title: A token economy for exercise adherence in pediatric cystic fibrosis: a single-subject analysis.
abstract: OBJECTIVE
  In cystic fibrosis (CF), adherence to airway clearance techniques (e.g., chest physiotherapy and exercise) is poor. Exercise is important because pulmonary difficulties are associated with the highest mortality rate. Despite this, very little research has focused on exercise adherence in CF. This study examined a token economy for increasing exercise in children with CF.
  
  
  METHODS
  An ABAB single-subject design evaluated a token economy for increasing and maintaining exercise in three children with CF. Patient report, parent report, and physiological measures were used to assess treatment integrity, medical stability, and changes in exercise.
  
  
  RESULTS
  Measures suggested that treatment integrity was strong. Results indicated strong treatment effects for all participants without negative medical side effects. Follow-up of 1 and 3 months supported continued exercise for all participants.
  
  
  CONCLUSIONS
  A token economy effectively increased exercise in children with CF, and the single-subject design highlighted some of the intricacies of individualized treatment of adherence. Implications and recommendations for further research are discussed.
authors.affiliation: Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford University School of Medicine, Stanford, CA 94305-5719, USA. ReBernard@stanfordmed.org
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Bernard
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Cohen
authors.forename: Kathryn
authors.initials: K
authors.lastname: Moffett
mesh_terms: D002648:Child; D003550:Cystic Fibrosis / Q000150:complications / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010349:Patient Compliance; D013997:Time Factors; D014040:Token Economy; D016896:Treatment Outcome