San Diego has been ranked the 16th most fit city in America, just a few steps behind its Northern California neighbor, San Francisco, according to the 11th annual Fitness Index, released Tuesday by the American College of Sports Medicine (ACSM) and the Anthem Foundation.

But San Diego is a far ways off from the top three cities: Arlington, Va., Minneapolis, Minn. and Washington, D.C.

Arlington residents don't smoke very much, the index found, and they have high reports of excellent health, compared to the other cities indexed. It was Arlington's balance of healthy behaviors and community infrastructure that earned it the title "most fit city in America."

“Along with dietary changes, exercise is one of the best ways people can turn this around; unfortunately, only 22 percent of Americans are meeting national physical activity guidelines," said Barbara Ainsworth, Ph.D., chair of the American Fitness Index Board and a Regents’ professor in the Exercise Science and Health Promotion Program at Arizona State University, in a statement. "Through the expanded Fitness Index rankings, more citizens and government leaders will be informed and motivated in developing strategies to improve health and fitness opportunities and modify the infrastructures to support them.”

The Fitness Index evaluates the 100 largest cities across America using health behaviors, chronic diseases and community infrastructure indicators, officials said. This is the first time the index includes 100 cities; in the past, the list had only included 50 cities.

Only one California city broke the top ten in the index: San Jose. Oakland ranked 11th overall, and San Francisco 14th. Los Angeles ranked 50th overall.

The index found nearly 78 percent of adults in the cities evaluated were physically active in the previous month, but just over 50 percent met aerobic activity guidelines and even fewer met both strength and aerobic guidelines.

For all cities in the index, the average smoking rate was 15 percent, though all 16 California cities averaged only 10.6 percent.

View the full index here.