Frequently Asked Questions – ACSM American Fitness Index®

The ACSM American Fitness Index® Data Report is a Scientific Snapshot of the State of Health and Fitness at the Metropolitan Level.

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Q: What is the ACSM American Fitness Index® (AFI)?

The AFI is a program, created in partnership with the Anthem Foundation, to help improve the health of the nation and promote active lifestyles by supporting local programming to develop a sustainable, healthy community culture.

The program features an annual data report that ranks and assigns a score to the 50 most populous metropolitan areas in the United States. The AFI Data Report reflects 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 report is to provide a valid and reliable measure of the health and community fitness at the metropolitan level in the United States.

In addition to a data report, the AFI program provides valuable resources that can help communities focus their programming efforts as well as assist them in developing collaborative activities and partnerships with other organizations that contribute to health promotion.

Using the AFI Data Report, 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 relevant AFI elements in future reports.

 

Q: Why was the AFI program created?

ACSM created the AFI program to help communities identify opportunities to improve the health of their residents and expand community assets to better support active, healthy lifestyles.

The overall goal of the AFI program is to help improve the health of the nation and promote active lifestyles by supporting local programming to develop a sustainable, healthy community culture.

 

Q: What does the AFI Data Report measure?

The AFI Data Report reflects a composite of community indicators for preventive health behaviors, levels of chronic disease conditions, as well as community supports and policies for physical activity. In addition, demographic and economic diversity are included for each metropolitan area to illustrate the unique attributes of each city. A complete breakdown of the data is available in the data report.

 

Q. What makes this study unique? How is this study different?

AFI 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 the communities’ built environment and resources is the first step toward developing programs, initiatives, and policies to increase physical activity and other 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 AFI program 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 AFI Data Report;
  • Data from reputable sources and scientific methodology were used to develop the AFI Data Report to increase its validity and reliability;
  • To help guide community action, areas of excellence for each MSA are shown, along with improvement priority areas (where the rating is worse than 20% of the target goal);
  • ACSM will provide technical assistance to priority metro areas to initiate locally driven health improvement efforts. The metro areas were selected by ACSM and the Anthem Foundation, based on local opportunity and interest.

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

  • Be related to the level of health status and/or physical activity environment for the MSA
  • Be measured recently and reported by a reputable agency or organization
  • Be available to the public
  • Be measured routinely and provided in a timely fashion
  • Be modifiable through community effort (for example, smoking rate is included, climate is not).

 

Q: Why do we need another study to tell us to get more active?

A better understanding of the prevalence rates for physical activity, obesity, and chronic disease related to physical inactivity as well as the communities’ built environment and resources are needed to approach the physical inactivity and obesity epidemic using a public health systems approach.

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.  Researching and understanding the scope of the problem is the first step toward developing programs, initiatives, and policies to increase physical activity, which would ultimately result in a reduction of the prevalence rates of obesity and other chronic diseases.

 

Q: What components does the AFI Data Report measure and why?

A panel of 26 health and physical activity experts scored potential elements for relevance in the AFI Data Report. Two Delphi Method-type rounds of scoring were used to reach consensus on whether each item should be in the data report and, if so, the weight it should carry.

Following are the components that make up the AFI Data Report and why that indicator is included.

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 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 angina or coronary heart disease – Individuals with angina or coronary heart disease are at risk for obesity.
  • 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 MSA land area – Indicates that there is a safe and affordable place for the community to be physically active.
  • Acres of parkland/1,000 – A second 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. Fewer automobiles also make for improved air quality.
  • Percent bicycling or walking to work    – These activities indicate an individual gets regular exercise.
  • 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 places to be physically active.
  • Ball diamonds/10,000 – Access to safe places to be physically active.
  • Dog parks/10,000 – Assumes the owner walks with their dog.
  • Park playgrounds/10,000 – Access to safe places to be physically active.
  • Golf courses/100,000 – 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 more of the 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 that a community is providing a safe and affordable place to be physically active. Community is also keeping these areas well maintained.
  • Level of State Requirement for PE classes – This is a reflection on the community’s public policy towards the promotion of physical activity.

 

Q: From what sources were the data derived?

Publicly available data sources from federal reports and past studies provided the information used in this version of the data report. The largest single data source for the personal health indicators was the Behavioral Risk Factor Surveillance System (BRFSS) provided by the U.S. Center for Disease Control and Prevention. Through a survey, conducted by the Center for City Park Excellence, the Trust for Public Land provided many of the community/environmental indicators, and the U.S. Census American Community Survey was the source for most of the MSA descriptions. Walk Score®, The 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 also provided data used in the MSA description 
and index. In all cases, the most recently available data were used.

 

Q: How were the data elements used in the report decided upon?

The first step in creating the data report for the AFI program involved developing a strategy to gather, analyze and present metro-level population, health, and built environment data. Data were identified, assessed and scored by a national expert panel for inclusion into an index to compare each metro area’s attributes with the U.S. values and with the other large metropolitan areas.

Elements included in the data report must:

  • Be related to the level of health status and/or physical activity for a community;
  • Have recently been measured and reported by a well respected agency or organization at the metropolitan level; and
  • Be modifiable through community effort (for example, “smoking rate” is included, but “climate” is not).

Publicly available data sources from federal reports and past studies provided the information used in this version of the data index. To be incorporated in the development of the data report, the selected data sources must provide recent data and have an established history of appropriately collecting and disseminating the data.

 

Q: How were the “Areas of Excellence” and “Improvement Priority Areas” determined?

The Areas of Excellence and Improvement Priority Areas for each MSA have been listed to assist communities in identifying potential areas where they might focus their efforts using approaches adopted by those cities that have strengths in the same area. This process involved comparing the data index elements of the MSA to a newly developed target goal.

The target goals for the personal health indicators were derived by generating the 90th percentile from the pooled 2008-2012 AFI data. For those new personal health indicators the target goal was 90% of the 2014 values.

The target goals for the community health indicators were derived by calculating the average from the pooled 2008-2012 AFI data. New community indicators target goals were an average from the 2015 values.

Data indicators with values equal to or better than the target goal were considered “Areas of Excellence.” Data indicators with values worse than 20% of the target goal were listed as “Improvement Priority Areas.”

 

Q: A new indicator was added to the 2015 version of the AFI Data Report. What was that indicator? Why was it chosen?

The new indicator was ‘Percent within a 10 minute walk to a park.’ This is a newly available measure that directly relates to the access to safe, convenient and affordable places for residents to be physically active. This measure was added to the community and environmental indicators.

 

 

Q: How might the addition of a new indicator impact a metro area’s score?

Each metro area’s score, sub-scores for personal health and community/environmental behaviors, and ranking for 2015 should not be compared to 2014 or previous years because of the addition of the new indicator.

Any changes in the overall scores from 2014 or earlier compared to 2015 may be artifact due to the addition of the new indicator for 2015. However, the individual indicators for 2015 that did not changes from previous years could be compared to previous years’ reports if desired. For example, comparing the percentage of residents currently smoking can be compared from 2014 to 2015.

 

Q: Many metro areas have a similar score from year to year, but some areas experience larger increases or decreases in their scores. How is this possible?

In these cases specifically, the improved indicators appear to be primarily responsible for the shifts in score and rank. In comparing the remaining individual indicators that were not modified for the two years, very little changes in the values occurred.

 

Q: Since each neighborhood within a city can have a different Walk Score ranking and each city or town within a MSA can have a different Walk Score ranking, how is the MSA’s Walk Score ranking calculated? 

The Walk Score ranking for the central community in the MSA was used for the AFI Data Report since it is considered a reasonable indicator for the MSA and matches the approach for many of the other community/environmental indicators included in the report.

 

Q: Why is my community not included in the report?

The AFI Data Report ranks and scores the 50 largest metropolitan areas in the United States. At this time, the program does not have definitive plans to measure additional MSAs in future versions of the report.

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 AFI to improve their community’s health and fitness. Additionally, the AFI 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 AFI Data Report provides detailed information for cities at the MSA level, the My AFI  community application tool integrates the components of the AFI program into a health promotion approach that can be used by other communities not included in the AFI Data Report. 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.

 

Q: Is the AFI Data Report 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 AFI Data Report 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.

In the AFI Data Report, it is important to consider both the score and rank for each city. While the ranking lists the MSAs from the one with the highest score to the one with the lowest, the scores for many cities are very similar, indicating that there is relatively little difference between them.

Letter “grades,” which are often used to indicate a range from “excellence” to “failures,” were not assigned to the MSAs based on their score. 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.

 

Q: Any words of encouragement or optimism for the residents of cities at the bottom of the list?

Yes, it’s good to remind folks that the ranking merely points out that relative to each other, some metro areas scored better on the indicators than the other. AFI 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.

In the AFI Data Report, it is important to consider both the score and rank for each city. While the ranking lists the MSAs from the one with the highest score to the one with the lowest, the scores for many cities are very similar, indicating that there is relatively little difference between them.

Letter “grades,” which are often used to indicate a range from “excellence” to “failures,” were not assigned to the MSAs based on their score. 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.

Those MSAs at the bottom of the ranking still have strengths and should be commended for their effort. We hope that the indicators presented in the AFI Data Report 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 MSAs 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 happening in Indianapolis, under the leadership of the YMCA, is a good example. They have formed a coalition aimed at moving Greater Indianapolis to the top 10 of AFI by 2025. That coalition is a direct result of the technical assistance program.

 

Q: Are there future plans for the AFI program?

The long-range vision for the AFI program is to provide annual updates to the rankings so communities can monitor their progress in improving health and active living fitness indicators.

Future versions will included refined data points.

Additionally, the AFI program will assist U.S. communities …

  • By creating unique partnerships and alliances at the national and local levels.
  • By providing tools, strategies and expertise to communities interested in making progress toward improved health, fitness and quality of life.
  • By connecting scientific knowledge with practices and policies that work.

 

Q: What is a MSA (Metropolitan Statistical Area)?

According the U.S. Census Bureau, the United States Office of Management and Budget (OMB) defines metropolitan statistical areas (MSAs) according to published standards that are applied to Census Bureau data. The general concept of a MSA is that of a core area containing a substantial population nucleus, together with adjacent communities having a high degree of economic and social integration with that core.

Each metropolitan statistical area must have at least one urbanized area of 50,000 or more inhabitants. If specified criteria are met, a MSA containing a single core with a population of 2.5 million or more may be subdivided to form small groupings of counties referred to as “metropolitan divisions.”

The largest city in each MSA is designated a “principal city.” Additional cities quality if specified requirements are met concerning population size and employment. The title of each MSA consists of the names of up to three of its principal cities and the name of each state into which the MSA extends. Titles of metropolitan divisions also typically are based on principal city names but in certain cases consist of county names.

 

Q: Why use MSAs (Metropolitan Statistical Areas)?

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.

 

Q: What is the difference between a city, a metropolitan area and a community?

For the purpose of AFI, the data report evaluates Metropolitan Statistical Areas (MSAs) according the U.S. Census Bureau. An MSA can also be referred to as a “community” and/or a “city.” If referred to by city, the report is referencing the entire MSA or metro area, but uses the name of the largest principal city. For example, Atlanta is the principal city of the Atlanta-Sandy Springs-Roswell MSA. The Atlanta community and the nickname Metro Atlanta refer to the Atlanta-Sandy Springs-Roswell MSA.

 

Q: What is Anthem, Inc.’s involvement in the AFI program?

The AFI program is funded by the Anthem Foundation. The Anthem Foundation is the philanthropic arm of Anthem, Inc. and through charitable contributions and programs, the Foundation promotes the inherent commitment of Anthem, Inc. to enhance the health and well-being of individuals and families in communities that Anthem, Inc. and its affiliated health plans serve.

 

Q: 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.

 

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