Introduction: Living at high altitudes requires the inhabitants to adapt biologically and socially to the environment. The objective of this study was to determine the difference in physical performance (PP) in rural populations at sea level and at high altitude. Material and methods: A cross-sectional study was conducted in rural communities in Ancash, Peru, located at 3.345 meters above sea level (m.a.s.l.) and also in communities located in coastal areas at 6. m.a.s.l. PP was measured by the Short Physical Performance Battery (SPPB) and other associated factors. Adjusted prevalence ratios (aPR) were calculated. Results: A total of 130 older adults were assessed in the high altitude communities and 129 on the coast. The median age was 71.4 years, and 55.6. % were female. Low physical performance (SPPB ≤ 6) was 10.0. % at high altitude and 19.4. % on the coast (p. <0.05). Factors associated with low physical performance were residing at the coast (aPR: 2.10, 95. % CI 1.02 to 4.33), self-reported poor health (aPR: 2.48, 95. % CI 1.21 -5.08), hypertension (aPR: 1.73, 95. % CI 1.01 to 2.98), and age (aPR: 1.04, 95. % CI 1.01 to 1.07), while being a farmer (aPR: 0.49, 95. % CI 0.25 to 0.97), and being independent (aPR: 0.37, 95. % CI 0,20-, 072) were found to be protective factors. It was also found that the inhabitants of the coast have a mean of 0.86 points lower total SPPB than the high altitude ones (p. =0.004). Conclusions: There is an association between altitude of residence and PP in older adults. The prevalence of a low PP in older adults in rural areas at sea level is twice as high compared to those living in high altitude rural communities.