Frequently Asked Questions

You have questions and we have answers. If you don’t find the answers to your questions here, contact us via email at afi@acsm.org.

What is the ACSM American Fitness Index® (Fitness Index)?

The ACSM American Fitness Index was created, in partnership with the Anthem Foundation, to help improve the health of the nation and promote active lifestyles by supporting local policies and programs to develop a sustainable, healthy community culture.

The Fitness Index features an annual ranking that assigns a score to the 50 most populous metropolitan areas in the United States. The Fitness Index rankings reflect a composite of preventive health behaviors, levels of chronic disease conditions, as well as community resources and policies that support physical activity. The intent of the rankings are to provide a valid and reliable measure of the health and community fitness at the metropolitan level in the United States.

In addition to the rankings, the Fitness Index provides valuable resources that can help communities focus their policy and programming efforts as well as assist them in developing collaborative activities and partnerships with other organizations that contribute to health promotion.

Using the Fitness Index rankings, communities will be able to identify opportunities to improve the health status of their residents. Additionally, as communities implement targeted programs to improve health status and environmental resources, they will be able to measure their progress using the Fitness Index in future years.

 

What makes the Fitness Index unique?

The Fitness Index starts with research and understanding the scope of the problem. A better understanding of the prevalence rates for physical activity, obesity, and chronic disease related to physical inactivity as well as communities’ built environment and resources is the first step toward developing programs, initiatives, and policies to increase physical activity and reduce chronic diseases.

Moreover, moving a community toward increasing physical activity and improving community fitness involves an understanding of the individual and societal behaviors and social norms related to physical activity. The key fundamentals for improving physical activity behaviors involve increasing awareness and motivation at the personal level, providing a built environment and resources that encourage physical activity, as well as setting policies to better enable individuals and communities to engage in physical activity as part of a healthier lifestyle.

Other things that make the Fitness Index unique:

  • Cities, communities and metropolitan areas are defined by Metropolitan Statistical Areas (MSA) of the U.S. Census Bureau. Defining a “city” by its city limits overlooks the interaction between the core of the city and the surrounding suburban areas.
  • Personal health status indicators, as well as community and environmental indicators, are included in the Fitness Index rankings;
  • Data from reputable sources and scientific methodology were used to develop the Fitness Index rankings to increase its validity and reliability;
  • To help guide community action, areas of excellence for each metro are shown, along with improvement priority areas (where the rating is worse than 20% of the target goal);
  • ACSM will provide technical assistance to metro areas to initiate locally driven health improvement efforts.

The data included in the rankings must meet the following criteria to be included:

  • Related to the level of health status and/or physical activity environment
  • Measured recently and reported by a reputable agency or organization
  • Available to the public
  • Measured routinely and provided in a timely fashion
  • Modifiable through community effort

 

What indicators are included in the Fitness Index rankings and why?

A panel of 26 health and physical activity experts scored potential indicator for relevance and inclusion in the Fitness Index rankings. Two Delphi Method-type rounds of scoring were used to reach consensus on whether each indicator should be in the analysis and, if so, the weight it should carry. The following indicators are included in the current ACSM American Fitness Index rankings.

Personal Health Indicators:

  • Percent any physical activity or exercise in the last 30 days – Regular exercise is important for optimal health and fitness.
  • Percent meeting CDC aerobic activity guidelines – ACSM recommends that all healthy adults ages 18 to 65 years need moderate-intensity aerobic physical activity for at least 30 minutes on five days each week or vigorous-intensity aerobic physical activity for at least 20 minutes on three days each week
  • Percent meeting both CDC aerobic and strength activity guidelines – ACSM recommends that all healthy adults ages 18 to 65 years need moderate-intensity aerobic physical activity for at least 30 minutes on five days each week or vigorous-intensity aerobic physical activity for at least 20 minutes on three days each week
  • Percent eating 2+ fruits per day – The CDC recommends a daily intake of 2 or more fruits for optimal health and fitness.
  • Percent eating 3+ vegetables per day – The CDC recommends a daily intake of 3 or more vegetables for optimal health and fitness.
  • Percent who get 7+ hours of sleep per day – Individuals not getting enough sleep are at risk for diabetes, cardiovascular disease, stroke, obesity, and depression.
  • Percent currently smoking – Smoking is harmful to one’s health and can lead to a variety of diseases including cardiovascular disease.
  • Percent obese – Obesity is a precursor to as asthma, diabetes and cardiovascular disease.
  • Percent in excellent or very good health – Individuals answering yes to this criteria are more likely to exercise regularly and eat healthier foods.
  • Any days when physical health, was not good during the past 30 days – Individuals answering yes to this criteria are less likely to exercise regularly.
  • Any days when mental health, was not good during the past 30 days – Individuals answering yes to this criteria are less likely to exercise regularly and eat healthier foods.
  • Percent with asthma – Individuals with asthma are at risk for obesity.
  • Percent with high blood pressure- Individuals with high blood pressure are at risk for heart disease and stroke.
  • Percent with angina or coronary heart disease – Individuals with angina or coronary heart disease are at risk for obesity.
  • Percent diagnosed with a stroke – Individuals diagnosed with a stroke are at risk for long-term disability or death.
  • Percent with diabetes – Individuals with diabetes are at risk for obesity.
  • Death rate/100,000 for cardiovascular (CV) disease – Provides an estimate of how this disease impacts a community. The second measure of CV disease helps reinforce the “percent with angina or coronary heart disease” figure.
  • Death rate/100,000 for diabetes – Provides an estimate of how this disease impacts a community. The second measure of diabetes helps reinforce the “percent with diabetes” figure.

 Community/Environmental Indicators

  • Parkland as a percent of city land area – Indication there is a safe and affordable place for the community to be physically active.
  • Acres of parkland/1,000 – A measure of safe and affordable places to be physically active.
  • Farmers’ markets/1,000,000- Assumes individuals have access to the freshest fruits and vegetables with the most vitamins and nutrients.
  • Percent using public transportation to work- Individuals have to walk to and from stops and stations.
  • Percent bicycling or walking to work- Indicates an individual gets exercise through active transportation.
  • Walk Score®- Directly relates to the availability of safe, convenient and affordable places for residents to be physically active.
  • Percent within a 10 minute walk to a park- Access to safe and affordable places to be physically active.
  • Ball diamonds/10,000- Access to safe places to be physically active.
  • Dog parks/10,000- Assumes dog owners walk with their dogs.
  • Park playgrounds/10,000- Access to safe places to be physically active.
  • Basketball hoops/10,000- Access to safe places to be physically active.
  • Park units/10,000- Access to safe places to be physically active. More small parks indicate these areas are available to the local community.
  • Recreation centers/20,000- Access to safe places to be physically active.
  • Swimming pools/100,000- Access to safe places to be physically active.
  • Tennis courts/10,000- Access to safe places to be physically active.
  • Park-related Expenditures per Capita – Indicates a community is providing and maintaining safe and affordable place to be physically active.
  • Level of State Requirement for PE classes – This is a reflection on the community’s public policy towards the promotion of physical activity.

 

From what sources were the data derived?

Publicly available data sources from federal reports and past studies provide the information used in the Fitness Index rankings analysis. The largest data source for the personal health indicators is the Behavioral Risk Factor Surveillance System (BRFSS) provided by the U.S. Centers for Disease Control and Prevention (CDC). The Trust for Public Land provides the majority of the community/environmental indicators. The U.S. Census American Community Survey is the source for most of the demographic descriptions. Additional data sources include: Walk Score®, U.S. Department of Agriculture; State Report Cards (School Health Policies and Programs Study by the CDC); and the Federal Bureau of Investigation’s (FBI) Uniform Crime Reporting Program.

 

Why use Metropolitan Statistical Areas (MSAs)?

Defining a “city” by its city limits overlooks the interaction between the core of the city and the surrounding suburban areas.  Residents outside the city limits have access to fitness-related resources in their suburban area as well as the city core; likewise, the residents within the city limits may access resources in the surrounding areas. Thus, the metropolitan area, including both the city core and the surrounding suburban areas, act as a unit to support the wellness efforts of residents of the area. In this report, the terms metropolitan area, community and city are synonymous.

 

Why is my community not included in the Fitness Index?

ACSM recognizes that numerous other U.S. cities and their surrounding communities are taking great steps toward improving their community health. All cities can use the resources provided by Fitness Index to improve their community’s health and fitness. Additionally, the Fitness Index has been designed so that any community, regardless of size, could locate the publicly available indicators and derive an assessment of their community’s health and fitness.

While the Fitness Index rankings provide detailed information at the metro level, the My AFI Community Application Tool  integrates the components of the Fitness Index into an approach that can be used by other communities not included in the rankings. Using this tool, leaders can understand the individual, societal and behavioral factors related to physical activity in their own community and implement culturally focused activities that are meaningful to their residents.

 

Is the Fitness Index a competition?

No, the ranking merely points out that relative to each other, some metro areas scored better on the indicators than the other. While ACSM recognizes that there will be a natural tendency to view comparisons as a competition, the Fitness Index rankings were created for communities to assess their level of health and fitness, assess areas that could use improvement, and to increase their scores over time.

It is important to consider both the Fitness Index score and rank for each city. While the ranking lists the metros from highest score to lowest, the scores for many cities are very similar, indicating that there is relatively little difference between them. While one metro area carried a rank of “1” and another carried a rank of “50,” this does not necessarily mean that the highest city has excellent values across all indicators and the lowest ranked city has failed the indicators.

 

Any words of encouragement or optimism for cities at the bottom of the rankings?

Yes, it’s good to remind people that the ranking merely points out that relative to each other, some metro areas scored better on the indicators than the other. The Fitness Index was created for communities to assess their level of health and fitness, assess areas that could use improvement, and to increase their scores over time.

Metros at the bottom of the ranking still have strengths and should be commended for their effort. We hope that the indicators presented in the Fitness Index will provide guidance and help identify opportunities for the individuals in these cities who are striving to improve the health status and environmental support for fitness behaviors. Obviously, other metros have been able to encourage healthier lifestyles and provide a better environment, but their experiences may be very useful to other cities wishing to create programs to evoke a similar response in their residents.

Additionally, the technical assistance program and collective impact efforts across the county are reason for optimism. Increasingly, health care providers and systems, local officials, community leaders and other experts are working together in communities across the U.S. to actively move their communities to better health.

 

What is ACSM?

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world.  More than 50,000 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.