How does your hometown stack up among fittest cities?

Nanci Hellmich | USA TODAY

The Twin Cities — Minneapolis-St.Paul — are the healthiest, fittest cities in the USA for the third year in a row, according to an analysis of the 50 most populous metropolitan areas in the USA.

Other top fit cities: Washington, D.C., Portland, San Francisco and Denver.

The annual American Fitness Index, out today from the American College of Sports Medicine, is based on a number of health behaviors including smoking, exercise, obesity rates, chronic health problems and access to health care. It also looks at the environment including availability of parks, recreational facilities, walking trails and farmers' markets. The fitness index was designed by health and medical experts.

"What Minneapolis has done brilliantly is put their resources where residents can use them effectively to maintain a high level of physical activity," says Walt Thompson, chairman of the advisory board who created the index and a professor of exercise physiology at Georgia State University in Atlanta.

Minneapolis does better than other cities when it comes to the number of baseball diamonds, playgrounds, golf courses and dog parks, he says. The city spends double the amount of money on parks per capita ($227 a person) as some other cities, Thompson says.

"We really believe that if people don't have the environment to exercise, they probably won't," he says.

Oklahoma City — which right now is dealing with bigger issues now in the aftermath of the devastating tornado that hit Moore, Okla., which is part of the city's metro area — came in last on the list of fittest cities. Detroit came in second to last.

Both cities share some of the same characteristics which include not spending nearly as much on park-related expenses as the top five cities, Thompson says. Plus, the cities have higher smoking rates and higher rates of death from heart disease.

The cities at the bottom of the list are trying to improve their environment and the health care of their residents, but it takes time to catch up, says Barbara Ainsworth, vice chairwoman of the fitness index and a professor in the school of nutrition and health promotion at Arizona State University, Phoenix. Personal health changes often follow environmental health changes, she says.

Thompson's advice to policy makers in cities that want to help their residents get healthier: Make some simple changes that could help make big health improvements. For instance, have smoking bans not only in buildings but in all public places such as parks and outdoor eating areas of restaurants, he says. "Another policy change that we also recommend is required physical education for kids through high school."

For more information, visit americanfitnessindex.org.

1. Minneapolis-St. Paul

2. Washington, D.C.

3. Portland, Ore.

4. San Francisco

5. Denver

6. Boston

7. Sacramento

8. Seattle

9. Hartford, Conn.

10. San Jose

11. Austin

12. Salt Lake City

13. Cincinnati

14. San Diego

15. Raleigh, N.C.

16. Pittsburgh

17. Baltimore

18. Virginia Beach

19. Cleveland

20. Richmond, Va.

21. Atlanta

22. Providence

23. Buffalo

24. New York City

25. Philadelphia

26. Milwaukee

27. Chicago

28. Kansas City, Mo.

29. Los Angeles

30. Columbus, Ohio

31. St. Louis

32. Nashville

33. Phoenix

34. Orlando

35. Riverside, Calif.

36. Charlotte

37. Jacksonville

38. New Orleans

39. Las Vegas

40. Tampa

41. Birmingham, Ala.

42. Miami

43. Houston

44. Dallas

45. Indianapolis

46. Memphis

47. Louisville

48. San Antonio

49. Detroit

50. Oklahoma City

Source: American Fitness Index from the American College of Sports Medicine