Minneapolis was rated as the country's healthiest and most fit city while Oklahoma City needs to get on a treadmill.

It is the third year in a row that Minneapolis topped the national ranking by the American College of Sports Medicine. It's the fifth year in a row that Oklahoma City has come in dead last.

The AFI's annual report ranks the health and fitness of the 50 largest metropolitan areas in the United States. Rounding out the top five were Washington D.C., Portland, San Francisco and Denver.

The most populous American cities were not among the most fit. New York ranked 24 th, Chicago 27 th, Los Angeles 29 th and Philadelphia 25 th.

The report ranks cities by the prevalence of preventative health behaviors, residents' access to healthcare, rate of chronic diseases, and "community resources and policies that support physical activity."

Roughly 90 percent of residents in the Minneapolis area have health insurance, and 77 percent exercised in the last month, according to data collected in the report.

Oklahoma City was ranked last in the 50 cities analyzed. The study found that 77 percent of Oklahoma City residents have health insurance, and 67 percent have exercised in the last month. The death rate for heart disease is 23 percent, while in Minneapolis it is 12 percent.

Gary Cox, executive director of the Oklahoma city county health department, told ABC News that he is aware the city falls short in this area, but said several initiatives are underway to promote healthier living, like the creation of new bike paths and wellness centers .

"We're not there yet, but all of the pieces are being put into play," he said.

Joining Oklahoma City as the unhealthiest cities were Memphis, Louisville, Ky., San Antonio and Detroit.