Washington, D.C. topped the list of America's fittest cities for three years in a row, until now.
Minneapolis and St. Paul rank at the top of the list of the 50 "Fittest Cities" according to the American College of Sports Medicine and the Anthem Foundation.
Houston falls far below, in 40th place.
Putting the cold aside, minnesotans simply bundle up and head outside to ski, sled and jog...whatever it takes to be physically active.
"I like to walk, even outside in the winter because it's gorgeous, even here, in the winter," says Minneapolis resident Rumen Hulmequist.
The annual report looks at heart disease and diabetes rates, smoking, availability of farmer's markets and whether cities are investing in natural areas where residents can exercise.
That's one reason the Twin Cities pushed Washington down to the #2 spot this year.
"Washington, D.C. didn't pay as much attention to its parks," says Dr. Pamela Peeke of the American College of Sports Medicine. "Not enough of an investment there."
San Francisco, Seattle and San Jose round out the top five.
The top 10 fittest cities:
1. Minneapolis-St. Paul
2. Washington, D.C.
3. San Francisco
5. San Jose
9. Salt Lake City
10. San Diego
Compared to last year 16-percent more people nationwide are getting enough aerobic exercise, and there was a 10-percent drop in diagnosed chest pain or heart disease.
Still, obesity has risen, as have deaths from diabetes, and fewer people say they're in "optimal" health.
At the bottom of the list were Indianapolis, Oklahoma City and Louisville.
Bottom 10 least fit cities:
41. Columbus, Ohio
44. San Antonio, Texas
47. Charlotte, N.C.
49. Oklahoma City, Oklahoma
50. Louisville, Kentucky
See where your city ranks, check out the full list here.
Read more at NBC News.