The role of the referee is far from minimal in the economy of soccer, as very often, particularly in professional soccer, a wrong judgment may have profound implications on the outcome of the game. In this regard, a better knowledge of soccer refereeing can obviously benefit the game. Recent studies have shown that during a competitive match, an elite soccer referee may cover 9-13 km attaining approximately 85-90% and approximately 70-80% of maximal heart rate and maximal oxygen uptake (VO2max), respectively. Of the total distance covered about 4-18% is covered at high intensity. Blood lactate concentration has been reported to be in the range of 4-5 mmol/L; however, during competitive matches, blood lactate concentrations as high as 14 mmol/L have been observed. This figure is similar to that extensively reported for soccer players, specifically paralleling that observed in midfield players. However, compared with players, referees are 15-20 years older, often have a non-professional status and cannot be substituted during the game. Furthermore, this important physical stress superimposes onto a high perceptual-cognitive workload throughout the entire game. In relation to fitness status, referees possess VO2max values somewhat lower than the players they officiate, with mean values in the range of 44-50 mL/kg/min. However, the methods used by the Federation Internationale de Football Association and the Union of European Football Associations to test referee fitness need to be changed as the current fitness tests do not relate to match performance. More task-specific tests such as the Yo-Yo Intermittent Recovery Test (YYIRT) have been devised and validated for use with referees. Given that aerobic performance is positively correlated with match performance, it is important that referees are trained to improve their ability to cover large distances during a match and also to repeat high-intensity efforts. A number of studies have shown large improvements in YYIRT performance following both short-term (12 weeks) and long-term (16 months) high-intensity interval training. Future research needs to focus on a number of important areas including the decision-making ability of referees when officiating under different conditions, such as high thermal strain, and the impact of age on both physical and mental performance.