McDermott MM, Criqui MH, Domanchuk K, et al. - Whether an improved walking performance can be achieved in people with peripheral artery disease (PAD) following intake of cocoa for six months vs placebo, was determined in this phase II randomized clinical trial. Patients with PAD were randomly assigned to either cocoa beverage vs placebo beverage. The cocoa beverage comprised 15 grams of cocoa and 75 mgs of epicatechin daily. The identical appearing placebo consisted of neither cocoa nor epicatechin. The study sample included 44 patients. Researchers found that cocoa consumption resulted in an improvement in six-minute walk distance at 6-month follow-up by 42.6 meters at 2.5 hours following a final study beverage and by 18.0 meters at 24 hours following a study beverage, relative to placebo, adjusting for smoking, race, and body mass index. Cocoa vs placebo resulted in improved mitochondrial cytochrome c oxidase activity, increased capillary density, improved calf muscle perfusion, and decreased central nuclei in calf muscle biopsies. According to these preliminary findings, cocoa has a therapeutic effect on walking performance in individuals with PAD.