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Her extraordinary devotion to exercise has given Madonna an almost superhuman physique a woman half her age would be proud of. But it seems that time is at last catching up with 48-year-old mother-of-three.

As the singer left her gym in St John's Wood, north London this week, she carried with her a Boots the chemist bag filled with boxes of a pain-killing cream so powerful that rheumatism and arthritis sufferers swear by it.

According to the instruction leaflet, the cream, called Voltarol Emulgel P, is used to "relieve pain and reduce inflammation and swelling in a number of painful local conditions affecting the joints, muscles, tendons and ligaments". It is also used for sprains, strains, soft tissue injuries, muscular rheumatism and mild arthritis.

The cream - which can be bought over the counter without a prescription - is often used by less youthful fitness fanatics to reduce inflammation in their joints brought on by exercise so that they can return to their fitness regime more quickly.

Fitness experts advise that women in their 40s should not put their bodies under the same amount of strain as they did in their 20s and 30s.

Emma Katelee, a personal trainer at leading health club Holmes Place, said: "Women in their 40s should not undertake the same exercise as they did when they were younger, but of course they should still keep fit. It is advisable to have a day off in between exercising so your muscles have a chance to recuperate."

Miss Katelee explained that people who do not give their muscles a chance to recover can develop a condition called DOM (delayed onset of muscle soreness) and inflammation can result.

She said: "Anti-inflammatory creams will quickly reduce the inflammation meaning you can get back to your routine quicker than you would if you let it heal naturally. But I'm an advocate of natural products like arnica, which do the same job but gradually. Powerful creams can be too much, you don't need such a strong dosage."

Madonna frequently puts herself through three-hour workouts which includes pilates and intensive weight training in her regime.

She is also a fan of the "Gyrotonic Expansion System", a rack-like contraption which stretches and strengthens the muscles-with the aim of making them longer and leaner.

The system was pioneered by the likes of James D'Silva - Madonna's personal trainer - who works from his north London gym and also does house calls to her Marylebone home. D'Silva also counts among his clients Sting's wife Trudie Styler and Gwyneth Paltrow.