This randomized, double-blind, placebo-controlled study evaluated among 44 patients with lower extremity peripheral artery disease the effects of daily supplementation with cocoa beverage containing 15 g of cocoa and 75 mg of epicatechin on walking performance and muscle parameters.

Cocoa improved six-minute walk distance at 6-month follow-up by 42.6 meters at 2.5 hours after a final study beverage (90% Confidence Interval (CI): +22.2,+infinity, p = 0.005)  and by 18.0 meters at 24 hours after a study beverage (90% CI:-1.7, +infinity, p = 0.12) , compared to placebo. In calf muscle biopsies, cocoa 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), compared to placebo.

In conclusion these results suggest a beneficial effect of cocoa on walking performance in people with peripheral artery disease.

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. Circ Res. 2020;126(5):589–599. doi:10.1161/CIRCRESAHA.119.315600