According to the annual American Fitness Index (AFI) prepared by the American College of Sports Medicine and the Anthem Foundation, Washington, DC, has come out on top of a national ranking of the fittest US cities for the second year in a row.

The next positions for being the fittest cities were achieved by Minneapolis-St. Paul, San Diego, Sacramento and San Francisco. The rank of being the least active or unfit city in the US was attained by Indianapolis followed by Memphis and Oklahoma City. The AFI ranks the 50 largest metropolitan statistical areas in the United States.

Walter Thompson, chair of the AFI Advisory Board, said, "The AFI is two things, a measure of how healthy a metro area is today, and a call to action for urban and suburban leaders to design infrastructures that promote active lifestyles and lead to positive health outcomes”. Thompson is a professor of health and kinesiology at Georgia State University.

The criteria used to rank the cities as based on the availability of healthy outdoor activity options reported rates of smoking, obesity and diabetes. Access to public parks was also added to this year's survey.

Thompson added that their goal is to provide resources to communities and residents so that they can respond and achieve a better and healthier life.

The AFI data is used by many US to settle policies and urban planning practices. For example, St. Louis, moved up from its 2014 ranking of 41 to 30 this year. It happened due to increase in recreational facilities for residents and opening up more public parks.

The AFI researchers mentioned that the more pedestrian-friendly a city was, the higher it ranked on the fitness scale. It was found that 95% of the population lives within a 10-minute walk to a park in Washington, D.C.

However, only 31% of residents of Indianapolis, at the bottom of the fitness list, have the same access to a public park.