The physical demands in soccer have been studied intensively, and the aim of the present review is to provide an overview of metabolic changes during a game and their relation to the development of fatigue. Heart-rate and body-temperature measurements suggest that for elite soccer players the average oxygen uptake during a match is around 70% of maximum oxygen uptake (VO₂ max). A top-class player has 150 to 250 brief intense actions during a game, indicating that the rates of creatine-phosphate (CP) utilization and glycolysis are frequently high during a game, which is supported by findings of reduced muscle CP levels and several-fold increases in blood and muscle lactate concentrations. Likewise, muscle pH is lowered and muscle inosine monophosphate (IMP) elevated during a soccer game. Fatigue appears to occur temporarily during a game, but it is not likely to be caused by elevated muscle lactate, lowered muscle pH, or change in muscle-energy status. It is unclear what causes the transient reduced ability of players to perform maximally. Muscle glycogen is reduced by 40% to 90% during a game and is probably the most important substrate for energy production, and fatigue toward the end of a game might be related to depletion of glycogen in some muscle fibers. Blood glucose and catecholamines are elevated and insulin lowered during a game. The blood free-fatty-acid levels increase progressively during a game, probably reflecting an increasing fat oxidation compensating for the lowering of muscle glycogen. Thus, elite soccer players have high aerobic requirements throughout a game and extensive anaerobic demands during periods of a match leading to major metabolic changes, which might contribute to the observed development of fatigue during and toward the end of a game.