.
Learn more at www.acsm.org.
About Elevance Health Foundation
Elevance Health Foundation is the philanthropic arm of Elevance Health, Inc. The Foundation works to advance health equity by focusing on improving the health of the socially vulnerable through partnerships and programs in our communities with an emphasis on maternal child health; substance use disorder; 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
