An interventional study of Resistance based exercise in Angina Patients With Non-obstructive Coronary Artery Disease, sponsored by NHS Greater Glasgow and Clyde. Not yet recruiting at 11 sites in United Kingdom. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-07-29.
Sponsored by NHS Greater Glasgow and Clyde · Not applicable, Interventional, and Treatment
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.
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.
453 studies on the registry are indexed under Angina Pectoris; 67 are open to participants now.
This study's planned enrollment of 76 is below the median of 100 across 273 interventional studies indexed under Angina Pectoris.
Browse Angina Pectoris studies →NHS Greater Glasgow and Clyde is the lead sponsor of 220 studies on the registry; 39 are open to participants now.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Allocated to exercise intervention first
Behavioral: Resistance based exercise
Allocated to exercise intervention second
Behavioral: Resistance based exercise
Participants will undergo daily resistance based exercise for 8 weeks
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.
Time frame: Change from Baseline to Week 9
Myocardial perfusion reserve (MPR)
The ratio of maximum blood flow in the heart muscle under stress compared to resting flow
Time frame: 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.
Time frame: Change from baseline to week 9
Short Physical Performance Battery (SPPB)
Used as a proxy for fitness
Time frame: 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
Time frame: 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.
Time frame: 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
Time frame: 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
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: Change from Baseline to Week 9
Episodes of care (primary, secondary, physiotherapy, rehabilitation)
How many times participants engaged with services
Time frame: 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
Time frame: Week 17
Plan to share: Yes — A decision will be made by the TSC once the study has ended.
Supporting information: Study protocol, Statistical analysis plan, Informed consent form, Clinical study report
Time frame: After the study has completed
Access criteria: Bone fide collaboration request
Data sharing details ↗ · www.gla.ac.uk
No publications or documents are linked to this record.
This study is not yet recruiting, as verified in Jul 2026. You cannot join it, but the record below documents what was studied.
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