Exercise Therapy for Women With ANOCA

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.

Inclusion Criteria: 1. Angina with no obstructive coronary arties (ANOCA) 2. Myocardial perfusion reserve or coronary flow reserve recorded within three years 3. Seattle Angina Questionnaire frequency score ≤60 4. Duke Activity Status Index ≤34 5. Female sex Exclusion Criteria: 1. Age \