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Cocoa Consumption Has Positive Therapeutic Effect on Walking Performance

February 14, 2020

A new study, published online in Circulation Research, suggests that cocoa consumption has a positive impact on walking performance for people with lower extremity peripheral artery disease (PAD).  

Cocoa and its major flavanol component, epicatechin, have therapeutic properties that may improve limb perfusion and increase calf muscle mitochondrial activity in people with lower extremity PAD,” said lead study author Mary McDermott, MD, Northwestern University, Feinberg School of Medicine, and colleagues.  

To better understand if cocoas improved walking performance after six months compared to placebo, Dr McDermott and her colleagues conducted a Phase II double blind randomized clinical trial. The study participants were randomized to either cocoa beverage or placebo beverage. More specifically, the cocoa beverage consisted of 15 grams of cocoa and 75 mgs of epicatechin daily, and the placebo drink did not contain cocoa or epicatechin.

The two primary outcomes were six-month change in six-minute walk distance measured 2.5 hours after a study beverage at 6-month follow-up and 24 hours after a study beverage at 6-month follow-up, respectively. A one-sided P value <0.10 was considered statistically significant,” explained the research team.  

The researchers identified 44 PAD participants who were randomized to complete the trial (mean age: 72.3 years (+7.1), mean ankle brachial index 0.66 (+0.15)), 40 (91%).  After adjusting for smoking, race, and body mass index, the researchers found that cocoa consumption—compared to placebo—improved six-minute walk distance at:  

  • 6-month follow-up by 42.6 meters (90% Confidence Interval (CI): +22.2,+∞, P=0.005);
  • 2.5 hours after a final study beverage and by 18.0 meters (90% CI:-1.7, +∞, P=0.12); and
  • 24 hours after a study beverage. 

Additional findings also showed that cocoa consumption, compared to placebo, was responsible for the following: 

  • improved mitochondrial cytochrome c oxidase activity (P=0.013);
  • increased capillary density (P=0.014);
  • improved calf muscle perfusion (P=0.098); and
  • reduced central nuclei (P=0.024).

“These preliminary results suggest a therapeutic effect of cocoa on walking performance in people with PAD,” Dr McDermott and colleagues concluded.  

“Further study is needed to definitively determine whether cocoa significantly improves walking performance in people with PAD.

Julie Gould  


McDermott MM, Criqui MH, Domanchuk K, et al. Cocoa to improve walking performance in older people with peripheral artery disease: the cocoa-pad pilot randomized clinical trial [published online February 14, 2020]. Circulation Res. doi:

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