D.C. leads, Indianapolis lags in fitness among top 50 U.S. cities

Corrections and clarifications:The name of the American College of Sports Medicine was incorrect in an earlier version of this story.

Access to parks and paths for jogging, walking and biking helped make the Washington, D.C., area the fittest of the 50 largest metropolitan areas in the U.S., according to a study out Tuesday.

Meanwhile, the Indianapolis area dropped from 46th in 2014 to become the least fit major metro area this year, according to the eighth annual American Fitness Index from the American College of Sports Medicine and the Anthem Foundation.

The rankings, based on outdoor exercise options and rates of smoking, obesity and diabetes, are designed to be a "call to action" for areas to improve their infrastructures so they promote healthy lifestyles, says Walter Thompson, chair of the AFI advisory board and a professor of kinesiology at Georgia State University.

Doing well in the rankings is increasingly difficult. Public health spending at the federal, state and local levels is below pre-recession levels, the non-profit Trust for America's Health reported last month.

In 2013, spending averaged $239 per person or $75.4 billion compared with $241 per person in 2009. When adjusted for inflation, public health spending was down 10% in those five years.

The index compares the top metro areas against target goals that were calculated using the highest and lowest scores in earlier data. That means for aerobic activity, just 32% of people needed to report meeting the U.S. Centers for Disease Control and Prevention's guidelines, which call for 2½ hours a week of brisk walking, which can be broken into 10-minute increments.

"They set a low bar here and we're still not beating it," says Trust for America's Health executive director Jeffrey Levi.

Indeed, even those involved acknowledge the index can be misleading.

"One of the issues with the index is it compares some places like Indianapolis with some places like Denver," with its mountains that draw exercisers, says NiCole Keith

, who is an advisory board member for the fitness index.

"We just don't have that level of green space," says Indianapolis-based Keith, who is an investigator at the health care research organization Regenstrief Institute. "We're not going to get mountains and we're not going to get oceans."

Pockets of Indianapolis — including areas that are relatively healthy — aren't counted in the metropolitan statistical area, so they don't figure into the rankings that put the Indianapolis-Carmel-Anderson, Ind., area dead last, Keith notes.

As for the 46th-ranked area around Louisville, there are other issues working against it, says Deborah Ann Ballard, a physician with Louisville-based KentuckyOne Health, who works with its Healthy Lifestyle Centers.

"The more highly educated a population is, the more people tend to practice good health behaviors such as exercise, healthy eating and stress reduction," Ballard says, adding that learned helplessness and hopelessness are also an issue in the region. "What I see in a lot of patients is that they accept illness and poor health as the norm."

Still, the National League of Cities cites progress made by three of the lowest-ranked big metro areas:

• In Memphis, which ranked 49th, the mayor has been a big proponent of bike infrastructure, including building bike lanes and scenic bike routes. A low percentage of people — fewer than 20% of the target goal — bike or walk to work, however.

• Oklahoma City, ranked 48th, is building new trail routes and improving sidewalks to boost recreation and safety, and a new public park is planned for the downtown area. Although the city already ranked high for having more parkland per capita, it ranked low for its expenditures on parks. Its residents also ranked low on all measures for all types of exercise.

• Partly due to a CDC grant, 47th-ranked San Antonio has added outdoor exercise equipment in many parks and added running and walking routes.

Thompson says those at AFI advise city leaders that spending on parks "makes it more attractive to live here and to stay here," which helps the economy and encourages healthful behavior.

Even though it ranked first for two years in a row, the Washington, D.C., area has many pockets of poverty, just as it has some areas of great wealth and health.

"When you take in huge swaths of metro areas, it can hide huge disparities," says Levi. "These are wonderful wake-up calls for communities at the bottom of the list, but they should not be reason for complacency at the top of the list."