Effects of cocoa extract supplementation on physical performance measures: results from the randomized controlled COcoa Supplement and Multivitamin Outcomes study.

2026-03-18
JBMR plus 10(5)
- Sharon H Chou
- Nancy Cook
- Eunjung Kim
- Gregory Kotler
- David A Ganz
- Peggy M Cawthon
- Allison Clar
- Aladdin H Shadyab
- JoAnn E Manson
- Howard D Sesso
- Carolyn J Crandall
- Meryl LeBoff

PubMed: 42004609
DOI: 10.1093/jbmrpl/ziag041

Study Design

Type: Clinical Trial
Population: 603 older US adults (mean age 69.7, 49.3% women)
Methods: Double-blinded, placebo-controlled randomized trial of supplemental cocoa extract and/or multivitamin/multimineral vs placebo for 2 years; ancillary study of physical performance measures
Blinding: Double-blind
Duration: 2 yr
Funding: Unclear

Poor physical performance is associated with a higher risk of falls, fractures, and premature death among older adults. We determined whether supplementation with cocoa extract vs placebo or multivitamin/multimineral (MVM) vs placebo for 2 yr benefited physical performance measures. The COcoa Supplement and Multivitamin Outcomes Study was a double-blinded, placebo-controlled randomized trial of supplemental cocoa extract and/or MVM vs placebo for the primary prevention of cardiovascular disease and cancer in 21 442 US adults. This ancillary study was completed in a New England sub-cohort that underwent physical performance measurements, including grip strength, walking speed, standing balance, repeated chair stands, and timed-up and go (TUG) test, at baseline and 2-yr follow-up. In the clinic sub-cohort (n = 603) with a mean (±SD) age of 69.7 ± 5.5 yr and 49.3% women, supplemental cocoa extract, compared to cocoa-extract placebo, did not affect 2-yr changes in our primary pre-specified, co-equal outcomes of grip strength, walking speed, and the Short Physical Performance Battery (composite of walking speed, standing balance, and chair stands) or in secondary outcomes of standing balance, chair stands, or TUG tests. No effect modification by baseline characteristics of age, sex, body mass index, or randomization to MVM supplementation was observed. In parallel analyses, MVM, compared to MVM placebo, also did not affect physical performance measures. Supplementation with cocoa extract did not prevent age-related declines in physical performance measures in older ambulatory US men and women.

Research Insights

Cocoa→Improved Chair Stand
or in secondary outcomes of standing balance, chair stands, or TUG tests
Effect
Neutral
Effect size
Small
Cocoa→Improved Grip Strength
supplemental cocoa extract, compared to cocoa-extract placebo, did not affect 2-yr changes in our primary pre-specified, co-equal outcomes of grip strength
Effect
Neutral
Effect size
Small
Cocoa→Improved Short Physical Performance Battery
supplemental cocoa extract, compared to cocoa-extract placebo, did not affect 2-yr changes in our primary pre-specified, co-equal outcomes of ... the Short Physical Performance Battery (composite of walking speed, standing balance, and chair stands)
Effect
Neutral
Effect size
Small
Cocoa→Improved Standing Balance
or in secondary outcomes of standing balance, chair stands, or TUG tests
Effect
Neutral
Effect size
Small
Cocoa→Improved Timed Up and Go Test
or in secondary outcomes of standing balance, chair stands, or TUG tests
Effect
Neutral
Effect size
Small
Cocoa→Improved Walking Speed
supplemental cocoa extract, compared to cocoa-extract placebo, did not affect 2-yr changes in our primary pre-specified, co-equal outcomes of ... walking speed
Effect
Neutral
Effect size
Small