Mindful energy balance exercise protocol as an adjunctive intervention for pediatric tourette syndrome: A randomized controlled trial

Children with Tourette Syndrome (TS) commonly experience chronic motor and vocal tics, anxiety, and impaired daily functioning, underscoring the need for accessible, developmentally appropriate interventions. This study evaluated the effects of a 12-week movement-based mindfulness intervention-Mindful Energy Balance Exercise (MEBE)-on self-regulation in children with TS. A total of 135 children aged 4-12 years were randomly assigned to either the MEBE plus standard care group or the standard care group alone, with 121 completing the intervention. The program consisted of 20-minute instructor-led group sessions delivered 5×/week (Weeks 1-3), 3×/week (Weeks 4-9), and 2×/week (Weeks 10-12), plus 10-minute daily home practice, including breathwork, body awareness, and mindful movement. Results showed significant improvements in the intervention group: motor tic frequency and intensity decreased, mindfulness scores increased, and anxiety symptoms-particularly separation and social anxiety-were reduced. Notable gains in daily functioning were observed, with the most robust gains in school-related functioning and a trend toward improvement in physical functioning. These findings support the feasibility and clinical promise of MEBE as a scalable, child-friendly mindfulness intervention with potential to improve psychological and functional outcomes in pediatric TS care.