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Abstract
Population aging in rural settings increases the risk of functional dependence and cognitive decline, requiring the identification of modifiable early markers within community-based clinical practice. The objective of this study was to determine the bidirectional relationship between cognitive function, skeletal muscle mass indices, and physical activity levels in older adults living in rural communities in Ecuador. A cross-sectional study was conducted with 316 participants (99 men and 217 women) aged 65 and older, assessing body composition through electrical bioimpedance, cognitive function using the Spanish version of the Mini-Mental State Examination (MMSE), and physical activity level through the exercise subscale of the PEPS-I instrument. Data were analyzed using Spearman’s correlation and binary logistic regression models adjusted for sociodemographic and baseline health confounders. A significant correlation was found between exercise and the MMSE (r?=?0.225; p?<?.001). Low exercise levels predicted a higher risk of cognitive decline (OR?=?2.41; 95% CI: 1.56-3.83), while cognitive decline predicted low physical activity levels (OR?=?2.40; 95% CI: 1.57-3.94). No significant associations were found between muscle mass indices and cognitive function. A clear bidirectional relationship exists between cognitive decline and low physical activity in rural older adults, highlighting the need for comprehensive clinical interventions addressing both domains simultaneously to preserve functional autonomy in this vulnerable population.
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