Objective: To explore the effects of imagination-reality exposure therapy on exercise fear in patients with chronic heart failure combined with hypertension. Methods: A total of 126 patients with chronic heart failure combined with hypertension who were hospitalized in the cardiology department were included from February 2020 to January 2022 by convenience sampling method. According to the random number table method, the patients were divided into the observation group and the control group with 63 cases in each group. The control group received routine nursing intervention, and the observation group received imagination-reality exposure therapy on the basis of routine nursing intervention for 12 weeks. The scores of Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-Heart-C), Self-efficacy for Exercise (SEE) and Connor-Davidson Resilience Scale(CD-RISC) were compared between the two groups. Results: During the study period, 4 cases dropped out of the study with 2 cases in each group. Finally, 61 cases in each group were included in the study. After intervention, the scores of exercise avoidance, perceived risk, self-dysfunction, exercise fear and total TSK-Heart-C in the observation group were significantly lower than those of the control group （P<0.05）；the SEE and CD-RISC scores of the observation group were significantly higher than those of the control group（P<0.05）. Conclusion: Imagination-reality exposure therapy can improve the exercise self-efficacy and psychological resilience of patients with chronic heart failure combined with hypertension with exercise fear, and reduce exercise fear.