The demand for titanium alloy has been increasing in various industries, including aerospace, marine, and biomedical fields, as they fulfilled the need for lightweight, high-strength, and corrosion-resistant material for modern manufacturing. However, titanium alloy has relatively low hardness, poor wear performance, and fatigue properties, which limits its popularization and application. These disadvantages could be efficiently overcome by surface strengthening technology, such as the ultrasonic surface rolling process (USRP). In this study, the true thermo-mechanical deformation behavior of Ti-6Al-4V was obtained by dynamic mechanical experiment using a Hopkinson pressure bar. Moreover, USRP was applied on the Ti-6Al-4V workpiece with different parameters of static forces to investigate the evolution in surface morphology, surface roughness, microstructure, hardness, residual stress, and fatigue performance. The strain rate and temperature during the USRP of Ti-6Al-4V under the corresponding conditions were about 3000 s-1 and 200 °C, respectively, which were derived from the numerical simulation. The correlation between the true thermo-mechanical behavior of Ti-6Al-4V alloy and the USRP parameters of the Ti-6Al-4V workpiece was established, which could provide a theoretical contribution to the optimization of the USRP parameters. After USRP, the cross-sectional hardness distribution of the workpiece was shown to initially rise, followed by a subsequent decrease, ultimately to matrix hardness. The cross-sectional residual compressive stress distribution of the workpiece showed a tendency to initially reduce, then increase, and finally decrease to zero. The fatigue performance of the workpiece was greatly enhanced after USRP due to the effect of grain refinement, work hardening, and beneficial residual compressive stress, thereby inhibiting the propagation of the fatigue crack. However, it could be noted that the excessive static force parameter of USRP could induce the decline in surface finish and compressive residual stress of the workpiece, which eliminated the beneficial effect of the USRP treatment. This indicated that the choice of the optimal USRP parameters was highly crucial. This work would be conducive to achieving high-efficiency and low-damage USRP machining, which could be used to effectively guide the development of high-end equipment manufacturing.