Dr. Paola Rossi’s Cancer Survivor Fitness and Nutrition

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/04/05

Dr. Paola Rossi, Clinical Program Director for Lifestyle Medicine at Sylvester Comprehensive Cancer Center, leads the Believe in You program, promoting exercise and nutrition for cancer survivors. Inspired by survivors struggling to participate in the Dolphins Challenge Cancer event, the initiative provides a 20-week structured training program with in-person and virtual sessions, nutritional guidance, and community support. Participants progress from inactive to active lifestyles, with data showing sustained improvements. Plans include a digital platform, expanded outreach, and national replication. Rossi emphasizes long-term sustainability, ensuring survivors maintain healthy habits beyond the program.

Scott Douglas Jacobsen: Today, we are here with Paola Rossi, M.D. She is the Clinical Program Director for Lifestyle Medicine at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine and South Florida’s only National Cancer Institute-designated cancer center. Originally from Argentina, she earned her medical degree from the University of Buenos Aires. She later pursued additional training in exercise physiology at the University of Miami.

Dr. Rossi’s work focuses on lifestyle factors, including Diet and exercise, in cancer prevention and survivorship. She helped develop Sylvester’s Believe in You program, a high-risk lifestyle medicine clinic designed to support cancer survivors through exercise and nutrition. She is passionate about community outreach and enjoys acting, dancing, and baking sourdough bread in her free time. So, thank you for joining me today. What inspired the creation of the Believe in You program?

Dr. Paola Rossi: About three years ago, we met with the Miami Dolphins Foundation to discuss the Dolphins Challenge Cancer (DCC) initiative, which raises funds for cancer research at Sylvester Comprehensive Cancer Center. During that meeting, a few cancer survivors shared that, while they thought the initiative was great, they couldn’t participate because they struggled to even walk from the parking lot to Hard Rock Stadium, let alone complete a 5K or a 30-mile bike ride, which is the minimum distance for the cycling event.

The Dolphins Challenge Cancer (DCC) has been raising funds for over a decade, supporting cancer research and patient care. However, at that moment, we realized we might have unintentionally excluded the people we were trying to help.

So, we decided to train these survivors and ensure that they could participate if they wanted to. We started with a small pilot program involving about 10 cancer survivors, which was a huge success. Every participant could complete the 5K.

Since then, we have expanded the program to include more participants and provide additional support, ensuring that any cancer survivor who wants to participate in DCC has the opportunity to do so.

Jacobsen: How is the 20-week program structured?

Rossi: The program is structured with weekly in-person training sessions, usually held on Saturdays, at two locations—one in Miami-Dade County and one in Broward County.

We also have one or two daily virtual sessions via Zoom, which complement the in-person training from Monday to Friday. This allows participants to reach the recommended 150 minutes of aerobic exercise per week.

Additionally, we provide educational newsletters covering topics like muscle soreness, the importance of warming up and cooling down, and the role of nutrition in exercise recovery.

We also hold monthly workshops on mental resilience, positive self-talk, and motivation—all essential skills for helping participants successfully complete a race or endurance event.

However, the key part of the program is building a strong community. Sticking with a four- to five-month training program is not easy, and many people struggle with exercise consistency. However, by fostering a sense of community and peer support, participants help keep each other accountable and motivated.

Jacobsen: For individual cancer survivors, how do you tailor the program to meet each person’s needs?

Rossi: That’s a great question.

We work with trainers who specialize in exercise oncology, and the program has a three-tier system to accommodate different fitness levels.

We make adaptations based on each participant’s physical condition and experience with exercise. For example, we categorize participants into groups:

• Walkers – for those new to exercise or have not been physically active for an extended period.
• Joggers – for those ready to take on a more moderate activity level.
• Runners – those with higher fitness levels and want to train for longer distances.

This tiered system ensures that each participant receives individualized support and can progress at their own pace, making the experience both inclusive and empowering for cancer survivors.

Some people are walking but don’t feel safe or haven’t pushed beyond basic movements, like walking the dog. Others have some training experience but still feel they need support. That’s why we have three tiers within the program. We ensure that participants have access to safe terrain, proper equipment, and a structured progression of exercises. Hence, they feel like they are progressing without pushing too hard—finding that balance is always the challenge.

Jacobsen: What about nutrition education alongside physical training? People can eat poorly and still build muscle, but that may not help with recovery or overall health in the long run.

Rossi: Yes, we place a strong emphasis on nutrition because, in addition to the Believe in You program, we are part of Lifestyle Medicine. Nutrition and exercise are two of our core pillars. We tailor the nutrition component to cancer survivorship, which comes with specific dietary recommendations.

Our newsletter includes nutrition objectives, recipes, and other practical resources. Additionally, we host monthly nutrition workshops covering grocery shopping, meal prep for busy weeks, and strategies to meet nutrient needs. These workshops are both educational and practical. We also provide guidance for those experiencing cancer-related symptoms that may affect their Diet—like nausea or early satiety (feeling full too quickly)—by offering alternative food options that still meet their nutritional needs.

While the program is tailored to cancer survivors, we also accommodate their companions or caregivers. Although cancer survivorship nutrition guidelines have some specific recommendations, they generally align with national nutrition guidelines, making them beneficial for a broader audience. However, we are careful not to push rigid dietary requirements, such as prescribing a fixed amount of protein daily, since individual needs vary.

Suppose we identify participants who require specialized support. In that case, we refer them to Sylvester Comprehensive Cancer Center dietitians. This complimentary service provides personalized nutrition counselling for cancer survivors.

Jacobsen: You have an interest in the community. Community helps people stay on the right path regarding Diet and exercise. How do you build a strong support system for participants?

Rossi: I’d love to say there’s something special about what we do, but honestly, they do most of the work. We provide the space, organization, and expertise in nutrition and exercise. Still, cancer survivors naturally form strong bonds with each other.

The experience of cancer diagnosis and treatment is so unique that people don’t need much encouragement to support one another. Once they connect, they hold each other accountable, sending messages like, “Hey, why didn’t you show up today?” or “I know you’re tired, but come anyway.”

Unfortunately, some participants end up in the ER or require inpatient care, but when they return, they often check in on each other. We provide a safe space, but the participants create the community themselves.

Jacobsen: Are there any cases that require a high level of individual tailoring? For instance, someone might have had a more aggressive form of cancer that affects their ability to eat or exercise, whether in terms of weight training, cardio, or other activities.

Rossi: Absolutely. We work with a diverse range of participants, including adolescent and young adult cancer survivors in their twenties and older participants—we currently have an 87-year-old participant who attends with his wife.

And, of course, participants are at different stages of their cancer journey, with varying levels of diagnosis and disease progression. This presents unique challenges, but we are fortunate to have a structured support system.

Each trainer works with four to five program assistants at each location. This setup allows the trainer to keep the session running while ensuring individual participants receive personalized support. Suppose someone needs to walk instead of run, repeat a specific exercise, or take a break. Someone is always available to assist and monitor their progress in that case.

This system helps us provide the necessary adaptations and modifications for participants facing greater challenges. On the flip side, participants themselves look out for one another. For example, they may approach us and say, “Hey, Scott isn’t feeling great today—can you check on him?” That kind of peer support and accountability is an incredible part of this program.

Suppose we notice someone struggling significantly to keep up with the training. In that case, we usually recommend one-on-one sessions with an exercise physiologist. This allows them to address specific challenges in a more individualized setting. After a few weeks, many participants can reintegrate into the entire program or, at the very least, participate at a level that works for them. In this way, our approach bridges the gap between clinical care and community support.

Jacobsen: What have you found to be the most fulfilling part of running this program?

Rossi: Being part of their stories, without a doubt.

Hearing how their lives have changed because of this program is incredibly rewarding. We have so many stories—like our 87-year-old participant who now refers to one of the younger participants as his “adopted grandchild” after meeting them in the program.

Another memorable story is from a woman who joined one of our early program editions. In her exit interview, she told us that on the first day, she thought, “I won’t be able to do this. I won’t come back.” But she did come back—and over time, she lost 30 pounds, became more active than ever before, and even saw a drop in her tumour markers.

Even if our role in these transformations is small, being part of their journey keeps me going. It motivates me to expand our reach and help more people benefit from the program.

Jacobsen: How do you benchmark fitness and diet standards? In other words, how do you measure where people start when they join the program compared to the minimum and recommended standards for Diet and fitness?

Rossi: Our participants joke about this because we conduct many baseline and end-of-program assessments—but it’s an essential part of our work.

We begin with questionnaires assessing their Diet, physical activity levels, and overall quality of life. These are standard research tools used in scientific studies to measure lifestyle factors.

We also conduct in-person assessments, including:

• Carotenoid level measurements – This skin pigment test indirectly reflects fruit and vegetable intake.
• Grip strength tests – A strong indicator of overall muscle function and health.
• Blood pressure monitoring – To assess cardiovascular health.
• One-mile walk test – To evaluate cardiorespiratory endurance, measuring how quickly they complete the mile and their level of exertion at the finish.

Throughout the 20-week program, we reassess these markers to track Diet, strength, and endurance improvements.

Jacobsen: A few of these assessments are repeated throughout the program, and at the end of the program, we conduct them all again to track progress. We compare the results to the initial assessments to see how participants have improved.

So far, the trends have been consistent, although we haven’t fully analyzed this year’s data yet. We have seen previously inactive participants become active, and those who were moderately active progress to vigorous activity levels.

We also see self-reported improvements in Diet, particularly an increase in fruit, vegetable, and whole grain consumption—key dietary components we emphasize. Overall, based on subjective feedback and objective measures, the program has been successful in helping participants adopt healthier habits.

Jacobsen: What about maintaining those standards over the long term?

1. How long has the program been running?
2. Diet and exercise programs often lead people back to their original habits once they stop actively participating. How do you address that challenge?

Rossi: The core program lasts five months, but we don’t stop there. We have what we call the “off-season,” which helps participants stay engaged throughout the rest of the year.

We hold monthly in-person training sessions during the off-season and continue offering some virtual sessions. Additionally, we host a workshop every two months to reinforce healthy habits and provide ongoing motivation.

We’ve observed that program repetition is the most significant factor in long-term success. Many participants return year after year—we now have individuals who have been with us from year one to year three. The data shows that those who stay engaged over multiple years are likelier to maintain and build on their progress.

On the other hand, when participants step away from the program, gathering follow-up data becomes more challenging for them to regain momentum. That’s why one of my biggest goals is ensuring that we don’t let the program become a one-time, short-term intervention. Instead, we want to create lasting behavioural change by keeping people involved beyond the initial five months.

It’s essential that participants can transition back into their real world and sustain these habits without relying on the structured support we provide throughout the program. If they can’t do that, we haven’t equipped them with the tools they need for long-term success.

For me, this is a key benchmark of success—if we struggle with long-term sustainability, then something in the program needs to change. Of course, many external factors influence sustainability, including social environment, policies, and systemic barriers. It’s an asymmetrical battle, but if participants keep returning, they only continue to improve.

That’s why we’ve been analyzing trends—we want to see whether repeating the Believe in You program each year leads to sustained behavioural change. If returning participants show continuous progress, that’s a strong indicator that the program is effectively reinforcing positive habits.

Jacobsen: What future enhancements or expansions do you envision for the program?

Rossi: Right now, we need to expand. One of our key priorities is creating a website where people can access educational materials anytime rather than receiving them only occasionally via email. We also want to offer on-demand training sessions so participants can follow along at their own pace instead of only attending live, scheduled classes.

Another primary focus is outreach. While the program is open to any cancer survivor in South Florida, regardless of whether they are a Sylvester patient, we still need to improve our messaging to ensure that more community members know about this free resource. Participants can even bring a companion, but we must increase awareness and build a stronger community network to spread the word more effectively.

Ultimately, I envision this program replicated in other parts of the U.S., not necessarily under our direct management, but as a model that other organizations can adopt and integrate into their cancer survivorship initiatives. Ideally, Believe in You could be linked to fundraising events nationwide, creating a national movement for cancer survivors’ health and wellness. That would be the dream—breaking out of a silo and making this a lasting, widespread initiative.

Jacobsen: I love that vision. Thank you so much for your time today. I appreciate your expertise, and it was great meeting you.

Rossi: Very nice to meet you!

Jacobsen: We’ll stay in touch. 

Rossi: Cool, sounds good.

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