San Francisco and Irvine have earned spots among the nation's fittest cities, according to the 2026 American College of Sports Medicine (ACSM) and Elevance Health Foundation report. San Francisco secured the No. 6 position, while Irvine ranked No. 7, marking a return to the top 10 for the Southern California city.
The annual report analyzes the 100 largest U.S. cities, evaluating factors such as access to parks and recreation, physical activity rates, and policies that support active living. Arlington, Virginia, took the top spot for the ninth consecutive year, followed by Washington D.C., Minneapolis, Seattle, and Denver. Atlanta, Madison, Wisconsin, and Boston completed the top 10.
According to the report, the healthiest cities foster environments where movement is integrated into daily life through infrastructure, transportation, and community design. These cities consistently demonstrate significantly lower rates of obesity and higher participation in walking, biking, and public transportation compared to lower-ranked cities.
"Where you live increasingly determines how healthy you are," said Stella Volpe, past president of the ACSM and chair of the Fitness Index Advisory Board. "The healthiest cities don’t just encourage exercise — they make movement part of daily life through infrastructure, transportation and community design."
The index utilizes 35 indicators to assess each city's health, environmental conditions, and community infrastructure. Cities that rank lower often contend with higher rates of diabetes, obesity, and cardiovascular disease.
However, the report also identified environmental challenges impacting health in some Southern California areas. Long Beach, Los Angeles, Riverside, San Diego, and Chula Vista were noted for having fewer days of good air quality. The report stated that poor air quality presents additional barriers to outdoor physical activity, particularly for residents with respiratory conditions.
"In cities with fewer days of good air quality, residents, particularly those with asthma and other respiratory conditions, face additional barriers to outdoor physical activity," the report said.
Shantanu Agrawal, MD, Chief Health Officer at Elevance Health, emphasized the report's value in providing communities with data to identify areas for improvement in public health. "Our longstanding support of the Fitness Index and the insights it provides for communities reflects our commitment to bettering whole health nationwide," Agrawal said. The cities that consistently rank at the top have built sustainable systems that support healthier living over time, creating environments where physical activity can easily become a part of everyday routines.