These are the healthiest cities in America

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Michael Dodger/Stringer/Getty Images

One of the healthiest cities in America is right in the nation’s capital.

For the third year in a row, Washington, D.C. earned the title of America’s fittest city, according to the ninth annual American Fitness Index from the American College of Sports Medicine.

The survey, released on Tuesday, compares the 50 largest metropolitan areas in the country based on factors like walkability, school physical education requirements, the number of recreational facilities like parks and swimming pools, and obesity, diabetes and smoking rates.

Cities near the top of the list have “more strengths and resources that support healthy living and fewer challenges that hinder it,” researchers wrote in the report.

Eighty percent of people in the Washington area who responded claimed that they exercised in the last 30 days, one of the factors that contributed to the region’s top rank.

In the Midwest, things aren’t looking quite so hot. Indianapolis came in last for the second straight year. Just 45.6% of residents there were deemed to be in “excellent or very good health.”

The survey also revealed some encouraging trends for the US as a whole. About 12% more Americans have exercised in the past 30 days compared to last year’s report, while the number of smokers dropped about 5%. Diabetes death rates dropped about 7%.

On the downside, the US is still one of the most overweight countries in the world.

See the full list here.

Here’s a selection of the top cities:


1. Washington, D.C.

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People jog along the National Mall, on February 18, 2011 in Washington, DC.
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Mark Wilson/Getty Images

2. Minneapolis

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A workout group runs hill sprints in downtown Minneapolis.
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Star Tribune

3. Denver

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Bicyclists enter downtown Denver during the 2011 USA Pro Cycling Challenge.
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Doug Pensinger/Getty Images

4. Portland, Oregon.

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Tourists ride bicycles on a tour through downtown Portland, Oregon.
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Flickr Creative Commons

5. San Francisco

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Runners cross the Golden Gate Bridge during the 2013 San Francisco Marathon and Half-Marathon on June 16, 2013 in San Francisco, California.
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Ezra Shaw/Getty Images

10. San Diego

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A surfer exits the water as the sun sets through low clouds near San Diego.
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Donald Miralle/Getty Images

14. Atlanta

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Runners at a 5k race in Atlanta.
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Flickr Creative Commons

22. New York

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Ice skaters enjoy the Rockefeller Center Ice Rink on its opening day on October 13, 2015 in New York City.
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Andrew Burton/Getty Images

29. Los Angeles

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A bodybuilder exercises during an event at Los Angeles’ Muscle Beach hosted by Arnold Schwarzenegger.
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Jerod Harris/Getty Images

32. Miami

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Yoga instructor Sarah Henry leads a class during a paddleboard yoga session at Adventure Sports Miami on July 10, 2011 in Miami, Florida.
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Joe Raedle/Getty Images