The gap between America’s healthiest and least healthy cities is growing.
The 2026 American College of Sports Medicine (ACSM) Fitness Index has released their annual report revealing the nation’s “fittest cities” — and the top 10 may not be what you’re expected.
The Fitness Index evaluated the 100 largest US cities using 35 evidence-based indicators across personal health, community infrastructure and environmental conditions to come up with the rankings.
Scores for the fittest cities came from factors like low chronic disease rates, higher physical activity, strong public transportation, and access to parks and recreation infrastructure.
Lower ranked cities generally had higher obesity, lower activity levels, food insecurity and fewer opportunities for movement in daily life.
For the ninth consecutive year, Arlington, Virginia was ranked as America’s fittest city. It ranked first place in notable categories that propelled them to the top: 92.2% of residents exercising in the previous month, 76.4% sleeping 7+ hours a day and 67.3% in excellent or very good health.
They also had the lowest percentage of smokers (1.2%) and smallest population with diabetes (5.7%).
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
New York City came in at number 26, with its individual rankings per category available here.
Compared with Arlington, where 92.2% of residents exercised in the previous month, just 74.4% of New Yorkers say they did. Only 43.6% of New Yorkers were found to be in excellent or very good health, and 40.2% reported having poor mental health in the previous month.
The report also called out the most improved cities, including Richmond, VA; Charlotte, NC; and Virginia Beach, VA.
At the bottom of the rankings is Oklahoma City, OK in 100th place, which fell behind Memphis, TN in 99th, and Port St. Lucie, FL in 98th.
The biggest gaps from top-ranked and lowest-ranked cities were obesity rates, which are significantly lower in top-ranked cities (more than 10 percentage points) than lower-ranked cities. Another large divide is residents in top-performing cities are significantly more likely to meet recommended physical activity guidelines.
Lower-ranked cities continue to have higher chronic disease indicators like obesity, diabetes and cardiovascular disease.
Notably, food insecurity has increased nationwide, with 99 out of 100 cities having higher rates since the previous year, for the second consecutive year. The national range is now above 14% of residents living with food insecurity.
Air quality also varied dramatically across communities, which significantly impacts the nearly 28 million Americans living with asthma. On average, cities experienced good air quality approximately 51% of days annually, with eight cities reporting 10% or fewer days with good air quality.
The Fitness Index indicators are reviewed by ACSM content experts and updated annually. Some data limitations include the sample variability from year to year, use of self-reported data and lack of availability for some data indicators.
The full 2026 American Fitness Index report is available here.
