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(BLACKSBURG, Va.) – An annual health ranking again puts Indy and Fort Wayne near the bottom.

The Indy-based American College of Sports Medicine ranks Indy fourth-worst on its 15th annual American Fitness Index of the 100 largest U.S. cities. Fort Wayne ranks 26th-worst, an improvement of three slots over last year.

The index rates cities on a combination of 34 factors. Indiana has consistently been dragged down on health rankings by high rates of smoking and obesity. Indy and Fort Wayne both score poorly on the index’s measurements of personal health, including smoking, obesity, high blood pressure, diabetes, and the percentage of residents who exercise and eat fruits and vegetables regularly.

But Indy and Fort Wayne fare worse on the index’s 19 measures of how cities have tried to build a healthy environment, including air quality, food insecurity, and the availability of parks, playgrounds, and other recreational facilities. Index advisory board chair Stella Volpe, who leads Virginia Tech’s Department of Human Nutrition, Foods, and Exercise, says Indy gets high marks for its Complete Streets Policy, which seeks to make streets safe for pedestrians and bicyclists, and for its work to expand its walking and biking trail network. But she says the city still lags in ensuring residents have easy access to those facilities.

The index measures what percentage of residents live within a 10-minute walk of a park. Volpe says Indy could also benefit from having parks and trails closer to places where people congregate, like lunch spots.

Volpe says the raw scores of cities across the rankings took a hit from the pandemic — not just COVID-19’s physical effects, but the cost in mental health. She says the pandemic also struck a blow at the intersection of mental and physical health, with people less able to gain the mental health benefits of getting their exercise with friends.

Indy slipped back one slot from last year’s survey, as Wichita, Kansas, vaulted eight spots forward to 89th.

Arlington, Virginia, is number one for a fifth year in a row.