For the third year in a row, Minneapolis-St. Paul is the fittest metropolitan area in the United States, according to a report released by the American College of Sports Medicine (ACSM).

Minneapolis-St. Paul achieved a score of 78.2 (out of 100 possible points) on ACSM's American Fitness Index (AFI) data report. The report measures personal health indicators such as preventive health behaviors, levels of chronic disease conditions and health care access, as well as community resources and policies that support physical activity in the 50 most populated metro areas in the country.

Minneapolis-St. Paul's high scores on community and environmental health indicators as well as personal health indicators helped it keep the top spot and improve on its previous scores of 76.4 in 2012 and 77.2 in 2011.

"We have issued the American Fitness Index each year since 2008 to help health advocates and community leader advocates improve the quality of life in their hometowns," Walter Thompson, chair of the AFI Advisory Board, said in a statement. "As urban areas attract more and more residents, it's imperative for cities to create a built environment, fund amenities and form policies that get residents active and encourage healthy lifestyles."

Washington, DC (77.7) once again came in second, while Portland, OR (69.8) placed third, according to the report titled "Health and Community Fitness Status of the 50 Largest Metropolitan Areas." Rounding out the top 10 are: San Francisco (68.7); Denver (68.1); Boston (67.1); Sacramento, CA (66.8); Seattle (66.7); Hartford, CT (66.6); and San Jose, CA (66.4).

Columbus, OH, improved the most, moving from No. 40 (39.8) in 2012 to No. 30 (48.2). Los Angeles also improved its position, going from No. 38 (41.2) to No. 29 (48.3). Cincinnati, which was ranked No. 20 in 2012 (56.2), moved to No. 13 (61.4) and had the highest community health score.

Other cities struggled to improve their scores. The bottom six are: Indianapolis (36.8); Memphis, TN (36); Louisville, KY (35.2); San Antonio (35.1); Detroit (33.6); and Oklahoma City (31.2). Louisville, Detroit and Oklahoma City also were in the bottom six in 2012, 2011 and 2010.

In 2011, the ACSM received a $171,880 grant from the WellPoint Foundation, which sponsors the reports, to pilot improvement efforts in Indianapolis and Oklahoma City. Although Oklahoma City stayed at No. 50, its AFI score improved by three points this year, while Indianapolis' score decreased from 37.3 in 2012, and its ranking fell from No. 43 to No. 45.

The Top 10 by 2025 coalition, formed by the YMCA of Greater Indianapolis and other community organizations, also is working with the ACSM to make changes in the city that will put it in the top 10 of the AFI by 2025.

"Based on the plan that we've put together, partners of the coalition are ready to move the health of Central Indiana in the right direction," John Sparzo, chairman of the coalition, said in a statement. "More than ever, now is a critical time for fellow residents to focus on their own personal health and the health of our entire community."

The group will continue to focus on increasing physical activity, improving nutrition, decreasing smoking and improving the wellness environment in Indianapolis. If they are successful in making improvements in these areas, coalition members say the city will have a better opportunity to move up on the AFI report, according to the statement.