Circulation April 2025 PMID 40228066

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality.

Emmanuel Stamatakis, Raaj K Biswas, Nicholas A Koemel, Angelo Sabag, Richard Pulsford, Andrew J Atkin, Afroditi Stathi, Sonia Cheng, Cecilie Thøgersen-Ntoumani, Joanna M Blodgett, Adrian Bauman, Carlos Celis-Morales, Mark Hamer, Jason M R Gill, Matthew N Ahmadi

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Mentions

138

Peak: 72 in Apr 2025

across 5 sources since Apr 2025

Extended reach

614,127

potential audience

Total likes

996

Video views

19,472

Mentions per month

Apr 2025 – Sep 2025

Where it's discussed

X / Twitter86 posts
News44 articles
Bluesky4 posts
YouTube2 videos
Blogs2 articles

AI synopsis

What people are saying

Numerous posts highlight the key findings of the research, such as the benefits of even brief periods of moderate or vigorous activity. Phrases like 'as little as 3 minutes' and 'steep reduction in CV risk' illustrate excitement and urgency, while the tone suggests a potential shift in how people might perceive and incorporate physical activity into their daily lives.

AgreementModerate agreement

Many posts reflect a general consensus that supports the conclusions of the publication, indicating a positive reception.

InterestHigh interest

The discussions demonstrate a strong curiosity in the findings, as keywords such as 'any amount of walking' and 'vital alternative' show a prevalent interest in incidental physical activity.

EngagementModerate engagement

The posts engage with the material at a surface level, referencing the study but not diving deeply into its methodology or implications.

ImpactHigh impact

A significant number of participants express the belief that the publication could significantly influence public health approaches or personal habits regarding physical activity.

Abstract in brief

This study analyzes the relationship between incidental physical activity (IPA) and cardiovascular health, focusing on major adverse cardiovascular events (MACE) and mortality among middle-aged and older adults.
Results indicate an L-shaped association whereby moderate levels of IPA lower the risk of MACE and mortality, with specific thresholds (14 minutes for vigorous and 34-50 minutes for moderate activities) showing optimal health benefits.
The findings highlight the importance of any level of physical activity, showing that even small amounts significantly contribute to reduced health risks, particularly in comparison to leisurely exercise.

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ОДНО ДЕЙСТВИЕ ОМОЛАЖИВАЕТ СЕРДЦЕ И СОСУДЫ. Секрет здоровья в 50+ лет.

Димитрий Лесков · Jul 10, 2025 19,443 views

Impact of Diet and Activity on Health and Sleep Quality

In this episode of Science You Can Use, Dr. Wendy Bazilian discusses three vital studies on butter, brisk movement, and sleep-enhancing fruit. Discover how simple lifestyle changes, such as moderate incidental physical…

1000 Waking Minutes | Podcast for Healthy Living · May 7, 2025 29 views

Altamiro Bottino

@BottinoAltamiro · X

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality https://t.co/dQQvLNVpWA https://t.co/2pSLllHnMu

Sep 26, 2025 · 93 followers View post →

syawal™ シ

@syawal · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Sep 9, 2025 · 24 shares · 3,183 followers View post →

UCL Discovery

@ucldiscovery.bsky.social · Bluesky

Open Access UCL Research: Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality discovery.ucl.ac.uk/id/eprint/10...

Jul 31, 2025 View post →

Claire

@clairejh69 · X

RT @drseanmullen: https://t.co/tAV4xbz6hX

Jun 27, 2025 · 2 shares · 181 followers View post →

Diana

@Diana79929170 · X

RT @drseanmullen: https://t.co/tAV4xbz6hX

Jun 27, 2025 · 2 shares · 852 followers View post →

bbddpp

@bbddpp · X

RT @drseanmullen: https://t.co/tAV4xbz6hX

Jun 27, 2025 · 2 shares · 3,080 followers View post →

Dr. Sean Mullen

@drseanmullen · X

https://t.co/tAV4xbz6hX

Jun 26, 2025 · 13 likes · 2 shares · 32,694 followers View post →

Esther❤

@witnessconnects · X

https://t.co/HkjFj0YVu5

Jun 2, 2025 · 16 followers View post →

Cristina de la Mata

@Crisirenedlm · X

RT @jacksonfyfe: Data from: Stamatakis E et al. Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality.…

May 16, 2025 · 2 shares · 283 followers View post →

Jackson Fyfe, PhD

@jacksonfyfe · X

Data from: Stamatakis E et al. Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality. Circulation. 2025 Apr 15;151(15):1063-1075. https://t.co/6oLkspOU25

May 15, 2025 · 2 likes · 2 shares · 8,330 followers View post →

Mind Your Science!

@MindYourSci · X

RT @agingdoc1: Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality https://t.co/AbBj0U92Je

May 12, 2025 · 1 share · 133 followers View post →

Thanh Nha Thai, MD

@thaithanhnha.bsky.social · Bluesky

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality. www.ahajournals.org/doi/10.1161/... @ahajournals.bsky.social #CardioSky #MedSky #Circulation

May 12, 2025 · 2 shares View post →

Agingdoc

@agingdoc1 · X

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality https://t.co/AbBj0U92Je

May 11, 2025 · 4 likes · 1 share · 41,394 followers View post →

Thanh Nha Thai, MD

@thaithanhnha.bsky.social · Bluesky

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality. www.ahajournals.org/doi/10.1161/... @ahajournals.bsky.social #CardioSky #Cardiology #MedSky #Circulation

May 3, 2025 · 2 likes · 3 shares View post →

segawa shota

@sega_syo · X

RT @muscle_penguin_: (467/347) #論文マラソン定期的に運動していない人の偶発的な身体活動と健康の関係は？毎日の高/中強度身体活動は、用量反応的にCVDリスクの低下と関連していた。1分の高強度または3.0分の中強度身体活動は、同程度のCVDリ…

May 1, 2025 · 3 shares · 114 followers View post →

tamurapanman

@tamurapanman1 · X

May 1, 2025 · 3 shares · 109 followers View post →

にじのそらた

@nijinosorata · X

May 1, 2025 · 3 shares · 701 followers View post →

筋肉博士

@muscle_penguin_ · X

May 1, 2025 · 12 likes · 3 shares · 35,980 followers View post →

Dr Mukesh Palsania

@m_palsania · X

RT @drdavemd: As little as 3 minutes of moderate intensity activity daily is enough to reduce CV risk @American_Heart https://t.co/80j2OK2…

Apr 25, 2025 · 1 share · 1,509 followers View post →

STITCHES Medicine - the Best of Medical Research

@STITCHESMed · X

Incidental physical activity significantly reduces cardiovascular risk, offering a vital alternative for those unable to engage in structured exercise. by Stamatakis E, Biswas RK (...) Ahmadi MN et 12 al. in Circulation https://t.co/BhLOfsMnih #MedX #MedResearch

Apr 23, 2025 · 83 followers View post →

David Winchester @drdavemd.bsky.social

@drdavemd · X

As little as 3 minutes of moderate intensity activity daily is enough to reduce CV risk @American_Heart https://t.co/80j2OK2zWL

Apr 23, 2025 · 1 like · 1 share · 1,008 followers View post →

Takuya Kishi @ねこ好き循環器内科医

@tkishi_cardiol · X

RT @YHC_Shibuya: 【DrゆみのWeekly Journal Scan】＊日常での身体活動と心血管イベント　from Circulation＊ https://t.co/ncK0QGfCDT…

Apr 21, 2025 · 1 share · 14,695 followers View post →

医療法人社団ゆみの

@yumino_medical · X

【DrゆみのWeekly Journal Scan】＊日常での身体活動と心血管イベント　from Circulation＊ https://t.co/ncK0QGfCDT

Apr 21, 2025 · 7 likes · 1 share · 1,235 followers View post →

Miquel Bennasar Veny

@miquelbennasar · X

RT @rincondesisifo: (Circulation) Dosis respuesta de actividad física incidental vs eventos CV y mortalidad https://t.co/RjY7mVtzeV Est Obs…

Apr 21, 2025 · 2 shares · 1,385 followers View post →

José Ríos

@jose1rt · X

RT @rincondesisifo: (Circulation) Dosis respuesta de actividad física incidental vs eventos CV y mortalidad https://t.co/RjY7mVtzeV Est Obs…

Apr 21, 2025 · 2 shares · 525 followers View post →

rincondesisifo

@rincondesisifo · X

(Circulation) Dosis respuesta de actividad física incidental vs eventos CV y mortalidad https://t.co/RjY7mVtzeV Est Observ https://t.co/hEwhHd3I0p

Apr 21, 2025 · 2 likes · 2 shares · 8,457 followers View post →

Ahmed Bennis MD

@drbennisahmed · X

Apr 21, 2025 · 4 likes · 2,653 followers View post →

Mind Your Science!

@MindYourSci · X

RT @nick_krontiris: Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality (open access) https://t.co/4…

Apr 20, 2025 · 1 share · 133 followers View post →

Guy-Stone, MD, MPH

@MPH_Stone · X

RT @drbennisahmed: Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality Any daily IPA amount of vigor…

Apr 20, 2025 · 1 share · 592 followers View post →

抗血栓療法

@antithrombosis · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 20, 2025 · 10 shares · 132 followers View post →

Shinya Goto

@sgoto4 · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 20, 2025 · 10 shares · 323 followers View post →

JAMACardiolJapan

@JamaJapan · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 19, 2025 · 10 shares · 35 followers View post →

Circulation 日本版

@Circulation_nih · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 19, 2025 · 10 shares · 345 followers View post →

biorheology333

@biorheology333 · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 19, 2025 · 10 shares · 17 followers View post →

Nobuhiro Ariyoshi MD

@AriyoshiMd · X

https://t.co/0DmPaAjSPd

Apr 19, 2025 · 4,234 followers View post →

Almansour

@malmansour81 · X

RT @ZHeart11768530:

Apr 19, 2025 · 2 shares · 209 followers View post →

Dona

@StudentN_ · X

RT @ZHeart11768530:

Apr 19, 2025 · 2 shares · 587 followers View post →

The Heart

@ZHeart11768530 · X

Apr 19, 2025 · 5 likes · 2 shares · 32,847 followers View post →

Nick Krontiris

@nick_krontiris · X

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality (open access) https://t.co/4drCcm8ktj

Apr 19, 2025 · 2 likes · 1 share · 19,000 followers View post →

Prof Julie McMullen

@ProfJRMcMullen · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 19, 2025 · 10 shares · 1,353 followers View post →

Ahmed Bennis MD

@drbennisahmed · X

Apr 19, 2025 · 13 likes · 1 share · 2,653 followers View post →

Luis Eduardo Celi C.

@luchitoceli · X

RT @SantasEnrique: https://t.co/Yu0FWsmajl

Apr 19, 2025 · 1 share · 162 followers View post →

Thanh Nha Thai, MD

@thaithanhnha.bsky.social · Bluesky

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality. www.ahajournals.org/doi/10.1161/... @ahajournals.bsky.social @ahascience.bsky.social #CardioSky #MedSky #Circulation

Apr 18, 2025 · 5 likes · 4 shares View post →

Nikhil Bassi, MD

@NikhilBassiMD · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 18, 2025 · 10 shares · 644 followers View post →

Niccolo Bonini

@BoniniNiccolo · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 18, 2025 · 10 shares · 106 followers View post →

Tim Kambič

@TimKambic · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 18, 2025 · 10 shares · 231 followers View post →

Joseph hill

@josephahill · X

RT @CircAHA: Incidental physical activity and CVD risk @ma_hamer @jasongill74 @AdrianBauman @angelosabag @blodgettjm @richpulsford @ecthog…

Apr 18, 2025 · 10 shares · 2,419 followers View post →

Circulation

@CircAHA · X

Apr 18, 2025 · 22 likes · 10 shares · 77,360 followers View post →

大城竜樹｜理学療法士

@souphysio · X

論文リンク https://t.co/qy9XzTJzhi

Apr 17, 2025 · 23 followers View post →

Lane Davide

@lanedavide9 · X

Daily movement may be important than going to the gym. This study found that 25 minutes of moderate activity and 5 minutes of vigorous activity and reduce cardiovascular events https://t.co/anwhVGSzbz #PSUClinExPhy @invinceible24

Apr 17, 2025 · 23 followers View post →

Liza Stathokostas, PhD

@ActiveAgingJnx · X

"Steep reduction in CV risk was observed for any daily duration up to ≈14 vigorous or up to 35-50 moderate-intensity minutes". Unclear if the reference to "optimal" = clinically significant. But these results are greater than current PA guidelines. https://t.co/iHaUsxAwE2

Apr 17, 2025 · 977 followers View post →

Gerasimos Grivas

@GerasimosGrivas · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 17, 2025 · 24 shares · 160 followers View post →

SANCYD

@SANCYDnutricion · X

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality | Circulation https://t.co/AGPScJh8Iz

Apr 17, 2025 · 3,013 followers View post →

Mary Sombra

@Marisombrita · X

RT @EddieRDMD: Journal Circulation:

Apr 16, 2025 · 2 shares · 55 followers View post →

Walter Suárez Carmona

@a_fisiolog57853 · X

limpiar la casa... ¡¡¡A leer, zagales!!! https://t.co/izn5UrlBx4

Apr 16, 2025 · 3 likes · 1 share · 3,891 followers View post →

Carlos Chacon

@CarlosC94407214 · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 16, 2025 · 24 shares · 177 followers View post →

Javed Alam

@jalam1001 · X

#exercise #oldage Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality DOI 10.1161/CIRCULATIONAHA.124.072253 Summary: This 2025 study by Emmanuel Stamatakis and colleagues, published in Circulation, analyzed 24,139 non-exercising https://t.co/I2cTT3E5P5 https://t.co/J8qAL08sG6

Apr 16, 2025 · 998 followers View post →

Rob Lyon

@Psychops · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 16, 2025 · 24 shares · 662 followers View post →

Marie Murphy

@MarieHMurphy · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 16, 2025 · 24 shares · 4,578 followers View post →

ISMPB

@ismpb_org · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 16, 2025 · 24 shares · 1,832 followers View post →

Fakulta tělesné kultury UP

@ftk_up · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 16, 2025 · 24 shares · 109 followers View post →

Daniel Corchado

@med__gym · X

Apr 16, 2025 · 1 like · 1,883 followers View post →

Jackson Fyfe, PhD

@jacksonfyfe · X

Data from: Stamatakis E, Biswas RK, Koemel NA, Sabag A, Pulsford R, Atkin AJ, Stathi A, Cheng S, Thøgersen-Ntoumani C, Blodgett JM, Bauman A, Celis-Morales C, Hamer M, Gill JMR, Ahmadi MN. Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality.

Apr 16, 2025 · 2 likes · 8,330 followers View post →

Lychee Wing

@juliachiwinglai · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 16, 2025 · 24 shares · 40 followers View post →

Nay

@ArtistAmira7 · X

RT @MedSync_AI: Recent study shows any amount of walking or activity boosts heart health! Even a few minutes daily can lower CV risk. Get o…

Apr 15, 2025 · 1 share · 2,239 followers View post →

Bruno Remígio, Ph.D.

@brunooremigio · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 234 followers View post →

Beth Frates MD

@BethFratesMD · X

RT @EddieRDMD: Journal Circulation:

Apr 15, 2025 · 2 shares · 154,814 followers View post →

Dr. Eddie Ramirez

@EddieRDMD · X

Journal Circulation:

Apr 15, 2025 · 8 likes · 2 shares · 4,749 followers View post →

Dr. Eddie Ramirez

@EddieRDMD · X

Journal Circulation:

Apr 15, 2025 · 4,749 followers View post →

Helen

@NHSGas · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 137 followers View post →

Nick Koemel

@NKoemel · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 144 followers View post →

Craig Liebenson

@CraigLiebenson · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 8,221 followers View post →

Enrique Santas

@SantasEnrique · X

https://t.co/Yu0FWsmajl

Apr 15, 2025 · 1 like · 1 share · 5,535 followers View post →

ProPASS Consortium

@ProPASSconsort · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 1,752 followers View post →

Raaj Kishore Biswas

@BiswasRaaj · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 97 followers View post →

Joel "Heart Prevention" Kahn MD, FACC

@drjkahn · X

https://t.co/y73vkUPY5s

Apr 15, 2025 · 32,285 followers View post →

Rx Readmore Livemore

@SopitaSirirata1 · X

RT @davykevinp: Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality | Circulation https://t.co/6xEIJi…

Apr 15, 2025 · 1 share · 165 followers View post →

Tim Kambič

@TimKambic · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 231 followers View post →

Kevin Davy

@davykevinp · X

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality | Circulation https://t.co/6xEIJixtVa. HT @M_Stamatakis

Apr 15, 2025 · 1 like · 1 share · 1,303 followers View post →

Nadi.egas

@NadiEgas · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 53 followers View post →

Joel "Heart Prevention" Kahn MD, FACC

@drjkahn · X

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality | Circulation https://t.co/y73vkUPY5s

Apr 15, 2025 · 1 like · 32,285 followers View post →

Stroke Clinical Trials Network Ireland (SCTNI)

@SCTNIreland · X

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality https://t.co/36uXL84uDn

Apr 15, 2025 · 454 followers View post →

Jan Dygryn

@JDygryn · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 154 followers View post →

Nanette Mutrie

@nanettemutrie · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 5,993 followers View post →

Dr Dora Papadopoulou

@Dora_Sportmed · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 2,366 followers View post →

Wouter Franssen

@FranssenWouter_ · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 79 followers View post →

Alasdair O'Doherty

@A_ODoherty · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 15, 2025 · 24 shares · 337 followers View post →

Dr Pete Sarich

@PeteSarich · X

RT @M_Stamatakis: First #wearables-based study describing dose-response of incidental #PhysicalActivity against #cardiovascular events and…

Apr 14, 2025 · 24 shares · 748 followers View post →

Emmanuel (Manos) Stamatakis

@M_Stamatakis · X

Apr 14, 2025 · 80 likes · 24 shares · 5,118 followers View post →

MedSync

@MedSync_AI · X

Recent study shows any amount of walking or activity boosts heart health! Even a few minutes daily can lower CV risk. Get out and walk more! https://t.co/bgNeANfp78 #HealthWellness #HeartHealth #Fitness #HealthyLiving #MoveMore #CardioCare

Apr 14, 2025 · 3 likes · 1 share · 128 followers View post →

Dose Response of Incidental Physical Activity Against Cardiovascular Events and Mortality.

Mentions per month

Where it's discussed

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Abstract in brief

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All mentions

ОДНО ДЕЙСТВИЕ ОМОЛАЖИВАЕТ СЕРДЦЕ И СОСУДЫ. Секрет здоровья в 50+ лет.

Impact of Diet and Activity on Health and Sleep Quality