This case report examined the cardiovascular stress imposed on an experienced elite basketball referee during national competition. The average heart rate was similar for all matches, approximated 73% of maximum heart rate, and was experienced for most (>63%) of the match. Similar relative exercise intensity was demonstrated regardless of match play (men's v women's) and officiating type (two v three-referee). Further study is needed to document the physiological characteristics of elite basketball referees for greater performance.