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O envelhecimento populacional em contextos rurais aumenta o risco de dependência funcional e comprometimento cognitivo, o que exige a identificação de marcadores precoces modificáveis na prática clínica comunitária. O objetivo deste estudo foi determinar a relação bidirecional entre a função cognitiva, os índices de massa muscular esquelética e o nível de exercício físico em idosos residentes em comunidades rurais do Equador. Realizou-se um estudo transversal com 316 participantes (99 homens e 217 mulheres) com mais de 65 anos, avaliando a composição corporal por bioimpedância elétrica, a função cognitiva com a versão em espanhol do Mini-Mental State Examination (MMSE) e o nível de atividade física por meio da subescala de exercício do instrumento PEPS-I. Os dados foram analisados mediante correlação de Spearman e modelos de regressão logística binária ajustados por fatores sociodemográficos e de saúde basal. Encontrou-se correlação significativa entre exercício e MMSE (r = 0,225; p < 0,001). Um baixo nível de exercício predisse maior risco de comprometimento cognitivo (OR = 2,41; IC 95%: 1,56–3,83), enquanto o comprometimento cognitivo predisse baixo nível de atividade física (OR = 2,40; IC 95%: 1,57–3,94). Não foram encontradas associações significativas entre os índices de massa muscular e a função cognitiva. Conclui-se que existe uma clara relação bidirecional entre o declínio cognitivo e a baixa atividade física em idosos rurais, destacando a necessidade de intervenções clínicas integrais que abordem simultaneamente ambos os domínios para preservar a autonomia funcional nessa população vulnerável.
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