Moving on Up: How Communities Can Inspire Healthy Living at Every Age
Key Highlights:
- Early experiences with active play may fuel habits that support physical and mental health later in life.
- The ACSM American Fitness Index — supported by the Elevance Health Foundation — shows how city design, from splashpads and playgrounds to trails and recreational facilities, influences opportunities for movement and overall community well-being.
- By prioritizing accessible spaces and policies that make activity an easy choice, cities can foster healthier, more connected communities for people of all ages.
A group of kids races through a splashpad on a warm afternoon, shrieking with laughter as jets of water shoot up from the ground, spraying feet and faces. It’s a summer scene that’s common for many across the United States, whether in a city playground or a sprawling suburban park — and it represents more than just fun.
Scenes like this also hint at how movement, exercise, and an alternative to hours that might otherwise be spent staring at screens may help form a foundation for physical activity — and better physical and mental health — later in life.
“Being physically active, playing outside is a really great thing,” said Stella Volpe, head of the Department of Human Nutrition, Foods, and Exercise at Virginia Tech and immediate past president of the American College of Sports Medicine (ACSM). And “being active when you are younger tends to increase the likelihood of you being active as you get older.”
Designing Cities to Invite Movement
The environments we create can invite a mindset for movement. The ACSM American Fitness Index — a collaboration between the ACSM and the Elevance Health Foundation — zeroes in on that point, ranking the 100 largest cities in the U.S., in part, on how well they support fitness and physical activity.
The same community that offers splashpads and playgrounds for toddlers and younger children may also provide basketball courts, walking paths, and pickleball courts for people of all ages. Recreational facilities and the built environment create opportunities for social or solo activity that can yield benefits for both individual and community health.
“When communities invest in spaces that invite movement and connection, they’re nurturing active habits that strengthen their residents and, in turn, the collective well-being of the community,” said Dr. Shantanu Agrawal, chief health officer at Elevance Health. “Personal health and community health intertwine, and the built environment connects them."
Availability is key, Volpe said, and is one reason why the ACSM included splashpads as an index measurement for the first time this year.
“There are individuals who don't have access to pools, whether it is a YMCA or a private place,” Volpe said. “But splashpads are pretty inexpensive, they are often located at parks, and they add another dimension to the index that reflects physical activity.”
Boston is the No. 1 big city for splashpads in the U.S., with the Massachusetts capital boasting 12.6 for every 100,000 residents — far above the index’s 100-city average of 2.4 per 100,000.
A Roadmap for Healthier Cities
In total, the ACSM Fitness Index uses more than 30 indicators to assess cities across two dimensions: personal health, and community and environment.
The personal health category considers health behaviors like exercise and smoking rates alongside health outcomes like obesity rate and the share of people who have experienced poor mental health. The community and environment category spans indicators from parks and basketball hoops to an area’s air quality and level of food insecurity.
Arlington, Virginia, captured the top ranking in the index for the eighth year in a row. Washington, D.C., followed at No. 2, with Seattle at No. 3.
Along with splashpads, the ACSM added trail miles as another new indicator in the 2025 rankings. Pickleball and dual-use courts are now included within the tennis courts indicator as well.
The inclusion of splashpads and pickleball point to the importance of physical activity over a lifetime. Creating spaces that encourage movement by kids and adults alike can help: Think of a playground with a walking loop around it, or with stationary fitness equipment available nearby.
“It is about having options that go beyond the basics,” Volpe said. “How do we build infrastructure that encourages people of different ages and abilities to be active and engaged?”
Overall, the index offers a holistic view of health that balances the personal achievements of residents with how policymakers and their partners can foster greater community health and well-being. According to the ACSM, steps can include:
- Advocating for urban planning policies that prioritize green spaces, parks, and protected bike lanes.
- Organizing community gardens where residents can grow their own fruits and vegetables.
- Assessing area walkability to create safer routes for children to school.
“Health is shaped by the neighborhoods we build, the policies we champion, and the opportunities we create,” Agrawal said. “Designing cities where activity is the easy choice lays the groundwork for healthier, more connected communities for generations to come.”