In A Nutshell
- The least fit states are heavily concentrated in the South, with
Louisiana, Mississippi, West Virginia, Alabama, and Tennessee all
landing in the bottom six, sharing limited exercise infrastructure and
high rates of inactivity, obesity, and smoking.
- Vermont ranked as the fittest state in the U.S. with a score of 8.97
out of 10, excelling in sleep, diet, physical activity, and low smoking
rates, while Louisiana landed last at 4.25.
- Massachusetts residents are the most active in the country, with
68.1% getting at least 150 minutes of aerobic exercise per week, and
West Virginia has the highest adult obesity rate in the nation at 41.4%.
- Colorado managed to rank 4th despite having more fast food locations
per capita than any other state, pointing to the outsized role that gym
access and outdoor activity culture can play in overall fitness.
Vermont leads the nation in fitness while Louisiana sits dead last,
and the gap between them tells a stark story about how geography,
lifestyle habits, and access to green space shape the health of an
entire population.
How the Fittest States Index Was Built
Nursa researchers pulled data from several credible sources.
- Obesity
and smoking figures came from the Centers for Disease Control and
Prevention.
- Sleep and inactivity data were sourced from America’s Health
Rankings, as were diet figures: specifically the percentage of adults
who eat at least two servings of fruit and three servings of vegetables
per day, based on 2021 data.
- Exercise
data came from the Apple Heart & Movement Study, which tracked the
share of residents getting 150 or more minutes of moderate aerobic
activity per week.
- Alcohol consumption figures came from World
Population Review’s 2023 per capita data.
- Gym counts, walking and hiking
route tallies, and fast food location density were all drawn from
OpenStreetMap data across all 50 states.
Each state was scored on all 10 factors, and a percent-rank method was
used to calculate the final composite score out of 10. All data was
finalized as of February 19, 2026.
The ranking doesn’t pretend to capture everything about a state’s
health. Income, healthcare access, and food environment all play a role
that a composite fitness score can’t fully account for. But as a
snapshot of where Americans are moving, eating, sleeping, and smoking:
it draws a clear enough picture.
Vermont’s top ranking reflects what happens when outdoor access, good
sleep habits, low smoking rates, and active residents converge in the
same place.
Louisiana’s last-place finish reflects the opposite. Limited
infrastructure for exercise, high rates of sedentary behavior,
and some of the worst diet and smoking numbers in the country. The gap
between them is wide, and it shows up in ways that go far beyond a
single fitness score.
Disclaimer: The Fittest States Index
was commissioned and published by Nursa, a per diem healthcare staffing
company, and has not been independently peer-reviewed.
- Rankings are
based on a composite of publicly available health and lifestyle data and
are intended for informational purposes only.
- This analysis should not
be interpreted as medical advice or used as a substitute for guidance
from a qualified healthcare professional.
Survey Notes
Methodology
Nursa researchers ranked all 50 U.S. states across 10 health and
lifestyle factors to produce a composite fitness score out of 10. Gym
counts, walking and hiking route tallies, and fast food location density
were drawn from U.S. OpenStreetMap data. Adult obesity and smoking
rates came from the Centers for Disease Control and Prevention. Sleep
data — specifically the share of adults averaging fewer than seven hours
per night — and physical inactivity figures were sourced from America’s
Health Rankings, as was diet data tracking the percentage of adults
consuming two or more daily fruit servings and three or more daily
vegetable servings (based on 2021 figures). Exercise participation data —
the share of residents getting at least 150 minutes of moderate aerobic
activity per week — came from the Apple Heart & Movement Study. Per
capita alcohol consumption figures (in gallons) came from World
Population Review’s 2023 dataset. Each state was scored on all 10
factors using the percentrank method, which measures how a given value
compares to all other values in the dataset, and final composite scores
were calculated from those rankings. All data was finalized as of
February 19, 2026.
Limitations
This index is a composite ranking, not a clinical study, and it
carries the limitations that come with that format. Diet data relies on
self-reported consumption figures from 2021, which may not reflect
current behavior. Tennessee’s obesity and physical inactivity figures
were drawn from 2023 datasets, and Florida’s fruit and vegetable data
came from 2019 rankings due to data availability constraints. The index
does not account for socioeconomic factors, healthcare access, food
deserts, or income inequality — all of which shape health outcomes in
meaningful ways. OpenStreetMap data, used for gym, route, and fast food
counts, may not reflect every location equally across all states. The
ranking also weights all 10 factors equally, which may not reflect the
actual relative contribution of each variable to overall fitness.
