By Mukaila Kareem
In the early 1950s, an English epidemiologist named Professor Jerry Morris made one of the most important health discoveries of the modern era. In the wake of Britain’s post-war industrial boom, as machines replaced muscle and the division of labor kept more workers seated than standing, Jerry Morris noticed a sharp rise in heart disease and set out to trace its pattern among London’s transport workers. Bus drivers, who sat all day, were dying from heart attacks at far higher rates than the conductors who climbed the stairs of double-deckers collecting fares. He found the same contrast between postal clerks and postal delivery men as the majority of the moving delivery men lived longer than their sedentary colleagues. His landmark 1953 Lancet paper didn’t rely on cholesterol or blood sugar; it relied on observation, physiology, and common sense.
Morris’s findings should have redefined modern medicine. It showed that physical inactivity itself was a pathological state, capable of predicting heart disease long before blood tests or imaging could. Yet the profession hesitated. The pharmaceutical revolution was already underway, and the new tools of cardiology such as cholesterol assays, blood pressure cuffs, and later statins promised quantifiable control. Movement, on the other hand, was inconvenient, couldn’t be patented, prescribed, or measured with a lab value. So the insight that activity was medicine quietly faded into background advice.
Today in the United States, the magnitude of the heart-disease burden makes that early discovery all the more relevant. About 805,000 Americans experience a heart attack each year, of which roughly 605,000 are first-time events, according to the CDC. Heart disease remains the leading cause of death, responsible for nearly one in five American deaths annually. Yet despite these numbers, cardiology has framed heart risk primarily through the lens of lipid chemistry such as cholesterol, triglycerides, and ApoB rather than energy flow. Morris’s insight was sidelined in favour of managing markers of consequence rather than correcting the cause.
There are generic “heart-healthy” diets, often shaped by professional consensus, government dietary guidelines, or individual cardiologist preference, and medications that block cholesterol formation but cannot dissipate the reductive power building up in sedentary circulation. Yet there are no effective drugs to clear triglycerides once they accumulate. Physicians can manage these lipid biomarkers for years, watching the numbers improve until the inevitable, heart attacks or open-heart surgery. Yet throughout this biochemical surveillance, no physical therapy referral is made for baseline-activity guidance, no structured movement prescription that mimics the 10,000-plus daily steps documented in hunting and gathering societies. Physical therapy only becomes visible after the heart fails. Cardiac rehab exists for those lucky enough to survive the attack because it is easy to quantify treatment but hard to bill prevention.
The tragedy is that cardiology had its warning. The driver-versus-conductor study was not a footnote; it was the origin story of preventive medicine. But rather than expand Morris’s insight into the biochemistry of energy flow, the field narrowed it into a numbers game. Movement, the one variable that flushes the system, was demoted to “lifestyle modification.” The profession became preoccupied with blocking molecules instead of restoring motion.
Most of today’s social-media cardiologists and medical influencers know exactly how to build massive followings, usually by blaming processed foods and insulin resistance.The phrase trends well, and it sounds scientific enough to sell books. While insulin resistance certainly contributes to the swamp of triglycerides, fatty acids, cholesterol, and even glucose, it has little to do with the actual chemistry of glycation, the spontaneous reactions that quietly damage proteins and vessels long before clinical disease appears. It attracts followers but doesn’t address the root chemistry. The real issue is not insulin or LDL, which are signaling molecules trying to communicate metabolic stress; it is the imbalance that arises when the circulation of energy stalls in a body that hardly moves.
Cardiology’s fixation on numerical biomarkers mirrors the rest of modern medicine’s reductionism. The field can lower cholesterol, block beta receptors, and stabilize plaques, yet it still cannot simulate what a twenty-minute walk accomplishes for endothelial shear stress, nitric-oxide signaling, and mitochondrial turnover, the invisible chemistry that keeps blood vessels youthful. The metrics improved, but metabolism froze. We engineered control while losing rhythm.
Revisiting Jerry Morris is more than historical homage; it is a reminder that the solution has always been in plain sight. The chemistry of life demands movement to stay balanced. No pill or biomarker can replace the thermodynamic truth that life stays orderly only when the body lets off its internal heat (entropy) through motion. Morris didn’t need molecular biology to prove it; he only needed a city full of buses and the courage to count who moved and who didn’t.
Mukaila Kareem, a doctor of physiotherapy and physical therapy advocate, writes from the USA and can be reached via makkareem5@gmail.com
