PAD: Polyphenols in Dark Chocolate May Improve Peripheral Artery Disease Interview with:
Lorenzo Loffredo, MD and Francesco Violi, MD
Department of Internal Medicine and Medical Specialties
Sapienza University of Rome, Rome, Italy;

MedicalResearch: What are the main findings of the study?

Answer: Dark chocolate is rich of polyphenols; these natural substances exert antioxidant properties and, through an increase of nitric oxide, dilate arteries. Our research group applied this effect to enhance blood flow in a very common disease, the peripheral arterial disease. This disease is characterized by reduced blood flow to the limbs. There are not any drugs that improve this blood flow, but dark chocolate could.

Our study suggest that dark chocolate, and only dark chocolate, could reduce oxidative stress and improve blood flow and walking autonomy in patients with peripheral arterial disease. We observed no effect on blood flow, oxidative stress and on walking autonomy in PAD patients after milk chocolate assumption. This lack of effect was probably due to the low concentration of polyphenols in milk chocolate.

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PAD: Home-Based Walking Exercise Intervention Interview with: Mary McGrae McDermott, MD
Professor of Medicine
Northwestern University Feinberg School of Medicine
Contributing Editor, JAMA

Home-Based Walking Exercise Intervention in Peripheral Artery Disease
A Randomized Clinical Trial What are the main findings of the study? 

Answer: The goals trial found that a group-mediated cognitive behavioral intervention significantly improved six-minute walk performance, physical activity levels, and patient-perceived walking performance compared to a control group.  The gains in six-minute walk in the intervention group were consistent with a large meaningful change in walking performance.

were any of the findings unexpected?

the magnitude of the gain in six-minute walk was greater than that observed in supervised treadmill exercise interventions in people with pad.  In addition, our prior work shows that a supervised treadmill exercise intervention does not significantly increase physical activity levels in daily life.  However, the current home-based intervention significantly improved physical activity levels in daily life. What should clinicians and patients take away from your report?

Answer:  That home-based exercise can be effective in people with peripheral artery disease. What recommendations do you have for future research as a result of this study? 

Answer: Our intervention required meetings at the medical center once weekly.  Future research should focus on home-based exercise interventions for people with peripheral artery disease that do not require any regular visits to the medical center.


McDermott MM, Liu K, Guralnik JM, et al. Home-Based Walking Exercise Intervention in Peripheral Artery Disease: A Randomized Clinical Trial. JAMA. 2013;310(1):57-65. doi:10.1001/jama.2013.7231.