Author(s): WANG, X., WILSON, G., FIATARONE SINGH, M., Institution: UNIVERSITY OF SYDNEY, Country: AUSTRALIA, Abstract-ID: 2293

INTRODUCTION:
Progressive resistance training (PRT) is a dose-sensitive intervention where minor implementation deviations can significantly alter the biological stimulus and adaptive response in older adults. Despite strong theoretical justification, even large-scale exercise trials continue to report inconsistent findings, making it difficult to determine whether null results reflect true intervention inefficacy or implementation failure (i.e., protocol drift). While existing tools (e.g., TIDieR, CERT) improve reporting transparency, they do not provide a mechanism to prospectively manage fidelity during trial delivery.
METHODS:
The framework was implemented within the FITTEST trial, a large-scale Australian multicentre RCT targeting older adults with early frailty. Fidelity was operationalised as a dynamic process across four domains: dose fidelity, technical fidelity, provider fidelity, and safety-related adjustments. Five QA procedures were embedded across the intervention lifecycle: (1) independent baseline screening verification; (2) video-based review of one-repetition maximum (1RM) testing to mitigate measurement bias; (3) weekly training log audits and milestone-based video verification; (4) structured audit–feedback–correction cycles to address protocol drift; and (5) scheduled implementation support meetings. Pre-defined criteria distinguished justified safety adaptations from unintended deviations. All documentation was centrally stored to ensure traceability.
RESULTS:
The framework established a continuous quality improvement cycle enabling early detection and correction of fidelity deviations while preserving necessary clinical flexibility.

CONCLUSION:
By reconceptualising fidelity as an actively managed process, this framework provides a methodological bridge between intervention design and real-world delivery, thereby strengthening the internal validity of complex geriatric exercise trials.