Fittest cities: Minneapolis; Washington, D.C.; Portland, Ore. Fittest cities: Minneapolis; Washington, D.C.; Portland, Ore.. First Lady Michelle Obama participates in a fitness event with military families on the South Lawn of the White House in Washington, DC, on May 9, 2011. INDIANAPOLIS, May 29 (UPI) -- The American College of Sports Medicine has ranked Minneapolis-St. Paul the healthiest, fittest U.S. metropolitan area for the third year in a row. The American Fitness Index -- established six years ago with support from the WellPoint Foundation -- evaluates the infrastructure, community assets and policies that encourage healthy and fit lifestyles in the 50 most populous U.S. metro areas. Also included in the analysis are preventive health behaviors, levels of chronic disease conditions, healthcare access and physical activity resources. Washington was second, followed by Portland, Ore.; San Francisco; Denver; Boston; Sacramento; Seattle; Hartford, Conn.; and San Jose, Calif. "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, chairman of the AFI Advisory Board, said in a statement. To assist with measurement and to provide a baseline measure of health and fitness status, the ACSM worked with the Indiana University School of Family Medicine and a panel of 26 health and physical activity experts on the methodology of the annual report. Researchers used data from the U.S. Census Bureau, the U.S. Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, The Trust for the Public Land City Park Facts and other research.