Dr. Dana King, a professor and chairman of WVU's Department of Family Medicine, noted that while Monongalia County's 10 recreational facilities were higher than the state average of seven, there's a lack of bike lanes and shoulders along roads for people who want to exercise.
"There's always room for more accessible places," he said. "Just imagine, what if everybody was really out walking 30 minutes a day. Where would they do it? "
Pendleton County's drop from the top spot might be because it had slight dips in clinical care, which included the percentage of uninsured residents, the number of primary-care physicians and dentists, screenings for diabetes and breast cancer, and preventable hospital stays; and in social-economic factors such as graduation rates, unemployment and poverty.
Doddridge County leaped from ninth to third in the study and was followed by Jefferson, Hampshire, Tucker, Pleasants, Upshur, Putnam and Hardy. Putnam is the lone southern county in the top 10.
Ritchie County improved from 30th to 11th and Gilmer improved from 45th to 24th.
Wirt fell from fourth to 22nd and Taylor went from 17th to 30th.
In ranking last, McDowell County had a premature death rate nearly double the state average, and it also has high rates of physical inactivity, adult smoking and obesity.
The county is the focus of a five-year initiative called Reconnecting McDowell, aimed at saving the schools and their students from failure, and addressing underlying social problems.
Other counties with the poorest health were Wyoming, Mingo, Logan, Boone, Mercer, Wayne, Lincoln, Fayette and Summers - all in the southern part of the state.