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America's 50 largest metro areas get their annual physical

The ACSM American Fitness Index™ provides a snapshot of the state of health and fitness, and Washington, D.C., tops the list of healthiest and fittest metro areas.

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For the third straight year, the Washington, D.C., metro area claimed the highest ranking in the American College of Sports Medicine’s (ACSM) American Fitness Index™ (AFI). The AFI data report, “Health and Community Fitness Status of the 50 Largest Metropolitan Areas,” evaluates the most populous city areas to determine the healthiest and fittest metro areas in the United States.

The AFI data report reflects a composite of preventive health behaviors, levels of chronic disease conditions, health care access, and community resources and policies that support physical activity.

“The ACSM American Fitness Index not only measures the state of health and fitness in our nation’s largest communities, but evaluates the infrastructure, community assets, policies and opportunities which encourage residents to live a healthy and fit lifestyle,” said AFI Advisory Board Chair Walt Thompson, Ph.D., FACSM. “I liken the data report and rankings to the metro areas ‘getting a physical’ at the doctor’s office. The information learned from the physical will help each metro area identify areas of strength and weakness.”

ACSM received a grant from the WellPoint Foundation, based in Indianapolis, to present the 2010 data report.

“The WellPoint Foundation is pleased to be a continuing sponsor of the American College of Sports Medicine American Fitness Index™ (AFI) program,” said Wesley Wong, M.D., M.M.M. Regional Vice President and National Medical Director for WellPoint’s affiliated health plans and member of the AFI Advisory Board. “This initiative enhances our health improvement efforts across the country and allows us to be a stronger community partner in the states we serve.”

Digging into the Data

The Metropolitan Statistical Areas (MSA) of Washington-Arlington-Alexandria scored 73.5 (out of 100 possible points) in the AFI data report to achieve the top ranking, just as it did in 2008 and 2009.

Characteristics of the D.C. area that helped it achieve the top ranking are a relatively low smoking rate, a higher-than-average percentage of folks eating the recommended daily serving of fruits and vegetables, and lower-than-average rates of chronic health concerns such as obesity, asthma, cardiovascular disease and diabetes. D.C.-area residents also use public transportation regularly, meaning they are likely to walk to and from their places of work or transit stations. Also, the area of parkland as a percentage of the city’s land area is significant, providing residents with lots of space to run, bike, play sports or take a leisurely walk.

Metro areas completing the top five were Boston, Minneapolis-St. Paul, Seattle and Portland, Ore. The Baltimore, Md., area (ACSM’s host city for its 2010 Annual Meeting), ranked 20th.

The western United States dominated the top 10, with only three cities lying along the eastern seaboard. The nation’s three largest cities finished in the middle of the pack with New York at 21st, Chicago at 33rd and Los Angeles at 38th.

Education proved to be a valuable predictor of health and fitness; areas with a high percentage of residents with high school degrees or higher are more likely to be physically active and be in excellent or very good health. This group is also more likely to have health insurance.

Considering the challenging economic climate in recent years, the data suggests being unemployed may be a health concern. Metro areas with a higher unemployment rate are more likely to have a higher percentage of death related to cardiovascular disease.

Poverty levels, disability rates and the rate of violent crime correlated with other health concerns, suggesting that health officials and programs may need to put more emphasis on populations that may be underserved. For example, areas with a higher percentage of households below the poverty level are more likely to smoke, be obese, have diabetes, and have both cardiovascular disease and diabetes related deaths. They are less likely to be physically active, in excellent or very good health, and have health insurance.

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