For the third consecutive year, Arlington, Va., is the fittest city in the United States, according to annual rankings compiled by the American College of Sports Medicine and the Anthem Foundation.

Seattle, Minneapolis, Madison, Wis., and San Francisco rounded out the top five cities on the 2020 American Fitness Index, released Tuesday.

Boston reached the top 10 for the first time in the index's 13-year history, while Buffalo, N.Y. (25), Anchorage, Alaska (37), and Toledo, Ohio (81), all climbed more than 15 spots from 2019.

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Bakersfield, Calif. and Oklahoma City, Okla., ranked No. 99 and No. 100, respectively, on this year’s list.

The index ranks the nation’s 100 most populous cities on 33 personal health and community fitness indicators, ranging from rates of exercise and diabetes to city assets such as parks and biking infrastructure.

Arlington ranked first on two indicators — lowest rate of obesity and highest rate of residents meeting exercise guidelines — and near the top on 19 others. This year marks the sixth time in seven years that a city in the Washington, D.C., region has topped the list.

Arizona State University professor Barbara Ainsworth, who chairs the American Fitness Index Advisory Board, said the rankings highlight the role of public investment in health-enhancing infrastructure.

“The top cities are consistently ranking in the top order because they have better bike trails, more parks that are close to where people can walk to them,” she said. “It's easier to live in a city and be healthy when there are resources available to be physically active.”

The five top cities each spend more than $100 per resident on parks, Ainsworth added — an investment that has become even more important when many gyms closed this spring due to the coronavirus pandemic.

“In light of the pandemic, the role of parks is critical for people to go outside in a safe area where they can just socially distance from each other and be active,” she said. “Physical activity builds the immune system and it provides a lot of mental health benefits that can alleviate depression and anxiety.”

Ainsworth said the goal of the Fitness Index is to encourage governments to invest in parks, public transportation and pedestrian safety measures.

“Less than 10 percent of all people use public transportation, so what we're talking about is a great opportunity for all cities to improve,” Ainsworth said.

Ainsworth said federal funding for bike and pedestrian safety in H.R. 2 — the $1.5 trillion infrastructure bill passed by the House in early July — would improve many cities’ performance on the index.

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellCoronavirus talks collapse as negotiators fail to reach deal Pelosi, Schumer say White House declined T coronavirus deal COVID-19 bill limiting liability would strike the wrong balance MORE (R-Ky.) dismissed the infrastructure bill as “nonsense” and the White House has threatened to veto the measure because of several provisions unrelated to bike and pedestrian safety.

Studies have shown that COVID-19 drastically reduced mobility rates across the world.

Within a month of the World Health Organization's declaration of a global pandemic, worldwide step counts dropped by 27.3 percent, likely due to social distancing requirements, according to a peer-reviewed study published in the Annals of Internal Medicine last month.

In the U.S., data from Descartes Labs shows that cities had larger decreases in mobility during April and May than rural areas, though most of the country has now returned to normal mobility rates.