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updated 5/1/2006 2:06:24 PM ET 2006-05-01T18:06:24

They feature graceful architectural details, marble accents and private cabanas. Members have access to elegant rooftop patios, private spas and dining areas serving gourmet food. Call them luxurious. Call them indulgent. Just don't call them "gyms."

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The highest-end fitness centers in the U.S. are more than just places to break a sweat on the treadmill after work. They provide the best in personal training and fitness equipment, plus plush extras like concierge services and high-tech lounges with plasma-screen televisions. Best of all, they offer privacy — something their celebrity and professional athlete clients covet almost as much as perfectly sculpted arms or a flawless game.

Of course, such amenities come at a price. According to the International Health, Racquet and Sportsclub Association, a trade group based in Boston, a typical American gym membership costs $30 to $35 per month — a far cry from the $50,000 annual membership at Bosse Sports and Health Club in Sudbury, Mass., or the $23,500 per year it costs at E for Equinox Fitness in Manhattan.

"I wanted to build a beautiful boutique gathering place where people could be healthy, but I didn't want it to look, smell or feel like a gym," says David Kirsch, owner of The Madison Square Club in New York City, where he trains celebrities such as actress Liv Tyler and supermodel Heidi Klum, host of Bravo's popular reality show Project Runway.

At The Madison Square Club, where clients spend about $20,000 per year for membership, you get far more than step classes and free weights. Kirsch and his staff of 12 highly trained and certified fitness experts assess each member's fitness needs in detail; the end result is a program so specific that clients are informed of the type of food they should eat and supplements they should take.

Clients also get private workout sessions with trainers (only six people are allowed on the floor per hour) consisting of circuit training, free weights, stretching and body toning. The expensive attention isn't just for vanity's sake — meeting your fitness goals is especially important when your paycheck is dependent on your looks.

"I asked David to get me ready for the Victoria's Secret Fashion Show after I had Henry," says Klum, who called on Kirsch to help her shed weight after the birth of her son last year. "He's tough and knows how to whip me into shape!"

Getting in shape is never easy, whether you're well-heeled or not. That's why most of the clubs on our list offer extensive medical assessments, one-on-one sessions and personalized workouts to better guarantee results. One of the clubs goes so far as to set an attendance requirement to counteract the habit of paying for a membership but never showing up. Members who do not meet the attendance requirement aren't allowed to rejoin. That alone may make it more cost-effective than cheaper club memberships that go unused.

"We don't want to beat people over the head and drag them in, but they probably aren't going to be very successful if they aren't committed," says Pat Manocchia, owner of La Palestra in New York City, which costs about $8,000 per year and caps its membership at about 200 people. "Not to mention, they are taking a spot from someone who could actually benefit from being here."

The right sum can buy the best of the best — from designer clothes to fancy homes. In this case, that also includes improved health and a sculpted body, which many agree is priceless.

"In a market where there is a demand for sports and health — people are willing to pay to get service," says D.J. Bosse, owner of Bosse Sports. "Our clients know they will get that."

© 2012 Forbes.com

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