• Chinese have been increasingly interested in health and fitness.

Chinese have been increasingly interested in health and fitness. (Photo : Reuters)

The new American Fitness Index (AFI) released this week ranked the 50 biggest metropolitan areas in the United States, based on fitness level. The defending champion among the healthiest U.S. cities won for the second year in a row.

The American College of Sports Medicine released its yearly AFI. It lists "Metropolitan Statistical Areas" (MSAs) because they are huge urban areas within certain U.S. counties, according to UT San Diego.

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Each MSA was given a fitness index calculated by using 32 critical factors. Such issues included community fitness habits, how close public parks were, and the population ratio with chronic health problems.

The AFI advisory board used data that was publically available and changed via community effort. Therefore, factors such as climate were not used as a health indicator.

For the second year in a row, the Washington D.C. Metro area topped the list of fittest U.S. cities. America's healthiest city earned a score of 79.6.

The Minneapolis-St. Paul Metro area (75.6) finished in second place. Among America's fittest cities was the San Diego-Carlsbad Metropolitan region (75.6), which earned third place.

California cities rounded out the top-5 of America's healthiest cities. They included the San Francisco-Oakland  Metropolitan area (72.6),and the Sacramento Metro region.

The unhealthiest U.S. city was the Indianapolis Metro area, according to California Healthline.  Other cities that ranked close to the bottom of the AFI included Memphis and Oklahoma City.

The AFI advisory board stated that the purpose of its health index is to measure the health levels and fitness levels of U.S. metro areas. Another objective is help local communities in their "health promotion."