Angina Patients With Non-obstructive Coronary Artery DiseaseANOCA ExerciseNCT07733986
Exercise Therapy for Women With ANOCA
A study testing Resistance based exercise in people with Angina Patients With Non-obstructive Coronary Artery Disease, run by NHS Greater Glasgow and Clyde at 11 sites in United Kingdom.
Trial summary
Angina is a feeling of chest pain or discomfort which can happen if there is reduced blood flow to the heart. Patients can experience angina with no obstructive coronary arteries (ANOCA) which is a difficult condition to treat (ie relieve angina) since few randomised, controlled therapy trials have been undertaken for… Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Angina Patients With Non-obstructive Coronary Artery Disease
- What is being tested?
- Resistance based exercise
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 76 participants
- Where
- 11 sitesUnited Kingdom
- Study dates
- 14 Sep 2026to 30 Jun 2029
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Angina with no obstructive coronary arties (ANOCA)
- Myocardial perfusion reserve or coronary flow reserve recorded within three years
- Seattle Angina Questionnaire frequency score ≤60
- Duke Activity Status Index ≤34
- Female sex
Who cannot join
- Age <18 years
- Unable to provide informed consent
- - Unable to comply with the protocol
- Pregnancy
- Currently undertaking resistance exercise activities
Trial locations and contacts
11 sites in 1 country. Contact the study team or a site near you to ask about taking part.
11 sites in 1 country
United Kingdom11 sites
Basildon University Hospital
Basildon
Royal United Hospital Bath
Bath
Royal Papworth Hospital
Cambridge
Queen Elizabeth University Hospital Clinical Research Facility
Glasgow, G51 4TF
Colin Berry, 0141 232 7600, Colin.Berry@Glasgow.ac.uk
Leeds General Infirmary
Leeds
Brompton Hospital
London
Guy and St Thomas Hospital
London
Kings College Hospital
London
Freeman Hospital
Newcastle upon Tyne
Vijay Kunadian
Nottingham City Hospital
Nottingham
Sunderland Royal hospital
Sunderland
About this study
Official title: Exercise Therapy for Women With ANOCA: a Randomised, Controlled Trial
Angina is a feeling of chest pain or discomfort which can happen if there is reduced blood flow to the heart. Patients can experience angina with no obstructive coronary arteries (ANOCA) which is a difficult condition to treat (ie relieve angina) since few randomised, controlled therapy trials have been undertaken for ANOCA. Until now, angina has been mainly studied in men even though women are at least two-fold more likely than men to experience ANOCA.
In 2023, a Scientific Statement from the American Heart Association affirmed that resistance exercise training can improve or maintain muscle mass and strength and confer favourable physiological and clinical effects on cardiovascular disease and risk factors. Resistance exercise has not been assessed in ANOCA and it offers an important opportunity to study non drug alternatives to treatment for women.
Read more
This study will use a resistance based exercise programme to investigate if symptoms of ANOCA can be improved in women. It will recruit at least 76 patients (maximum 152 patients) across 13 hospitals in the UK and the Netherlands.
The study will use a randomised wait list control design. This means all participants will be offered the intervention, but the randomisation will decide when they undergo it.
It is part of a platform of trials for women with ANOCA. We are also setting up a drug study called ANOCA Therapy and a cohort study called ANOCA- Diagnosis.
Read the detailed description
There is a gap in knowledge on evidence-based therapy for ANOCA. Stratified medicine is a population-level diagnostic approach for identifying endotypes in a heterogenous population of all-comers. An endotype is defined as a subtype of a condition, which must be characterised by a distinct functional or pathophysiological mechanism.
Use of quantitative noninvasive and invasive diagnostic methods, such as magnetic resonance imaging and coronary function tests involving acetylcholine testing, enables more accurate identification and discrimination of causal endotypes of ANOCA. This is especially relevant for women with ANOCA who have historically been under-recognised.
Quantitative diagnostic methods should bring an end to empirical therapy, therapeutic nihilism and sex disparities in ANOCA.
Precision medicine is different. Precision medicine targets the individual (and their endotype) with a mechanism informed therapy. Accordingly, in this Wellcome Leap Visible project, we will employ a stratified medicine diagnostic approach in women with suspected ANOCA undergoing invasive CFTs in multiple hospitals and then employ a precision medicine strategy by offering each woman an endotype-informed therapy option.
Resistance exercise has not been previously investigated in ANOCA and it therefore represents a novel therapeutic option. This lifestyle intervention will increase the range of trial options, maximize patient choice for participation, and facilitate timely delivery of this project. The beneficial effects of resistance exercise on cardiovascular function have recently been endorsed in a Scientific Statement from the American Heart Association and further supported by a systematic review and favourable experience in our recent randomized trial in Long COVID.
In 2023, a Scientific Statement from the American Heart Association affirmed that resistance exercise training can improve or maintain muscle mass and strength and confer favourable physiological and clinical effects on cardiovascular disease and risk factors. In 19 men with coronary artery disease and endothelial dysfunction, indicated by abnormal acetylcholine-induced coronary vasoconstriction, a randomized controlled trial of aerobic exercise training demonstrated improvements in endothelium-dependent vasodilatation both in epicardial coronary vessels and in resistance vessels. The intervention involved an exercise program six times per day for at least 10 minutes. These results were promising but came with major limitations: no women were included in the study and the exercise program is both burdensome and impractical.
Resistance exercise has not been assessed in ANOCA. Inclusion of a non-CTIMP (lifestyle intervention) brings strategic advantages to our ANOCA platform. A non-medicinal intervention provides an accessible therapy option for women of child-bearing age and for those who may prefer not to participate in an investigational drug trial. This non-CTIMP may also become an option for women who withdraw from a CTIMP, or who complete a CTIMP and are willing to continue into a second trial. The basket trial of resistance exercise may include participants who have completed a precision medicine CTIMP who then wish to participate in the resistance exercise trial or vice versa.
- Being tested
- Resistance based exercise
- Keywords
- Angina, Women, Resistance exercise, Cardiovascular disease, Clinical trial
- Medical subject headings
- Angina Pectoris, Cardiovascular Diseases
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Resistance based exerciseBehavioural
Participants will undergo daily resistance based exercise for 8 weeks
| Study group | Role | What they receive |
|---|---|---|
| Intervention | Experimental | Allocated to exercise intervention first Receives: Behavioral: Resistance based exercise |
| Control | Active comparator | Allocated to exercise intervention second Receives: Behavioral: Resistance based exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Seattle Angina Questionnaire
The Seattle Angina Questionnaire a validated 19-item patient-reported survey used to measure coronary artery disease and angina treatment efficacy. Patients will complete on paper or electronically. The scores range from 0 to 100, with higher scores indicating less frequent angina, improved function, and better quality of life.
Measured: Change from Baseline to Week 9
Secondary outcomes (12)
Myocardial perfusion reserve (MPR)
The ratio of maximum blood flow in the heart muscle under stress compared to resting flow
Measured: Change from baseline to week 9
Handgrip strength using hand dynamometer
Measured in Kgs. This is used as a proxy for overall body strength with lower measures indicating less strength.
Measured: Change from baseline to week 9
Short Physical Performance Battery (SPPB)
Used as a proxy for fitness
Measured: Change from baseline to week 9
Brief Illness perception Questionnaire (Brief IPQ)
A nine-item scale designed to rapidly assess the cognitive and emotional representations of illness. It consists of 9 items: 8 are scored on a 0-10 scale, and item 9 is an open-ended question assessing perceived causes. The total score (0-80) is calculated by summing the first 8 items, with items 3, 4, and 7 reverse scored. Higher scores generally reflect a more threatening perception of the illness
Measured: Change from baseline to week 9
Patient Health Questionnaire-4 of (PHQ4)
An ultra-brief screening tool used to assess core symptoms of anxiety and depression. Higher scores indicate greater feelings of anxiety and depression.
Measured: Change from Baseline to Week 9
Duke Activity Status Index (DASI)
A 12-item, self-administered questionnaire used to estimate a patient's functional capacity and peak oxygen uptake. Scores range from 0 to 58.2, with higher scores indicating better physical fitness and lower risk
Measured: From Baseline to Week 9
EQ-5D (EQ-5D-5L)
The EQ-5D evaluates health across 5 domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). It yields three metrics: a 5-digit health profile string, a weighted index value, and a 0-100 self-rated Visual Analogue Scale (VAS) score.
For the 5-digit health profile string higher individual numbers indicate worse health problems.
For the weighted index value a score of 1 indicates perfect health, while 0 represents death.
For the visual analogue score higher numbers here indicate better health
Measured: Change from Baseline to Week 9
International Physical Activity Questionnaire (IPAQ)
Used to obtain comparable estimates of physical activity between populations and countries. Higher scores indicate greater physical activity.
Measured: Change from Baseline to Week 9
Fatigue severity scale questionnaire
Rates level of fatigue. 9 statements assess how fatigue impacts daily life. Each statement is rated on a 7-point Likert scale, ranging from 1 (strongly disagree) to 7 (strongly agree). Higher scores indicate greater fatigue.
Measured: Change from Baseline to Week 9
Short Form Post-Exercise Malaise Questionnaire
measures symptom exacerbation by assessing frequency and severity of symptoms. Higher scores reflect a stronger indication of post exercise malaise.
Measured: Change from Baseline to Week 9
Episodes of care (primary, secondary, physiotherapy, rehabilitation)
How many times participants engaged with services
Measured: Week 9
Hospitalisation for any reason by electronic health record review (where available) up to 4 months (Visit 3)
Review of medical notes to see if the patient has been in hospital
Measured: Week 17
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jul 2026
- Study start14 Sep 2026 (estimated)
- Primary completion30 Jun 2029 (estimated)
- Study completion30 Jun 2029 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Angina Patients With Non-obstructive Coronary Artery DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Randomised, open-label, parallel group, waiting list controlled clinical trial
- Masking
- None (open label)
- Enrolment
- 76 participants (estimated)
Sponsor and investigators
- Lead sponsor
- NHS Greater Glasgow and Clyde
- Sponsor type
- University, hospital or other
- Collaborators
- The University of Glasgow
- Responsible party
- Sponsor
- Investigators
- Colin Berry, Principal investigator, The University of Glasgow
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07733986
- Sponsor's protocol ID
- GN26CA170
- Acronym
- ANOCA Exercise
- Status last verified
- Jul 2026
- First submitted
- 20 Jul 2026
- Last updated
- 29 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: A decision will be made by the TSC once the study has ended.
Study at a glance
From the registry record, last updated by the sponsor on 29 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Exercise Therapy for Women With ANOCA: a Randomised, Controlled Trial
- ClinicalTrials.gov ID
- NCT07733986
- Acronym / sponsor ID
- ANOCA Exercise / GN26CA170
- Keywords
- Angina, Women, Resistance exercise, Cardiovascular disease, Clinical trial
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 76 participants (estimated)
- Lead sponsor
- NHS Greater Glasgow and ClydeUniversity, hospital or other
- Collaborators
- The University of Glasgow
- Study start
- 14 Sep 2026 (estimated)
- Primary completion
- 30 Jun 2029 (estimated)
- Study completion
- 30 Jun 2029 (estimated)
- First posted
- 29 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Angina is a feeling of chest pain or discomfort which can happen if there is reduced blood flow to the heart. Patients can experience angina with no obstructive coronary arteries (ANOCA) which is a difficult condition to treat (ie relieve angina) since few randomised, controlled therapy trials have been undertaken for ANOCA. Until now, angina has been mainly studied in men even though women are at least two-fold more likely than men to experience ANOCA.
In 2023, a Scientific Statement from the American Heart Association affirmed that resistance exercise training can improve or maintain muscle mass and strength and confer favourable physiological and clinical effects on cardiovascular disease and risk factors. Resistance exercise has not been assessed in ANOCA and it offers an important opportunity to study non drug alternatives to treatment for women.
This study will use a resistance based exercise programme to investigate if symptoms of ANOCA can be improved in women. It will recruit at least 76 patients (maximum 152 patients) across 13 hospitals in the UK and the Netherlands.
The study will use a randomised wait list control design. This means all participants will be offered the intervention, but the randomisation will decide when they undergo it.
It is part of a platform of trials for women with ANOCA. We are also setting up a drug study called ANOCA Therapy and a cohort study called ANOCA- Diagnosis.
Detailed description
There is a gap in knowledge on evidence-based therapy for ANOCA. Stratified medicine is a population-level diagnostic approach for identifying endotypes in a heterogenous population of all-comers. An endotype is defined as a subtype of a condition, which must be characterised by a distinct functional or pathophysiological mechanism.
Use of quantitative noninvasive and invasive diagnostic methods, such as magnetic resonance imaging and coronary function tests involving acetylcholine testing, enables more accurate identification and discrimination of causal endotypes of ANOCA. This is especially relevant for women with ANOCA who have historically been under-recognised.
Quantitative diagnostic methods should bring an end to empirical therapy, therapeutic nihilism and sex disparities in ANOCA.
Precision medicine is different. Precision medicine targets the individual (and their endotype) with a mechanism informed therapy. Accordingly, in this Wellcome Leap Visible project, we will employ a stratified medicine diagnostic approach in women with suspected ANOCA undergoing invasive CFTs in multiple hospitals and then employ a precision medicine strategy by offering each woman an endotype-informed therapy option.
Resistance exercise has not been previously investigated in ANOCA and it therefore represents a novel therapeutic option. This lifestyle intervention will increase the range of trial options, maximize patient choice for participation, and facilitate timely delivery of this project. The beneficial effects of resistance exercise on cardiovascular function have recently been endorsed in a Scientific Statement from the American Heart Association and further supported by a systematic review and favourable experience in our recent randomized trial in Long COVID.
In 2023, a Scientific Statement from the American Heart Association affirmed that resistance exercise training can improve or maintain muscle mass and strength and confer favourable physiological and clinical effects on cardiovascular disease and risk factors. In 19 men with coronary artery disease and endothelial dysfunction, indicated by abnormal acetylcholine-induced coronary vasoconstriction, a randomized controlled trial of aerobic exercise training demonstrated improvements in endothelium-dependent vasodilatation both in epicardial coronary vessels and in resistance vessels. The intervention involved an exercise program six times per day for at least 10 minutes. These results were promising but came with major limitations: no women were included in the study and the exercise program is both burdensome and impractical.
Resistance exercise has not been assessed in ANOCA. Inclusion of a non-CTIMP (lifestyle intervention) brings strategic advantages to our ANOCA platform. A non-medicinal intervention provides an accessible therapy option for women of child-bearing age and for those who may prefer not to participate in an investigational drug trial. This non-CTIMP may also become an option for women who withdraw from a CTIMP, or who complete a CTIMP and are willing to continue into a second trial. The basket trial of resistance exercise may include participants who have completed a precision medicine CTIMP who then wish to participate in the resistance exercise trial or vice versa.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Randomised, open-label, parallel group, waiting list controlled clinical trial
| Arm | Type | Receives |
|---|---|---|
| Intervention | Experimental | Behavioral: Resistance based exerciseAllocated to exercise intervention first |
| Control | Active comparator | Behavioral: Resistance based exerciseAllocated to exercise intervention second |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Angina with no obstructive coronary arties (ANOCA)
- Myocardial perfusion reserve or coronary flow reserve recorded within three years
- Seattle Angina Questionnaire frequency score ≤60
- Duke Activity Status Index ≤34
- Female sex
Key exclusion criteria (5 listed)
- Age <18 years
- Unable to provide informed consent
- - Unable to comply with the protocol
- Pregnancy
- Currently undertaking resistance exercise activities
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Resistance based exerciseParticipants will undergo daily resistance based exercise for 8 weeks | Behavioural | Control, Intervention |
Primary outcome
Seattle Angina Questionnaire
Time frame: Change from Baseline to Week 9
The Seattle Angina Questionnaire a validated 19-item patient-reported survey used to measure coronary artery disease and angina treatment efficacy. Patients will complete on paper or electronically. The scores range from 0 to 100, with higher scores indicating less frequent angina, improved function, and better quality of life.
12 secondary outcomes
Myocardial perfusion reserve (MPR)
Time frame: Change from baseline to week 9
Handgrip strength using hand dynamometer
Time frame: Change from baseline to week 9
Short Physical Performance Battery (SPPB)
Time frame: Change from baseline to week 9
Brief Illness perception Questionnaire (Brief IPQ)
Time frame: Change from baseline to week 9
Patient Health Questionnaire-4 of (PHQ4)
Time frame: Change from Baseline to Week 9
Duke Activity Status Index (DASI)
Time frame: From Baseline to Week 9
EQ-5D (EQ-5D-5L)
Time frame: Change from Baseline to Week 9
International Physical Activity Questionnaire (IPAQ)
Time frame: Change from Baseline to Week 9
Fatigue severity scale questionnaire
Time frame: Change from Baseline to Week 9
Short Form Post-Exercise Malaise Questionnaire
Time frame: Change from Baseline to Week 9
Episodes of care (primary, secondary, physiotherapy, rehabilitation)
Time frame: Week 9
Hospitalisation for any reason by electronic health record review (where available) up to 4 months (Visit 3)
Time frame: Week 17
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Jul 2026.
- Individual participant dataSharing planned: Yes. A decision will be made by the TSC once the study has ended.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Colin Berry principal investigator
The University of Glasgow
11 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Resistance based exercise in people with Angina Patients With Non-obstructive Coronary Artery Disease, run by NHS Greater Glasgow and Clyde at 11 sites in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 29 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 11 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Clare Dolan (0141 314 4328, clare.dolan3@nhs.scot), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Seattle Angina Questionnaire (time frame: Change from Baseline to Week 9). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2026; AzTrials last refreshed its copy on 26 Oct 2026.