Fittest U.S. Cities of 2013

How does your city shape up?

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Which city is the fittest in the nation? According to one annual ranking, the Twin Cities of Minneapolis and St. Paul in Minnesota are. Looking at personal health habits, community resources and access to health care, the American College of Sports Medicine (ACSM), along with the Indiana University School of Family Medicine and a panel of experts, released on Wednesday its sixth annual rankings for the 50 largest metropolitan areas in the United States.

The Minneapolis-St. Paul area–most notable to some for its seven-story Mall of America in nearby Bloomington–took top honors for the third year in a row, with Washington and Portland earning second and third place. New York City ranked #24 (knocked down from #22 in 2012) and Los Angeles came in at #29 (a big leap from from #38 in 2012). Coming in last for the sixth straight year was Oklahoma City, Okla.

Residents in cities with the highest rankings tended to have higher levels of physical activity and low rates of heart disease and diabetes. They also had more parks per capita as well as advanced state requirements for physical education classes.

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When only personal habits–such as self-reported physical activity and chronic health (physical and mental) problems–are measured, Washington D.C. comes in first, followed by Minneapolis, Minn. and San Francisco, Calif.

When only community resources–such as availability of public transportation and parks–are measured, Cincinnati, Ohio beats others cities to the top, trailed by by Minneapolis, Minn. and Washington D.C.

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Ryan Puckett, a spokesperson for the Fitness Index, told TIME that the individual city rankings are less important than how each city has changed, for better or worse, over the years. For instance, fired up by its current low ranking as the 5th least fit metro area (out of 50), Indianapolis started a campaign sponsored by the local YMCA, to get to the “Top 10 by 2025” by focusing on increasing physical activity, improving nutrition, decreasing smoking and improving the environment.

Here’s the complete Top 20 list:

  1. Minneapolis-St. Paul, Minn.
  2. Washington, D.C.
  3. Portland, Ore.
  4. San Francisco, Calif.
  5. Denver, Colo.
  6. Boston, Mass.
  7. Sacramento, Calif.
  8. Seattle, Wash.
  9. Hartford, Conn.
  10. San Jose, Calif.
  11. Austin, Texas
  12. Salt Lake City, Utah
  13. Cincinnati, Ohio
  14. San Diego, Calif.
  15. Raleigh, N.C.
  16. Pittsburgh, Pa.
  17. Baltimore, Md.
  18. Virginia Beach, Va.
  19. Cleveland, Ohio
  20. Richmond, Va.

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