The American College of Sports Medicine (ACSM), in partnership with the Elevance Health Foundation, released the American Fitness Index in July 2025, a comprehensive report analyzing health and physical activity conditions in the 100 most populous cities in the United States. The document presents contrasting results: significant improvement in physical activity indices alongside worsening national food insecurity.
Methodology and Evaluation Criteria
The report evaluated 35 health indicators, incorporating new categories reflecting the evolution of urban fitness infrastructure, including trail mileage, recreational water areas (splash pads), and tennis and pickleball courts. Arlington, Virginia, maintained its leadership for the eighth consecutive year, followed by Washington D.C., Seattle, San Francisco, and Denver.
Physical Activity Indicators
Compliance with Aerobic Recommendations
Data demonstrate substantial progress in adherence to Centers for Disease Control and Prevention (CDC) guidelines. According to these guidelines, adults should perform at least 150 minutes weekly of moderate-intensity aerobic activity, supplemented by muscle-strengthening exercises twice per week.
The 2025 report recorded that 59.9% of Americans met or exceeded aerobic activity recommendations, representing a 9 percentage point increase from the previous year. This improvement manifested broadly across the national territory: 94 of the 100 largest American cities showed high levels of aerobic activity, while 89 cities demonstrated progress in combined aerobic and strength exercise metrics.
Contributing Factors
The report identifies reduced smoking rates and increased investment in public parks as contributing elements to improved urban health outcomes.
Food Security
National Deterioration
Contrary to positive physical activity trends, food security indicators reveal significant deterioration. The percentage of Americans facing food insecurity increased from 10.4% in 2024 to 12.9% in 2025. Food insecurity is characterized by lack of access or financial inability to obtain nutritionally adequate and safe foods.
Anchorage, Alaska, was the only city among the top 100 not to register increased food insecurity rates during the analyzed period.
Political and Economic Factors
The worsening of food insecurity coincides with the termination of assistance programs expanded during the COVID-19 pandemic, including expanded child tax credits. The resumption of Medicaid eligibility verifications, suspended during the health emergency, resulted in coverage loss for low-income families. KFF survey data indicate that approximately 25% of Medicaid beneficiaries who lost coverage during eligibility reviews remained uninsured in 2024.
Urban Institute analyses project that up to 22.2 million Americans may lose total or partial benefits from the Supplemental Nutrition Assistance Program (SNAP) under proposed legislation. Cindy Jordan, CEO of Pyx Health, highlights systemic implications: inadequate nutrition results in postponement of preventive care and greater utilization of emergency services, significantly elevating healthcare system costs.
Environmental Quality
Air Quality Deterioration
Environmental indicators registered concerning decline. Days with good air quality reduced from approximately two-thirds of the year in 2024 to less than half in 2025. Smoke from Canadian wildfires affected millions of residents in the Northeast and Great Lakes regions, substantially contributing to this deterioration.
Compromised air quality is associated with respiratory symptoms such as coughing, wheezing, and asthma exacerbations, in addition to contributing to cardiovascular and pulmonary disease development, according to Environmental Protection Agency data.
Mental Health
Mental health indicators showed stagnation, with 44.9% of respondents reporting mental health problems in the month prior to the survey, compared to 44.7% in the preceding year. Simultaneously, a 2% decline was observed in the percentage of Americans who classify their general health as excellent or very good.
ACSM President Stella Volpe observes the interconnection between health factors, highlighting that mental health impairments can reduce physical activity levels, establishing a cycle that elevates chronic disease risk.
Municipal Application of Data
The classification system provides quantifiable data for public health policy development. Cities can analyze their performance through indicators including public green spaces, park accessibility, recreational facilities, sports courts, and bicycle infrastructure. Individual health metrics encompass obesity rates, fruit and vegetable consumption, sleep quality, and smoking prevalence.
Volpe emphasizes that cities with lower classifications can study strategies implemented by successful municipalities, observing that systematic changes can significantly impact population health outcomes. The report functions simultaneously as a diagnostic instrument and guide for implementing evidence-based health policies at the municipal level.
Conclusions
The 2025 ACSM report documents a complex panorama of American health, characterized by measurable progress in national physical activity contrasting with deterioration in fundamental socioeconomic and environmental indicators. The data suggest that isolated improvements in physical activity may be insufficient to address systemic public health challenges without coordinated interventions in food security, environmental quality, and mental health.
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Information source: usatoday.com
