A pair California cities earned top spots in the new ranking of America’s fittest cities.
The 2026 American College of Sports Medicine (ACSM) and the Elevance Health Foundation report ranked San Francisco and Irvine among its top 10 healthiest cities in the US.
The report, which looked at the nation’s 100 largest cities, put San Francisco in the No. 6 spot and Irvine at No. 7 — with the Southern California enclave jumping back into the top 10 this year after falling to number 12 in 2025.
The two Golden State cities lagged only behind Arlington,Virginia, Washington DC, Minneapolis, Seattle, and Denver.
Arlington claimed the crown for the ninth consecutive year, with Atlanta, Madison, Wisc., and Boston rounding out the top 10.
The overall rankings are based on broad access to parks and recreation, physical activity rates and policies that support active lifestyles, among other factors.
“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 top 10 cities reported “significantly lower obesity rates than lower-ranked cities — often by more than 10 percentage points,” according to the ranking. The cities also had higher rates of walking, biking and use of public transportation.
“The cities that consistently rank at the top aren’t succeeding because of one program or one investment. They’ve built systems that support healthier living over time,” Volpe said.
“They are the ones creating environments where physical activity can easily become a part of everyday routines.”
Cities ranking low in the report had higher rates of diabetes, obesity, and cardiovascular disease.
A total of 35 indicators were used for each city, evaluating things like people’s health, environmental conditions and community infrastructure.
Environmental concerns placed several Southern California locales in the ranking for cities with the fewest good air quality days. They included Long Beach, Los Angeles, Riverside, San Diego and Chula Vista.
“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, said its fitness index gives communities vital information needed to show where improvements can be made to improve the overall health of the city.
“Our longstanding support of the Fitness Index and the insights it provides for communities reflects our commitment to bettering whole health nationwide,” Agrawal said.
